Agenda 06/06/2017 W (Community Mental Health Services)COLLIER COUNTY
Board of County Commissioners
WORKSHOP AGENDA
COMMUNITY MENTAL HEALTH SERVICES
Board of County Commission Chambers
Collier County Government Center
3299 Tamiami Trail East, 3rd Floor
Naples, FL 34112
June 06, 2017
9:00 AM
Commissioner Penny Taylor, District 4 - BCC Chair
Commissioner Andy Solis, District 2 - BCC Vice-Chair
Commissioner Donna Fiala, District 1; CRAB Co-Chair
Commissioner Burt Saunders, District 3
Commissioner William L. McDaniel, Jr., District 5; CRAB Co-Chair
Notice: All persons wishing to speak must turn in a speaker slip. Each speaker will receive no more than three (3) minutes.
Collier County Ordinance No. 2003-53 as amended by Ordinance 2004-05 and 2007-24, requires that all lobbyists shall,
before engaging in any lobbying activities (including but not limited to, addressing the Board of County Commissioners),
register with the Clerk to the Board at the Board Minutes and Records Department.
1. PLEDGE OF ALLEGIANCE
2. WORKSHOP TOPICS
2.A. Welcome - Commissioner Andy Solis
2.B. Overview of Current County Services - Steve Carnell, Public Services Department
Head
2.C. State of Mental Health - US, State, Collier - Scott Burgess, CEO, David Lawrence
Center
2.D. Impact on Systems - Sheriff Kevin Rambosk
2.E. Partnerships/Prevention/Diversion - Sgt. Leslie Weidenhammer & Manager Katina
Bouza, Collier County Sheriff's Office; Judge Janeice Martin & Judge Christine
Greider, Collier County Courts; Dr. Susan Kimper, Naples Community Hospital
(NCH); Scott Burgess, CEO, David Lawrence Center; Pamela Baker, CEO,
National Alliance on Mental Illness (NAMI); Dr. Kamela Patton, Superintendent,
Collier County Public Schools
3. PUBLIC COMMENTS
4. ADJOURN
Inquiries concerning changes to the Board’s Agenda should be made to the County Manager’s Office at
252-8383.
06/06/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.A
Item Summary: Welcome - Commissioner Andy Solis
Meeting Date: 06/06/2017
Prepared by:
Title: Manager - Technical Systems Operations – Administrative Services Department
Name: Michael Cox
05/30/2017 3:54 PM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/30/2017 3:54 PM
Approved By:
Review:
County Manager's Office Michael Cox County Manager Review Skipped 05/30/2017 4:01 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/06/2017 9:00 AM
2.A
Packet Pg. 3
06/06/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.B
Item Summary: Overview of Current County Services - Steve Carnell, Public Services
Department Head
Meeting Date: 06/06/2017
Prepared by:
Title: Operations Analyst – County Manager's Office
Name: Geoffrey Willig
05/26/2017 2:20 PM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/26/2017 2:20 PM
Approved By:
Review:
County Manager's Office Geoffrey Willig County Manager Review Completed 05/30/2017 11:00 AM
Public Services Department Sean Callahan Additional Reviewer Completed 05/30/2017 12:51 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/06/2017 9:00 AM
2.B
Packet Pg. 4
1
I.Welcome
Andy Solis, Esq.
Commissioner, Collier County District 2
2.B.1
Packet Pg. 5 Attachment: June 6 Workshop Agenda and Materials Pgs 1-5 (3216 : Overview of Current County Services)
2
II.Overview of Current County Services
Steve Carnell
Public Services Department Head
2.B.1
Packet Pg. 6 Attachment: June 6 Workshop Agenda and Materials Pgs 1-5 (3216 : Overview of Current County Services)
3
MENTAL HEALTH SERVICES
FY17 COUNTY BUDGET APPROPRIATIONS – A QUICK LOOK
David Lawrence Center State Mandated $ 1,649,000
David Lawrence Center CJMHSA Grant $ 167,713
David Lawrence Center Drug Court (pending) $ 117,972*
NAMI CJMHSA Grant $ 16,000
NAMI ESG Grant Rental Assist (pending) $ 25,000
Sherriff's Office CJMHSA Grant $ 102,136
Criminal Justice Mental Health and Substance Abuse (CJMHSA) Award
The CJMHSA Grant is a collaborative product of the Victims Advocacy Organization (VAO) partnership
between not for profits and the County:
o VAO agencies involved: David Lawrence Center (DLC), National Alliance of Mental Illness (NAMI)
of Collier County, The Sheriff’s Office
o County departments involved: Clerk Finance, Community and Human Services, Grant
Compliance Office in the Office of Management and Budget
This approach will continue to implement a centralized coordination program to increase access to
substance use and/or mental health treatment for adults who are in, or at risk of entering the criminal
justice system.
Some key components are:
o specialized training for law enforcement to learn to identify people who have these issues and
redirect them to appropriate services (180 law enforcement officers)
o assignment of a peer specialist to work with each participant
o assessment for all participants and provision of the needed services over the three-year period
Ultimately, the goal is to increase public safety, while at the same time providing appropriate resources
for those with substance use or mental health issues to receive the assistance most suited for their
situation.
CJMHSA Planning Council
The Collier County CJMHSA Planning Council was formed in 2010, which includes participants from
across the County, aims to ensure best practices in criminal justice, mental health and substance abuse
fields. To oversee planning and grant activities, Florida’s Reinvestment Act legislation requires either the
Public Safety Coordinating Council or another local planning council to oversee grant activities.
Ongoing goals from the Planning Council include:
• Establish effective inter-organizational communication and information sharing.
• Maintain coordinated supported housing and homeless plans.
• Enhance and expand the acute care behavioral health system.
• Maintain an annual cross-training plan for criminal justice and behavioral health care.
• Maintain a funding/sustainability plan to enhance and expand service delivery.
2.B.1
Packet Pg. 7 Attachment: June 6 Workshop Agenda and Materials Pgs 1-5 (3216 : Overview of Current County Services)
4
MENTAL HEALTH SERVICES
FY17 COUNTY BUDGET APPROPRIATIONS – A QUICK LOOK – Con’t
Adopted goals from the Planning Council’s 2015-2019 Strategic Plan include:
• Increase capacity for Mental Health Court and Veterans Court by 30%.
• Expand and enhance substance abuse treatment continuum, including Adult Drug Court and
Integrated Dual Disorders Treatment.
• Improve local options for integrated, low-income housing and Housing First programs.
• Streamline the process for referral and admission to treatment courts for incarcerated
individuals. Ensure that persons admitted to treatment courts are those with the greatest risk of
recidivism.
• Include a licensed behavioral health clinician in the CCSO Pretrial Services Division to provide in-
jail screening and assessment for potential admission to three Treatment Courts, FIRST, or other
community and behavioral health services.
• Expand access to trauma-specific counseling including prompt, thorough, and appropriate
screening of all treatment court participants.
The Planning Council’s 2015 – 2019 Strategic Priorities and list of Members follow.
David Lawrence Center
Collier County believes it to be in the public interest to provide addiction and mental health services to
County residents through the David Lawrence Center (DLC). As such, Collier County has appropriated
$1,649,000 in funding for the DLC in Fiscal Year 2017. Below is a chart that shows the historical funding
provided to DLC from Collier County since Fiscal Year 2012.
