The Columbia, Montour, Snyder, Union Counties MH/MR/D&A program (CMSU) has, for several years, had a strong interest in the recovery model of service delivery and the development of “evidence-based practices.”  Although CMSU has had several of its staff attend trainings in recovery-oriented treatment strategies, we have never made a “system wide” effort and commitment to embrace and implement these philosophies and practices.  We believe that CMSU is uniquely positioned to transform its system into an evidenced-based, recovery-oriented system for the following reasons:


  • CMSU is in its third year of implementing a successful CHIPP/S program that has greatly enhanced its array of service and support options for the adult SMI population and has consistently maintained a state hospital census well below its bed cap.
  • CMSU has strong ties to the consumer community and utilizes them in planning for and evaluating its service delivery system.
  • CMSU has recently added a Continuous Quality Improvement Specialist position to its behavioral health administrative component, thus enhancing our capacity to spearhead such an ambitious undertaking.
  • CMSU operates many of the treatment and support services for the adult SMI population on its staff i.e. psychiatry and nursing, targeted case management, community residential rehabilitation, social rehabilitation and housing support.  As CMSU provides these services, we are well positioned to transform them.
  • CMSU has an active Behavioral Health Provider Network that we intend to involve throughout this project’s planning and implementation process.


We are excited about the possibility of undertaking such a challenging project and believe we have the capacity and resolve to implement it successfully.


I.          Description of System Change:

CMSU proposes to transform our mental health system on an incremental basis over a three-year period.  Therefore, we will develop specific goals and objectives for each year of this project.  Year one will be dedicated primarily to “system evaluation and orientation.”  The project will examine the CMSU mental health system and provide intensive training for key stakeholders in the system, i.e., consumers, CMSU staff, provider agency staff and family members in the development and implementation of recovery principles and practices and develop strategies for year two.    Year two will focus on continued analysis of the effectiveness of the CMSU service system and its design and continued training from year one.  During year two we will also develop specific plans for system redesign in year three.  Year three will entail implementing system redesign, measuring its effectiveness and developing plans for future system advancement.


Year One Goal:

To conduct a comprehensive analysis of the CMSU mental health system to identify its strengths and needs relative to the development of an effective, recovery-based system.


Objective 1:

The technical assistance consultants and project team will analyze the CMSU MH system and identify what changes need to occur in order  for the system to become recovery oriented.  This evaluation will occur throughout the first year of the project.

Year One Goal:

To provide a comprehensive orientation of the CMSU behavioral health service system in recovery principles and evidence based practices.


Objective 1:

Eighty-five percent of CMSU and provider agency staff who serve adult mental health consumers will attend a minimum of one full-day training session on recovery principles and evidence-based practices.  If CMSU is chosen for this project, it will require its staff and provider agency staff who serve the adult SMI population to attend this training.


Objective 2:

All consumers and family members who participate in various CMSU committees ( CSP, C/FST, ICAN), will receive a minimum of one full day training session on recovery principles and practices.


Year One Goal:

To ensure that policies and procedures in CMSU and provider agencies that provide services to the adult SMI population are “recovery friendly,” reflect the values and principles of a recovery oriented system and are, in fact, followed.


Objective 1:

CMSU will develop written guidelines/expectations for CMSU and provider programs to incorporate into its internal policies, procedures and practice guidelines by March 1, 2005 and distribute them to all service providers by April 1, 2005.  Implementation of these guidelines will be contractually required for fiscal year 2005/2006.  These requirements will address the following areas:


§          Staff training requirements on recovery principles and evidence-based practices will be required.

§         Agency policies and procedures will clearly reflect recovery principles and practices.

§          Staff evaluations and advancements will be based on adherence to recovery practices.

§         C/FST evaluation criteria will be revised to objectively measure programs’ adherence to recovery-based principles and evidence-based practices.

§         CMSU provider contracts and monitoring guidelines will be revised to measure adherence to recovery-based principles and evidence-based practices.


Year Two Goal:

To ensure comprehensive implementation of the system-wide recovery oriented guidelines/expectations developed in year one.


Objective One:

Seventy five percent of the providers who serve the adult population in the CMSU system will clearly demonstrate movement toward implementing recovery oriented principles and practices in their delivery of services by April 1, 2006.


§         CMSU’S CQI Specialist will systematically measure the extent to which recovery-based principles and practices are being implemented by provider programs.  This will be accomplished by reviewing records and meeting with direct service and supervisory staff.

§         The CMSU C/FST will measure through its program evaluations and its contacts with consumers, the extent to which consumers are experiencing the application of recovery-based principles and practices through their interactions with mental health care givers.

§         A final report and recommendations will be completed by May 30th and provide specific recommendations for year three of the project.


Year Two Goal:

To provide continued training opportunities for CMSU MH system staff to reinforce the previous activities in year one.


Objective One:

To provide two full days of training for new system staff or staff who did not receive training in year one.


Objective Two:

To develop a training curriculum and train trainers, preferably agency and CMSU supervisors, to continue training efforts in subsequent years in order to “institutionalize” recovery principles and practices in the CMSU system.  This curriculum will be developed by April 1, 2006.  Training of trainers will occur by May 30, 2006.