FY 2015-2016 funding included an additional appropriation of $230,800 to supplement lost funding due
to the elimination of the Low Income Pool (LIP program) in the State budget. In FY 2017, the DLC
requested an increase and was provided an increase of approximately $264,000. In FY 2018, LIP funding
is programmed to return, and may offer a way to increase funding opportunities for our mental health
partners.
In addition, Collier County has awarded $1,156,177 of Community Development Block Grants (CDBG) to
various projects for improvements at DLC.
2.B.1
Packet Pg. 8 Attachment: June 6 Workshop Agenda and Materials Pgs 1-5 (3216 : Overview of Current County Services)
5
MENTAL HEALTH SERVICES
FY17 COUNTY BUDGET APPROPRIATIONS – A QUICK LOOK – Con’t
Drug Court (pending)
The Drug Court grant is pending decision and expected to be resolved in September 2017. If approved,
Collier County will contract with DLC as sub-awardee for all treatment and recover support aspects of
the Drug Court Enhancement grant. When an outside treatment is required (i.e. Methadone) DLC will
coordinate with the outside provider. Funding under the contract will include personnel costs, program
supply costs, bus passes, comprehensive drug testing, and training for a drug court therapist.
ESG Grant (pending)
If awarded via the County’s Action Plan submission at the 6/27/17 BCC meeting, NAMI, also a VAO
designated organization, will assist literally homeless mentally ill individuals with rental assistance for up
to one year. It is estimated that with their own matching funds, approximately 5 -10 individuals may be
served.
Other Services Provided by the County
Veterans Services Unit General Fund $ 372,600
The Veterans Services Unit in the Public Services Operations and Veterans Services Division assists
Collier County Veterans filing for disability compensation, non-service-connected pensions, appeals
burial benefits, education benefits, health benefits, survivor's benefits, and other support. The Veterans
Service Unit has four full-time employees Collier County’s Veterans Services Officers help every veteran,
dependent, and survivor in an assessment of their benefits. The unit also runs a volunteer
transportation program that assists Collier County Veterans with getting to medical appointments
around the State.
Currently, the Veterans Services Unit is working with the Bay Pines VA Healthcare System on an initiative
to provide Veterans with an Other-Than-Honorable Discharge suffering from Post-Traumatic Stress
Disorder and other forms of mental illness with benefits. Currently, veterans lacking an Honorable
Discharge can be denied care by the Department of Veterans Affairs.
2.B.1
Packet Pg. 9 Attachment: June 6 Workshop Agenda and Materials Pgs 1-5 (3216 : Overview of Current County Services)
Mental Health Ser vices Support
2.B.2
Packet Pg. 10 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
Collier County Mental Health Services
•Collier County has a long history of funding mental health initiatives.
•Approximately $2.1 million in the current fiscal year
•Criminal Justice Mental Health Substance Abuse (CJMHSA) Grant works
as collaborative product between not-for-profits and Collier County.
•Partnership between DLC, NAMI, Sherriff’s Office, 20th Judicial Circuit
•Funding partnership with David Lawrence Center.
•Allocation from General Fund has increased 83% since Fiscal Year 2012
2.B.2
Packet Pg. 11 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
FY17 Collier County Mental Health Appropriations
David Lawrence Center State Mandated $ 1,649,000
David Lawrence Center CJMHSA Grant $ 167,713
David Lawrence Center Drug Court (pending)$ 117,972
Sherriff's Office CJMHSA Grant $ 102,136
NAMI ESG Grant Rental Assist (pending)$ 25,000
NAMI CJMHSA Grant $ 16,000
$ 2,077,821
2.B.2
Packet Pg. 12 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
David Lawrence Center Funding FY 2012-2017
•Since 2009, the County has also awarded $1,156,177 of Community Development Block Grants to
various projects for improvements at DLC.
Year General Fund YoY GF Increase LIP Total
FY2012 $ 899,300 $ 168,619 $ 1,067,919
FY2013*$ 1,154,200 28%$ 154,170 $ 1,308,370
FY2014 $ 1,154,200 0%$ 238,840 $ 1,393,040
FY2015 $ 1,154,200 0%$ 238,840 $ 1,393,040
FY2016 $ 1,385,040 20%$ -$ 1,385,040
FY2017 $ 1,649,000 19%$ -$ 1,649,000
Total % Increase 83%54%
*+$300k from general fund for Baker Act Beds
2.B.2
Packet Pg. 13 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
Veterans
Services
Unit
CDBG
Funding for
Special
Projects
CJMHSA
Planning
Council
Staff TA
Services
for Grant
Admin.
Other County Services
2.B.2
Packet Pg. 14 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
Ongoing CJMHSA Planning Council Goals
•Establish effective inter-organizational communication and information sharing.
•Maintain coordinated supported housing and homeless plans.
•Enhance and expand the acute care behavioral health system.
•Maintain annual cross-training plan for criminal justice and behavioral health care.
•Maintain a funding/sustainability plan to enhance and expand service delivery.
2.B.2
Packet Pg. 15 Attachment: Collier County Mental Health Presentation (3216 : Overview of Current County Services)
Page 1 of 9
Collier County Criminal Justice, Mental Health & Substance Abuse (CJMHSA)
Planning Council
Strategic Plan 2015 - 2019
Vision: Collier County citizens with serious mental illnesses and substance use
disorders receive effective, community-based treatment and supports to avoid
unnecessary jail admissions.
Mission: The mission of the Collier County CJMHSA Planning Council is to implement
coordinated and effective series for people with mental health and substance abuse
problems who have contact with the criminal justice system.
Overview and Purpose
Criminal justice diversion programs have become a viable and humane alternative to
the over-criminalization and inappropriate criminal detention of individuals with
mental and substance use disorders.
In 2007, the Florida Legislature created the Criminal Justice, Mental Health,
Substance Abuse (CJMHSA) Reinvestment Act and Grant Program within the
Department of Children & Families (Ch. 394.658 F.S.). The purpose of the program is
to provide funding to counties for initiatives that increase public safety, avert
increased spending on criminal justice, and improve the accessibility and
effectiveness of treatment for people with mental illnesses and substance abuse
problems who are in, or at risk of involvement in the criminal justice system. The
goal of the program is to demonstrate that an investment in diversion and treatment
strategies will result in reduced demand on the local criminal justice resources while
producing better outcomes for the target population. Grant funding is provided
directly to counties via an MOU with the state. An important, innovative component
of the reinvestment grant is that counties must demonstrate full commitment by
providing 100% local match for the state grant funds.
Strategic Planning Partners and Process
To oversee planning and grant activities, Florida’s Reinvestment Act legislation
requires either the Public Safety Coordinating Council or another local planning
council to oversee grant activities. Members must include the judiciary, State’s
Attorney and Public Defenders’ Offices, mental health and substance abuse
treatment providers, housing providers, advocacy organizations, family members,
and behavioral health consumers. The Collier County Criminal Justice, Mental Health
and Substance Abuse Planning Council (Planning Council) was formed for this
purpose in 2010, and created its first strategic plan that year. A list of Planning
Council members is included at the end of this report.
The current strategic plan was completed using information from several sources,
including CJMHSA Planning Council partner input, best practices in criminal justice,
mental health and substance abuse fields, and relevant aspects of partners’ agency-
2.B.3
Packet Pg. 16 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 2 of 9
specific strategic plans to ensure cohesion among plans and coordinated community
planning efforts.
Target Population and Rationalization
The local Planning Council chose to focus on the adult population for CJMHSA
Reinvestment grant for several reasons. The first reason was the overrepresentation
in numbers of and costs related to adults with mental illnesses in the local jail.
Secondly, partnerships necessary to implement programs for adults were already
forged through the implementation and operation of adult mental health and drug
courts. Thirdly, Crisis Intervention Team (CIT) trained officers cited a greater need
for adult diversions versus those for juveniles. And, finally, the Youth Resource
Coalition, chaired by the Sheriff’s Office, provides coordinated planning for youth
with mental health and substance abuse problems at risk of involvement in the
juvenile justice system.
Sequential Intercept Model
The Planning Council uses the Sequential Intercept Model (Munetz & Griffin, 2006) as
a ‘cross system map’ and conceptual tool for planning purposes. The model (Figure
1) depicts the five primary points or intercepts where an individual would typically
progress through the criminal justice system. At each of these points are
opportunities to intervene and “intercept” the person, moving or diverting them from
the justice system to the treatment system. The following discussion considers each
intercept with respect to related local resources and gaps in the system.
Intercept 1: Law Enforcement and Emergency Services
Intercept 2: Initial Detention / Court Hearings
Intercept 3: Jails and Courts
Intercept 4: Community Reentry
Intercept 5: Community Corrections / Community Support
Figure 1. Sequential Intercept Model. Source: http://gainscenter.samhsa.gov
2.B.3
Packet Pg. 17 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 3 of 9
Resources and Challenges by Sequential Intercept
Intercept 1: Law Enforcement and Emergency Services
Collier County has a robust Crisis Intervention Team (CIT) training program. CIT is a
central part of the Collier County system, with a goal of training 100% of all law
enforcement, including state and county probation. As of September 2015, a total of
877 law enforcement officers had completed CIT training. This includes 578 members
of the Collier County Sheriff’s Office (CCSO). Seven CIT classes (as opposed to the
usual four) are scheduled during 2015 to maximize the number of CIT trained
officers.
The Collier County Sheriff’s Office 2014-2017 strategic plan has a goal to: “Expand
CCSO’s commitment to mental health matters through increased services to
individuals suffering from mental illness and their families”. CCSO Strategic Plan
Objectives include:
1) Adopt a formal Crisis Intervention Team model in which there is a CIT
trained officer for each patrol and corrections shift designated as team leader
by January 2016.
2) Formally create the Mental Health Unit (MHU) within the CCSO and
assigning a full time supervisor. This position was (at least temporarily) filled
in 2015.
3) Expand services under the corrections’ health care provider Members
Assistance Program to increase the number of covered mental health
practitioners. This was completed in 2015.
4) Expand the MHU to include two full-time CIT deputies, one in each of the
two regions, to provide enhanced response to consumers identified as high
risk by CIT team members by December of 2016.
David Lawrence Center’s Community Assessment Center can provide assessments on
a walk-in basis, 24 hours a day 7 days a week. The CIT officers use the CAC when
mental health concerns are suspected by the officer. However, if a criminal offense is
committed, charges are usually filed.
Intercept 2: Initial Detention / Initial Court Appearance
As part of the CJMHSA 2014-2017 grant, CCSO now screens all inmates for potential
mental health and substance abuse problems, and are screened by CCSO’s Pretrial
Supervision Program using a risk assessment tool. Those who are being assessed for
the Forensic Intensive Reintegration Support Team (FIRST) are screened using the
LSI-CM. The tool helps facilitate access to services and identify appropriate levels of
need, including criminogenic risk, and resources. The jail’s new Mental Health Unit
also helps to ensure that persons needing specialized care are able to receive that
care early and all the while they are incarcerated. The Medical Housing Unit holds up
to 26 inmates which is not sufficient for the needs of persons with mental illnesses.
In addition to the Medical Housing Unit, the Jail has Medical Stepdown blocks which
can hold an additional 52 male inmates and 52 female inmates who have special
medical needs or mental illnesses.
2.B.3
Packet Pg. 18 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 4 of 9
First appearances generally occur as a video hearing with a judge and public
defenders are always present. Collier County recently implemented a Pre-Trial
Supervision program. The core functions/roles of the Pretrial Supervision Program
are to:
1)Collect, verify and investigate demographic and criminal history
information.
2)Perform assessment of eligibility for every booked defendant.
3) Present information to the First Appearance Judge to aid in release
decisions.
4) Early identification of defendants with substance abuse or mental health
needs.
5)Supervision of defendants released on pretrial supervision to reduce
recidivism and ensure all court appearances.
The program helps to accelerate access to mental health court or drug court for
eligible individuals. Pretrial Supervision can also make direct referrals to the FIRST
team.
Intercept 3: Jails and Courts
Psychiatric care is provided in the jail by the Sheriff’s contracted comprehensive
healthcare provider. The jail has a strong CIT presence. Collier County has an in-jail
substance abuse treatment program, called the Project Recovery Program (PRP). The
program has been in operation since the late 1990’s, and is licensed by the state
substance abuse office. PRP provides treatment in jail and can help facilitate early
release of successful program graduates.
Challenges: Collier County’s Mental Health Court, which includes a docket for
Veterans, and Adult Felony Drug Court are each at full capacity with significant wait
lists. The programs, which attain meaningful outcomes for the participants and the
community, are meeting only about 60% of the current demand.
David Lawrence Center’s 2015-2017 Strategic Plan identified a goal of increasing
access to care, in part by expanding the substance abuse continuum of care,
including expansion of services for the Drug Court to meet the growing need.
Intercept 4: Community Reentry
The FIRST team is the only reentry / reintegration service specifically targeting
persons with mental illness and substance use disorders. The team can serve up to
60 persons at a given time, with a goal of serving 180 by June of 2016. The FIRST
program has been successful in reducing recidivism among participants. In
2014/2015, FIRST served 119 individuals with 13 re-arrests post admission, an 11%
recidivism rate. Many of the 119 participants had three or more arrests during the
year prior to admission to FIRST.
The CJMHSA grant provides funding for 2.65 FTE Reintegration Specialists in the Jail.
Discharge planning uses the LSI-CM to determine each person’s needs, predict
potential for future recidivism or probation violations, and to inform case
management activities.
2.B.3
Packet Pg. 19 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 5 of 9
As part of its strategic plan, the Sheriff’s Office has instituted several Re-entry
strategies that benefit all inmates, including persons with mental health and
substance abuse problems. These include culinary ServSafe certification, GED and
workforce classes, and a 2nd Chance Cell Dog Program; all geared toward improving
job opportunities for inmates after release.
Challenges: Persons with substance use disorders were added in 2014 as an
eligibility category for FIRST. However, the FIRST team has had difficulty convincing
eligible persons with substance use disorders to commit to the program. And,
persons in this category who do choose to work with the FIRST team make up the
majority of program participants who are eventually re-arrested.
Intercept 5: Community Corrections / Community Support
The FIRST program assists with immediate reentry for participants, then provides
intensive case management services as needed, generally for less than one year. For
those needing longer-term support, FIRST provides links to mainstream programs
including case management, supported employment and supported housing. NAMI of
Collier County operates a busy Drop In Center, providing socialization, support groups,
educational programs, transportation if needed, and hot meals some days.