Year Two Goal:

To develop a realistic plan for system design changes in year three of NFI project in order to move CMSU to a recovery oriented system in subsequent years.


Objective One:

To finalize the analysis of each component of the CMSU MH system of services and supports by December 31, 2005.  The final analysis will be conducted by the project team and OMHSAS consultants and will provide recommendations for specific changes to occur in the CMSU system.


Objective Two:

To determine if the changes recommended by the project team can be implemented from a fiscal and clinical standpoint by utilizing OMHSAS project consultants and project team members. 


Objective Three:

To develop a written system redesign plan by March 31, 2006.  This plan, which will serve as a blueprint for change in subsequent years will have specific goals, objectives and timeframes and be incorporated into the CMSU planning process.


Year Three Goal:

To ensure that the redesign plan that was adopted in year two of the NFI project is implemented in a planned and thoughtful manner.


Objective One:

To begin systematic implementation of the system redesign plan that was adopted by the CMSU program in year two.


Objective Two:

To develop and implement a monitoring system to determine on an ongoing basis if the system changes are having the desired impact by developing written reports to the CMSU Behavioral Health Advisory Board and OMSAS on a quarterly basis.  The NFI project team will develop and present these reports.

Objective Three:

To develop a final written report that will summarize the NFI three year project’s accomplishments, limitations and recommendations for subsequent years.  The report will be submitted to the CMSU Behavioral Health Advisory Board and OMSAS’S NFI project staff.


If this project is successful, CMSU will gladly assist other counties in implementing this project in subsequent years.


II.        Resources that CMSU is willing to commit to this project:

CMSU is willing to direct significant resources toward the NFI project as we believe that this process will ultimately result in an improved service-delivery system for consumers with serious mental illness.  The estimated resources are as follows:


§         CMSU CQI Specialist one day per week                 $14,000

§         CS/FST coordinator one day/week                             $7,000

§         Psychiatric Training 56 hrs:                                          $6,400

§         Training Costs                                                            $2,000

§         Total CMSU sponsored costs for year one:               $29,400


III.       NFI Project Team Composition:


CMSU Behavioral Health CQI Specialist

The CMSU CQI Specialist is currently responsible for overseeing the evaluation of mental health and drug and alcohol services, contract monitoring, and spearheading new initiatives in the CMSU behavioral health system.  This individual will also serve as the NFI project coordinator if CMSU is chosen for this project.


CS/FST Coordinator:

This individual, who is employed by the local Mental Health Association, is a consumer who is responsible for evaluating the behavioral health services in the CMSU system.  The CS/FST plays a key role in CMSU’S program evaluation system.


CSP Committee Member:

As the CSP committee is involved in CMSU’s planning and advocacy, we believe that having a representative from this group could provide valuable input into this initiative.


CMSU Deputy Administrator for Mental Health Services:

This individual is responsible for oversight of the MH system in CMSU and will bring valuable administrative, operational and budgetary skills to the project team.


Provider Network Representative:

This individual would provide representation from the providers in the CMSU system.  We believe that having a stakeholder from the provider community would provide the team with valuable input from a service-delivery perspective, and increase the likelihood of substantial “buy in” from this important constituency.


1V.      Definition of Successful Outcomes:

Unlike pornography, which escapes a clear definition but “You know it when you see it!”, we believe that a successful recovery based system can be defined.  The CMSU NFI Project will be considered successful if:


§         A sizeable majority (85%) of the CMSU programs serving the SMI adult population successfully demonstrate that they have embraced the recovery model and are, in fact, providing evidence-based practices in the course of their service delivery.  We will know this is true if staff have been trained in recovery principles, policies are in place in each service area expecting staff at all levels of the organization to engage in processes that promote positive recovery outcomes, and staff display understanding and competence in outcome-based recovery practices.

§         A sizeable majority of consumers (85%) receiving services through the CMSU mental health system report that professionals who deliver services to them do so in a manner that they (consumers) believe is supporting their recovery from mental illness.

§         A sizeable majority of records (85%) sampled clearly reflect the implementation of recovery-based practices and one can see some demonstrable progress toward recovery over the course of service delivery.

§         The system changes that CMSU has implemented have resulted in a more comprehensive array of services and supports to facilitate recovery.


Are these benchmarks realistic?  Perhaps they are not achievable in the next three years, but we clearly want to avoid setting the bar too low, as it is better to fall short of a high standard than to achieve a low one.


Required Training and Consultation:

To successfully complete this project, we believe the following training and consultation will be needed each year above the two day kickoff and site visit prior to initiation.


Year One

*      Five training days

*      Six consultation days


Year Two:

*      Five training days

*      Seven consultation days

*      One networking day


Year Three:

*      Seven consultation days.

*      Five training days.

*      One networking day.


I agree that the CMSU Mental Health/Mental Retardation Program is applying for participation in the New Freedom Initiative 3-year Project and agree to the guidelines set forth in the project concept paper and included in the attachment requirements for participation.




Philip T Keating,                                                                                            Date

CMSU MH/MR Administrator