Challenges: For people with a criminal background and mental health or substance
abuse problems, safe, affordable housing with benevolent landlords and
opportunities for competitive employment remain the biggest barriers to successful,
long-term community integration.
Ultimate Intercept and Essential System of Care Recommendations:
In addition to the five intercepts illustrated by the Sequential Intercept Model, local
planning efforts also focus on what has been called the ultimate intercept. An
accessible, comprehensive mental health system focused on the needs of individuals
with mental health and substance use disorders is considered the ultimate intercept -
- and the most effective means of preventing criminalization of people with mental
illnesses. Treatment needs to be integrated in multiple areas, including mental
illness, substance dependence, trauma, situation stress, social disadvantages, and
criminogenic risks (Epperson et al, 2011; Morgan et al., 2010).
The National Leadership Forum for Behavioral Health and Criminal Justice Services, a
group made up of national behavioral health experts, compiled its recommendations
for what would be considered ultimate intercept services (2009). They recommended
eight evidence-based components of an “essential system of care”, organized into
two phases, for implementation by local jurisdictions. Phase 1 includes less
expensive, “easier to mount” services that are considered minimally necessary to
break the cycle of arrest, incarceration and recidivism. Phase 2 includes more
expensive, difficult to implement practices, but those that are considered critical for
obtaining the best possible outcomes. As shown below, all of Phase I practices, and
the majority of Phase 2 practices are currently in place in Collier County. Below are
the recommended practices and a brief discussion of their current local operation.
2.B.3
Packet Pg. 20 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 6 of 9
System of Care Recommendations and Level of Local Implementation
Phase 1
Forensic Intensive Case Management
Collier County’s Forensic Intensive Reintegration Support Team (FIRST) is a
forensic intensive case management team for persons with mental illnesses
and substance abuse problems re-entering the community post-arrest. The
multidisciplinary team consists of in-jail screeners, a case manager, therapist,
and a basic living skills coach.
Supportive Housing
David Lawrence Center provides supportive housing through all of its Adult
Community Services programs, including FIRST. They also operate HUD
housing for 30 individuals in Collier County. Community Assisted Supported
Living (CASL) has a total of 22 units. Each of the housing programs
specializes in housing for persons with disabilities, including mental illnesses.
A Memorandum of Understanding with the Homeless Coalition outlines
planning strategies and (the few) available housing alternatives for the
population and requires that partners ensure community inclusion and non -
discrimination with regards to housing for persons with mental health and
substance abuse problems.
Challenges include a dearth of affordable housing, individuals’ lack of
sufficient financial resources, and lack of benevolent landlords willing to rent
to persons with a criminal background. Much of the target population’s
members are disabled, and either receiving disability income or are eligible
for disability income. SOAR, a best practice for disability applications, is
employed locally to obtain benefits for the latter group. However, many of the
persons served by FIRST, and often those involved in the Adult Drug Court,
are able to work but unable to find employment; particularly employment that
pays them enough to cover even modest living expenses.
Peer Support
NAMI of Collier County and the David Lawrence Center employ the use of
peer supports in various programs. Many of these peers are certified through
the Florida Certification Board as Certified Peer Specialists.
Accessible and Appropriate Medication
David Lawrence Center provides psychiatric care for persons regardless of
their ability to pay, and has some dedicated funding for psychotropic
medications for indigent persons. FIRST participants may access funds for
medications via the CJMHSA Reinvestment grant enhancement funding.
Medicaid and Medicare help fund the cost of medications and psychiatric
/medical care for disabled persons. For persons not eligible for disability, case
managers can connect them with resources to enroll in a plan from the
Affordable Care Act marketplace, however paying the premiums is often cost
prohibitive.
2.B.3
Packet Pg. 21 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 7 of 9
Phase 2
Integrated Dual Disorders Treatment (IDDT)
While David Lawrence Center’s programs are considered co-occurring
capable, there is no formal IDDT program in Collier County. IDDT uses a
manualized approach to comprehensively and simultaneously address an
individual’s co-occurring mental illness and substance use disorder in a single
setting. IDDT’s focus is to reduce hospitalizations, incarcerations, and detox
admissions for those served. Challenges include the cost and time to
implement the practice.
Supported Employment
David Lawrence Center employs a Supported Employment Specialist who
adheres to the standards of the evidence-based practice, and has been
successful building relationships with employers and getting people placed in
competitive employment.
Challenges: Similar to housing, employment challenges include the lack of
jobs that accept persons with criminal backgrounds.
Assertive Community Treatment
Mental Health Resource Center operates a Florida Assertive Community
Treatment (FACT) Team in Collier County that can serve 100 persons with
serious mental illnesses and those with co-occurring substance use disorders.
This intensive supported housing model includes substantial ‘enhancement’
funds that may be used for rent, medications, transportation and other
essentials for successful community living. The FACT team is usually at
capacity and not able to take more than a few new admissions each year.
Cognitive Behavioral Interventions Targeted to Risk Factors
David Lawrence Center’s clinicians are trained in Moral Reconation Therapy
(MRT), a cognitive behavioral treatment strategy that seeks to decrease
recidivism among criminal offenders by increasing moral reasoning skills.
David Lawrence Center’s clinicians also employ the use of Seeking S afety, a
cognitive behavioral group therapy that specifically targets problems resulting
from the struggle with drug/alcohol use and post-traumatic stress disorder
(PTSD).
Goals from Strategic Plan 2010-2014: Updated 2011/2012
The following goals outlined in the most recent strategic plan update have each been
met. Since these are ongoing needs they will continue as priorities for the current
2015- 2019 strategic plan:
Establish effective inter-organizational communication and information
sharing.
Maintain coordinated supported housing and homeless plans.
Enhance and expand the acute care behavioral health system.
Maintain an annual cross-training plan for criminal justice and behavioral
health care.
Maintain a funding/sustainability plan to enhance and expand service delivery.
2.B.3
Packet Pg. 22 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
Page 8 of 9
2015 – 2019 Strategic Plan Priorities
In addition to the goals continued from the 2010-2014 plan, the following are Collier
County priorities for 2015-2019:
Increase capacity for Mental Health Court and Veteran’s Court by 30%.
Expand and enhance the substance abuse treatment continuum, including Adult
Drug Court and Integrated Dual Disorders Treatment.
Improve local options for integrated, low income housing and Housing First
programs.
Streamline the process for referral and admission to treatment courts for
incarcerated individuals. Ensure that persons admitted to treatment courts are
those with greatest risk for recidivism.
Include a licensed behavioral health clinician in the CCSO Pretrial Services
division to provide in-jail screening and assessment for potential admission to
three Treatment Courts, FIRST, or other community behavioral health services.
Expand access to trauma-specific counseling including prompt, thorough and
appropriate screening of all treatment court participants.
2.B.3
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Page 9 of 9
Collier County Criminal Justice Substance Abuse & Mental Health Planning Council
Name Agency
Bonnie Fredeen: Co Chair David Lawrence Center, COO
Lt. George Welch: Co Chair Collier County Sheriff's Office
Sheriff Kevin Rambosk Collier County Sheriff’s Office
Honorable Janeice Martin Mental Health Court and Drug Court Judge
Charles Crews Collier County Court Administration
Chief Chris Roberts Collier County Sheriff’s Office
Connie Kelley Public Defender’s Office/Mental Health Court
Lana Curran DOC Probation Officer/Drug Court
Amanda Stokes Public Defender’s Office/Mental Health Court
Mark Englehardt University of South Florida Technical Assistance Center
Beverly Belli David Lawrence Center/Program Director
Rene Givens Collier Hunger & Homeless Coalition Executive Director
Jay Freshwater State Probation
James Garnett Veteran's Administration
Jeff Nichols County Probation/Court Administration
Juan Ramos County Probation/Court Administration
Jennifer Toussaint State Attorney's Office
Kathryn Hunter NAMI of Collier County CEO
Katie Burrows David Lawrence Center/Forensics Supervisor
Katina Bouza Collier County Sheriff's Office
Kim Grant Collier Community & Human Services- Director
Kris Dunbar Armor Correctional
Kristi Sonntag Collier Human and Community Services - Grants Manager
Domenic Lucarelli Private Law Firm
Leslie Weidenhammer Collier County Sheriff’s Office
Marien Ruiz Collier County Sheriff/Grants
Michael Sheffield Collier County Administration
Pamela Baker Independent Evaluator CJMHSA Grant
Patricia Gifford Collier County Sheriff’s Office
Rachel Brandhorst Collier Community & Human Services- Grant Coordinator
Darrow Rexford Public Defender’s Office/Mental Health Court
Richard Montecalvo State Attorney’s Office
Ron Stanford NAMI/DLC CSU/Peer Specialist
Jeannette Morales Armor Correctional
Sara Miller State Attorney’s Office/Mental Health Court
Susan Vivonetto Collier County Sheriff’s Office
Traci Foss Department of Juvenile Justice
Bill Gonsalves Naples Police Department
Ron Soltes Armor Correctional /Director of Mental Health Services
2.B.3
Packet Pg. 24 Attachment: Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council Strategic Plan 2015 2019 (3216 : Overview of
06/06/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.C
Item Summary: State of Mental Health - US, State, Collier - Scott Burgess, CEO, David
Lawrence Center
Meeting Date: 06/06/2017
Prepared by:
Title: Operations Analyst – County Manager's Office
Name: Geoffrey Willig
05/29/2017 10:48 AM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/29/2017 10:48 AM
Approved By:
Review:
County Manager's Office Geoffrey Willig County Manager Review Completed 05/30/2017 11:00 AM
Public Services Department Sean Callahan Additional Reviewer Completed 05/30/2017 12:50 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/06/2017 9:00 AM
2.C
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6
III. State of Mental Health
Scott Burgess
CEO, David Lawrence Center
2.C.1
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2.C.1
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2.C.1
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2.C.1
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10
2.C.1
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2.C.1
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2.C.1
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Scale of Overdose Deaths, United States
•52,000 drug overdose deaths in 2015 (CDC)
•Surpassed MVA fatalities ~ year 2013
•Now rivals HIV/AIDS deaths in early 1990s peak
•2015: 33,091 total opioid-related deaths
•2014: 28,647 total opioid-related deaths
•Only 5-10% of all “ODs” are fatal
2.C.1
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Florida -Specific 2003 –2009
* Number of deaths caused by drug overdose in Florida
increased 61.0%(from 1,804 to 2,905)
* Especially large increases in deaths caused by the opioid
pain reliever oxycodone and the benzodiazepine alprazolam
(Xanax).
* In response, Florida implemented various laws and
enforcement actions as part of a comprehensive effort to
reverse the trend
2.C.1
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2.C.1
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DLC Fiscal Year 2016 By the Numbers
9,015 -Number of people engaged in mental health and substance abuse treatment services
222,015 -Number of services provided to children and adults
16,263 -Number of individual, group & family therapy sessions
313 –Number of DLC employees
2.C.1
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CCSO BAKER ACTS
01/01/2001 –12/31/2016
0
200
400
600
800
1000
1200
1400
1600
2001200220032004200520062007200820092010201120122013201420152016Total
Total
YEAR Total
2001 300
2002 355
2003 357
2004 370
2005 409
2006 377
2007 477
2008 502
2009 707
2010 796
2011 892
2012 1052
2013 1182
2014 1226
2015 1303
2016 1336
Grand Total 11641
2.C.1
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12.29 12.81 13.06
11.54
13.47
11.42
14.07
16.46
12.87 11.97 11.65 12.1
22.58
16.67
19.63
21.09
17.76
20.77
27.74 28.10
24.61 24.57
26.53
33
25
28
26 26
33
30
34
31 31
32
0
5
10
15
20
25
30
35
40
July August September October November December January February March April May June
Adult and Children’s Crisis Unit -Average Daily Census Comparison
FY10-11 Avg. Daily Census
Current Avg. Daily Census
Highest Census Day
*Note: May 2017 based on census as of 5/15/17
Construction July-December
2.C.1
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0.55
1
1.63
0.77 0.57
1.16
2.23
3.17
1.32 1.1
0.52
1.53
2.55
2.06
2.40
3.32
2.93 3.19
4.42 4.39 4.45
5.97
8.13
6
4 4
5 5
6
8
9
8
11
12
0
2
4
6
8
10
12
14
July August September October November December January February March April May June
Children’s Crisis Unit -Average Daily Census Comparison
FY10-11 Average Daily Census
Current Avg. Daily Census
Highest Census Day
Construction July-December
*Note: May 2017 based on census as of 5/15/17
2.C.1
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2012 –2016 FISCAL YEAR GROWTH
Total Services Provided to Children and Adults
(Fiscal Year July 1 –June 30)
*Percent increase FY12 to FY16
146,986
165,062
180,285
209,224
222,015
140,000
150,000
160,000
170,000
180,000
190,000
200,000
210,000
220,000
230,000
FY12 FY13 FY 14 FY 15 FY 16
*51%
2.C.1
Packet Pg. 40 Attachment: June 6 Workshop Agenda and Materials Pgs 6-20 (3265 : State of Mental Health - US, State,
06/06/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.D
Item Summary: Impact on Systems - Sheriff Kevin Rambosk
Meeting Date: 06/06/2017
Prepared by:
Title: Operations Analyst – County Manager's Office
Name: Geoffrey Willig
05/29/2017 10:50 AM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/29/2017 10:50 AM
Approved By:
Review:
County Manager's Office Geoffrey Willig County Manager Review Completed 05/30/2017 11:01 AM
Public Services Department Sean Callahan Additional Reviewer Completed 05/30/2017 12:50 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/06/2017 9:00 AM
2.D
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21
IV. Impacts on Systems
Sheriff Kevin Rambosk
Collier County Sheriff’s Office
Effects of mental illness on public safety
Cost of services by county policing
2.D.1
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06/06/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.E
Item Summary: Partnerships/Prevention/Diversion - Sgt. Leslie Weidenhammer & Manager
Katina Bouza, Collier County Sheriff's Office; Judge Janeice Martin & Judge Christine Greider, Collier
County Courts; Dr. Susan Kimper, Naples Community Hospital (NCH); Scott Burgess, CEO, David
Lawrence Center; Pamela Baker, CEO, National Alliance on Mental Illness (NAMI); Dr. Kamela Patton,
Superintendent, Collier County Public Schools
Meeting Date: 06/06/2017
Prepared by:
Title: Operations Analyst – County Manager's Office
Name: Geoffrey Willig
05/29/2017 10:54 AM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/29/2017 10:54 AM
Approved By:
Review:
County Manager's Office Geoffrey Willig County Manager Review Completed 05/30/2017 11:01 AM
Public Services Department Sean Callahan Additional Reviewer Completed 05/30/2017 12:50 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/06/2017 9:00 AM
2.E
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22
V. Partnerships | Prevention | Diversion
• Collier County Sheriff’s Office
• Criminal Justice – Treatment Courts
• Naples Community Hospital
• David Lawrence Center
• National Alliance on Mental Illness
• Collier County School Board
2.E.1
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Overview
Collier County Sheriff's Office
• Sheriff Rambosk recognized the opportunity to create a Mental Health Unit
(MHU) at the Collier County Sheriff's Office in January 2016 to expand law
enforcement prevention and intervention initiatives in the community.
• Collier County Sheriff's Office MHU is responsible for identifying and
providing intervention in the community concerning matters of mental health
issues and addiction. The MHU partners with agencies in and around Collier
County that provide mental health care to the community.
• These efforts include the training of all Collier County Sheriff's Office Law
Enforcement Deputies, Youth Relations Deputies, Correctional Deputies, and
Communications Officers in Crisis Intervention Team (CIT) Training. The initiation
of CIT training for Collier County Firefighter Paramedics was launched earlier this
year. The training has been achieved with a strong partnership with National
Alliance of Mental Illness (NAMI) Collier County and the David Lawrence Center
(DLC). The Collier County Sheriff's Office received the “Gold” Standard
Recognition from Crisis Intervention Teams of Florida in 2016. As a result of these
strong partnerships Collier County Sheriff's Office has trained over 1,045
individuals in CIT. This training provides instruction on how to identify individuals
having a mental health crisis and when possible provide an opportunity to divert
the person out of the criminal justice system.
• CIT training has directly contributed to a 159% increase in Baker Acts from
2008-2016 (502-1336).
• The CCSO MHU unit also participates in Collier County’s three treatment
courts: Mental Health Court, Drug Court, and Veterans Court. This participation
allows participants to have positive contact with Law Enforcement and serves as
an arm of accountability for the participants in the program.
• The Collier County Jail is the largest mental health facility in Collier County
with approximately 22% of the jail population diagnosed with a mental health
issues.
• The Collier County Sheriff's Office Jail offers Project Recovery, which is a jail
diversion program and a group therapy experience for substance abuse
administered within the Collier County Jail.
• The Collier County Sheriff's Office Jail partners with DLC in administering
the Forensic Intensive Reintegration Support Team (FIRST) program that provides
intensive community reintegration assistance to people that need treatment for
mental health and/or substance abuse disorders.
2.E.1
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Overview
Collier County Treatment Courts
Mental Health Court, Drug Court, Veterans Treatment Court
• Collier County’s three treatment courts seek to identify persons facing
criminal charges for whom a program of intensive treatment, supervision, and
accountability would have a reasonable chance of halting the criminal behavior
and restoring the individual to health, stability, and productivity.
• With these efforts, these courts aim to reduce crime, improve public safety,
increase access to treatment, restore families, increase restitution to victims,
improve quality of life, and conserve resources.
• Treatment courts employ a multi-disciplinary, collaborative approach. In
Collier, the team is comprised of a judge, a prosecutor, a public defender, a
probation officer, a law enforcement officer, and various clinicians and case
managers, each of whom has received specialized training in best practices for
such courts.
• The vast majority of treatment for participants in our 3 courts is provided
by the David Lawrence Center, often at greatly reduced cost to the individual,
based on a sliding scale for ability to pay.
• Several other community partners actively support the team in this
process, including St. Matthew’s House, NAMI, the VA, Project HELP, the
Neighborhood Health Clinic, JFCS, The Shelter, The Vet Center, Goodwill,
CareerSource, and many others.
2.E.1
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Overview
Naples Community Hospital
4 SE Department of Psychiatric Medicine
Clinical Scope of Services- 12 Bed Inpatient Crisis Stabilization Unit
A.Introduction
Our mission is to provide a safe healing environment where patients can be
stabilized, treated, and assisted to the next level of care. Patient, visitor,
and staff rules are all devised for the safety of everyone. All visitation
including visits with other patients must occur in public areas. We are
protected by federal regulations and all of our patients are treated as
privacy patients. We are not allowed to confirm a patient is admitted unless
the patient has given us written permission to share that information.
1.Physical Environment
The Department of Psychiatric Medicine is located on the fourth floor on
the southeast side of the building at the downtown hospital campus. It is
adjacent to 4 South Unit. It is a 12-bed newly renovated unit with state of
the art safety features. 10 of the beds are semi private and there is one
camera-monitored private room and one quiet room.
2.Type of Services provided
The staff of the unit provides care for voluntary patients with decisional
capacity age 18 to 90 who are able to care for themselves and participate in
treatment. Patients must have acute psychiatric illness as defined by the
American Psychiatric Association DSM 5 as well as primary or co-morbid
substance abuse illness. Patients are assessed and monitored throughout
their stay by a multidisciplinary team. Every patient is assigned a psychiatric
provider and they are assessed and by the psychiatric physician every day.
Patients are assessed each shift by the nursing/occupational therapy staff
using evidence based standards and tools and for their progress toward
goals and the need to make any changes in their treatment plan. In addition
to their psychiatric care, patients have access to medical, psychological/
specialty consultations as needed.
2.E.1
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Overview – Naples Community Hospital – con’t.
Our discharge planners work with the patient/family/friends and the
multidisciplinary team, outside providers and insurance companies for after
care planning. There is a structured schedule seven days a week, which
includes ongoing assessment and groups to help patients understand their
illness and how to begin their journey to wellness. Our average daily census
is 9.0 patients and our average length of stay is 4.2 days.
3. Hours of Operation
7 days a week 24 hours a day
SE has a multidisciplinary team that meets 7 days a week and collaborates
on the treatment plan with the patient and if the patient permits family
members or significant others. Members of the multidisciplinary care team
include psychiatrists, nurses, occupational therapists, respiratory therapists,
medical physicians, psychologists, pharmacy, physical therapy, chaplains,
volunteers, the NCH foundation, and diabetes and wound care services. In
addition, art in healing, alcoholics anonymous, and narcotics anonymous
provide groups for patients from 1-7 days a week.
CONSULTATION SERVICE
The Department of Psychiatric Medicine provides a consultation services 7
days a week to the 710 bed 2 hospital facilities. Psychiatric staff are always
available to collaborate with any department in the hospital or outside
facility regarding psychiatric or addiction issues. This includes discussing
patient needs, referrals to other agencies, etc.
Collaboration with Other Providers
The Department of Psychiatric Medicine has collaborative relationships
with David Lawrence Mental Health Center, Park Royal Hospital, Salus Care
Hospital, Riverside Behavioral Health, Charlotte Behavioral Health and
Suncoast Behavioral Health, Hazelden Foundation, The Willough of Naples,
Drug Free Collier, NAMI, St. Matthews House, Collier County Sheriff’s,
Naples Police Department, the Neighborhood Health Clinic and many local
providers of psychiatric and addiction services.
4. Interdisciplinary Collaboration
2.E.1
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Mental health and Addiction
Recovery
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About David Lawrence Center
•Not-for-profit, largest provider of mental health and
addiction recovery services in Collier County since 1968.
•Framework provided in the last bill signed into law by John
F. Kennedy, in 1963, the Community Mental Health Act.
•The only comprehensive provider of behavioral health care
in Collier County. Services span from inpatient to
outpatient to community based care; treatment services
are available for children and adults who experience
psychological and substance abuse challenges.
•Committed to providing care for ALL in need!
2.E.1
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Our Services
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Complete System of Care
•Emergency Services
•Inpatient Services
•Outpatient Services
•Community-Based Care
2.E.1
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Emergency Services Assessment Center
Available, Every Moment, Every day
•24/7/365 Crisis Intervention
•Mental Health and Addictions ER for Collier
•Baker Act Receiving Facility for Collier County
•Dramatic Increase in Admissions
•Live and phone assessments average over 250 per month.
•Assessing Clinicians, Psychiatrists, Observation Beds
2.E.1
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Mental Health Immediate Care
Access services with no appointment
necessary
•Innovative and Unique Model
•Walk in Clinic
•Same Day Clinical Assessments
•Vast majority connected with Outpatient
Services
2.E.1
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Inpatient Crisis Stabilization Services
Intensive, Inpatient Services for Children & adults
•Baker Act Receiving Facility
(Voluntary & Involuntary Admissions)
•Adult Crisis Stabilization Unit
•22 Beds
•Children’s Crisis Stabilization Unit
•8 Beds (doubled capacity in Jan 2017)
2.E.1
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Substance Abuse Services
Addiction and Recovery Services
•Detoxification Unit•15 Beds
•Residential Treatment•18 Licensed Beds
•Partial Hospitalization Program
•Intensive Outpatient Services
•Ongoing Supports
•Specialized co-occurring mental health and psychiatric services available
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Outpatient Services
Routine, Scheduled appointments
•Psychiatric Evaluation and Medication Management
•Individual and Family Therapy
•Group Therapy
•Substance Abuse Intervention
•Medication-Assisted Substance Abuse Treatment
•Dialectical Behavioral Therapy (DBT)
•TeleMedicine/TeleHealth
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•Services where it’s needed, when it’s
needed
•For adults, children and families
•Coordination of care across all levels of
treatment
•Meeting people literally and
figuratively “where they are at”
Complete System of Care
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Community Services
Provided in the community setting –homes, schools, healthcare
facilities, human service agencies such as the child protective services
agency –to divert at-risk clients from institutional care, further
decompensation or legal involvement
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Children’s Community Services
•In-Home Wrap Around Services
•School-Based Services
•Children’s Community Action Team
•Embedded MH Clinician at Child
Protection Office
•Prevention and Education Services
2.E.1
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Adult Community Services
•Case Management
•Homeless Outreach
•Affordable Housing
•Supported Living Services
•Supported Employment Services
•Prevention Education
•Mental Health First Aid
•Parenting Classes
2.E.1
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Specialty Services-Treatment Works!!!
Effective diversion and deflection services provided
in conjunction with the courts to give clients with
legal involvement access to mental health and
substance abuse services as a solution.
•Mental Health Court
•Drug Court
•Veterans Court
•Juvenile Assessment Services
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Holistic Services
•Art Therapy
•Pet Therapy / Equine Facilitated Psychotherapy
•Music Therapy
•Spiritual Support Services
•Tobacco Cessation Services
•Wellness and Nutrition
•Just opened: Integrated On-site Primary Care
Clinic and On-site Pharmacy Services
Wellness-based supportive services that treat the whole person
and work in conjunction with traditional behavioral health
treatment.
2.E.1
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DLC collaborates with a variety organizations
and providers throughout Collier County to ensure
coordinated, unduplicated care that promotes the
health, well-being and safety of the entire
community.
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Locations
•Polly Keller Main Campus –off of Golden Gate Parkway
•Admissions, Crisis Unit, Crossroads Detox & Residential, Outpatient
Services, Administration
•Horseshoe Drive Satellite Services
•Community Services, Prevention, Specialty Court Related Services
•Immokalee Satellite Services
•Urgent and Routine Outpatient Services
•Affordable Housing Units –24 units in East Naples and
Golden Gate
2.E.1
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Overview
Helping those Affected by Mental Illnesses
Long-term, Community-Wide Support: Treatment
is necessary--but not sufficient-- to address
complex, life-altering challenges presented by mental illnesses. NAMI of
Collier County provides ongoing education, advocacy, and support for
adults, children, and families affected by mental illnesses. NAMI maintains
ongoing, supportive relationships with individuals with mental illnesses,
despite whether they are in treatment at the David Lawrence Center,
incarcerated in the county jail, staying at St. Matthews House, or living
productive lives in the community.
Crisis Intervention Team (CIT) Training. NAMI oversees several trainings per
year for law enforcement officers and first responders on how to effectively
respond to individuals in mental health crisis, preventing unnecessary
arrests.
Daily Activities and Diversion Option: NAMI’s Sarah Ann Drop In Center, (SAC)
is a welcoming place where adults with mental illnesses receive social
support and work towards their recovery, serving over 400 persons each
month. On any given day, about 30% of attendees are homeless. Along with
fun activities and peer support groups, the Sarah Ann Center offers daily
meals, a free clothing closet, and a food pantry. Participation at Sarah Ann
Center can help prevent undesirable interactions in the community for
people who are unable to work and may have nowhere else to go. Many
people can be safely diverted from unnecessary criminal justice involvement
though membership at the Sarah Ann Center.
Employment: NAMI creates a path for employment and hope for individuals
with mental illnesses. NAMI employs Certified Recovery Peer Specialists at
the Sarah Ann Center and in several other programs. They are people in
recovery from a mental illness who have had specialized training and
experience supporting others with mental health conditions.
2.E.1
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Overview NAMI – con’t.
Emergency Fund: Through its emergency funds, NAMI helps individuals
address barriers to mental health care so people get the help they need
despite economic factors. Funds are based on documented need, and are
paid directly to the agency by NAMI. For example, NAMI may cover an
individual’s copay for a psychiatric appointment at David Lawrence Center.
Reintegration: NAMI employs a Certified Recovery Peer Specialist as member
of a jail reintegration/re- entry team for people with mental illnesses who
have been arrested. David Lawrence Center, the Collier County Sheriff’s
Office and the County collaborate to create the team which is funded by
Department of Children & Families with 100% local match.
Prevention and Early Intervention: NAMI’s children’s mental health program
offers standardized, community-based mental health screenings for children
up to 18 years old, specifically focusing on high risk/low income areas of the
community. Screening helps to identify children early, before symptoms
have become serious and before major behavioral problems occur,
preventing school problems and negative interactions with law enforcement
or DJJ. As part of a local collaboration called ‘Beautiful Minds’, NAMI’s
System Navigators refer children to mental health care; attend meetings
with the family and school; help families understand their child’s potential
problems; the importance of obtaining treatment (e.g. at David Lawrence
Center), and following through with professional recommendations.
2.E.1
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Overview
Mental Health Services
Collier County Public Schools
Introduction
Mental health is as important as physical health to our quality of life. Good
mental health means having the skills necessary to cope with life’s
challenges. Strengthening programs that support adult mental health
services have positive impacts on educational and mental health outcomes
of students. Unmet mental health needs of children can be a significant
obstacle to learning, social-emotional development, physical health, and
can compromise school safety. Children’s mental health can affect children
and youth in a variety of ways to varying degrees in the school
environment.
Abstract
School and district personnel can provide a continuum of mental health
services for students ranging from universal mental wellness promotion
and behavior supports to staff and parent training, identification and
assessment, early intervention, individual and group counseling, crisis
intervention, and referral for community services.
Problem Statement
The U.S. Surgeon General’s 2000 Report on Children’s Mental Health
estimates that one in five children and
adolescents will experience a significant
mental health issue during their school
years. Fifty percent of mental health
disorders begin before age 14 and 75%
before age 24 (Child Mind Institute
Children’s Mental Health, 2016). This
affects the learning and school experience
for all children. Children’s mental health
difficulties are associated with poor
academic performance, behavior
problems, school violence, school drop-
out, substance abuse/self-medication,
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special education referral, suicide, and criminal activity. Mental health
concerns can develop as early as infancy and, like other aspects of child
development, the earlier we address them the better.
According to The Baker Act Fiscal Year 2015/2016 Annual Report prepared
by The Department of Children and Families, statewide involuntary
examinations for children increased 49.30% from FY10/11 to 15/16,
compared to a 5.53% statewide population increase from 2010 to 2015.
Almost one-quarter of involuntary examinations were for children who
were at school at the time of the Baker Act initiation.
Analyses for change over time were conducted for the 30 counties that had
250 more involuntary examinations for children in FY 15/16. Collier County
reported a 170.0% increase, the highest in the state.
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School/District Resources
Mental health disorders can affect classroom learning and social
interactions. We can often maximize student success and minimize
negative impacts when appropriate services are put in place to support a
student’s mental health needs. Sometimes meeting mental health needs
requires schools to provide targeted and/or intensive general education
interventions and positive behavior supports for children to benefit from
instruction. This support is provided via Student Success Plan. Some
children and youth have ongoing behavioral challenges that may need
additional support, e.g., a functional behavior assessment and a behavior
intervention plan; a 504 Plan or Individual Educational Plan with
accommodations and strategies; specially designed instruction; and
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services from specialized instructional support personnel in an effort to
reduce emotional, behavioral, or mental health problems and help a child
cope with them.
Specialized instructional support personnel provide and support school-
based prevention and intervention services to address barriers to
educational success, ensure positive conditions for learning, and help all
students achieve academically. Licensed and/or credentialed and qualified
professionals promoting the health and well-being of the child assist in
identifying children with mental health needs and may provide direct
services to children and families or serve as the conduit to community
resources. Providers of services include masters/specialist and doctoral
level personnel. The following are brief descriptions of Collier County Public
Schools’ mental health services:
School Counselor Services. School counselors recognize and respond
to the need of mental health and behavioral prevention, early
intervention and crisis services that promote psychosocial wellness
and development for all students. School counselors are employed
by the District and support elementary, middle and high schools.
Psychological Services. School psychologists provide a range of
psychological and behavioral assessments, intervention, prevention,
crisis response, and short-term solution based counseling.
Additionally, school psychologists provide teacher consultation with
program development, promoting educationally and psychologically
healthy environments to enhance developmental processes of
children and youth and to promote optimal learning. School
psychologists are employed by the District and provide services and
support to all schools.
School Nurses. Registered nurses are dedicated to improving the
health and educational success of children and youth. Specifically, a
school nurse provides health related services to minimize health
conditions that interfere with learning. The nurse identifies possible
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mental health concerns through daily interactions and assessment of
students, administers medications prescribed by mental health
professionals, is a member of the multi-disciplinary team, and serves
as a liaison to community health resources. School nurses are
contracted through NCH.
Behavior Management and Therapeutic Counseling Services.
Children with wide psychiatric, emotional and behavioral health
disabilities who demonstrate a need for special education and
related services and, are in need of placement in a self-contained
class, are provided intensive behavioral services. Students receive
daily personal assistance, monitoring, and intervention including a
highly structured, individualized behavioral intervention plan infused
throughout the school day based on a functional behavioral
assessment, and behavioral support from a behavior analyst.
Therapeutic counseling is provided by a school intervention therapist
(“mental health clinician”) through individual or small group
counseling, and continuous monitoring and assistance related to
mental health care needs is provided in collaboration with outside
providers. The students are assigned to this placement through the
Individual Educational Plan (IEP) process.
Educational Day Program (EDT). Collier’s EDT Program is the most
intensive non-residential program that can be provided over an
extended period of time. School-based day treatment provides
access to community-based mental health services in conjunction
with, and integrated into, the student’s educational program. Day
treatment brings together a broad range of behavioral management
and counseling services designed to foster the emotional, social, and
academic skills necessary for transition. The EDT Program is designed
for high school students who have been unable to achieve academic
success in the less restrictive self-contained class on a high school
campus due to severe emotional/behavioral and mental health
needs. A student in this program enters and exits the program
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through the IEP process which is representative of a multidisciplinary,
community-based approach combining educational and mental
health elements and other services as needed. Individualized
therapeutic behavioral on-site services including treatment planning
and case management review with David Lawrence Center, individual
and family therapy, and referral and linkage of services including
psychiatric services and medication management. The program is
staffed with an instructional teacher, behavior analyst and classroom
assistants, and a school intervention therapist as well as a clinician
provided by David Lawrence Center who works collaboratively with
school-based staff.
“We Care” Campaign. Collier County Public Schools (CCPS) partnered
with National Alliance on Mental Illness (NAMI) of Collier County,
David Lawrence Center, and the Collier County Sheriff’s Office (CCSO)
to launch a student mental health awareness campaign called “We
Care” to produce a video series on mental health. This campaign
was created to assist with prevention, early intervention, treatment,
and improved care coordination for children with mental health
concerns. The “We Care” campaign is geared toward middle and high
school students, and the goals of the campaign are to open the
dialog (and decrease) stigma, educate about the warning signs of
suicide, depression, dating violence, substance abuse, and bullying.
CCPS Mental Health. CCPS provides parents access to information
and resources on its Mental Health webpage including a Mental
Health Awareness Help for Parents video that was created with the
partners named above.
Community Partnerships
CCPS partners with several community agencies/organizations for purpose
of providing linkage to resources and services for children with mental
health concerns and their parents. These partnerships include, but are not
limited to: David Lawrence Center; NAMI including H.U.G.S.; AVOW
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Hospice; Valerie’s House; Collier 911; child welfare agencies; and the
Department of Children and Families.
Collaborative Monthly Meeting
CCPS’ leaders facilitate a meeting in coordination with CCSO and David
Lawrence Center. This collaboration focuses on communication, problem-
solving, streamlining of processes, and case management procedures to
assist families in need of mental health services. This team has been
instrumental in the development/implementation of a universal
Authorization and Consent for Information and a Parent Request form;
creation of a David Lawrence Center Liaison position to interface with
schools; sharing of transition “re-entry” information from David Lawrence
Center’s Partial Hospitalization Program; shared knowledge and
understanding of requirements associated with CCSO’s initiation of a Baker
Act; and staff training (e.g., Mental Health First Aid certification course).
Currently, this team is developing a Youth Suicide Awareness and
Prevention Training for Instructional Personnel pursuant to s. 1012.583,
F.A.C.
Barriers
For many children and youth, schools are the primary provider of mental
health support. Along with this are the associated limited financial
resources to fund mental health professionals (e.g., school social workers
and school psychologists). Another barrier involves limited eligible
providers for Medicaid billing. Services provided by school counselors are
not Medicaid eligible. Government and foundation grants are an option,
but schools must demonstrate their capability of sustainability.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
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