Executive Summary: Community Mental Health Initiative Project Findings

CMHI 1.0 Building Systems of Care, Community by Community

Many Illinois communities have insufficient resources or strategies to address children’s healthy mental development. The Children’s Mental Health Initiative, Building Systems of Care, Community by Community (CMHI 1.0) was designed to enable four communities to find local solutions to these critical challenges.

Mental Health Disorder Prevalence

Population that will develop a mental health disorder at some point in their lifetimes

Of Those in US with Mental
Health Disorders

Of Those in US with Mental
Health Disorders

CMHI 1.0 Outcomes

With ILCHF grant funding, the four CMHI teams significantly shifted community culture and practices surrounding children’s mental health. CMHI has shown that empowering communities through an investment in their unique visions and capabilities enables providers to align their organizational plans and operations in order to more effectively serve children with a community-wide strategy.

  • 4 communities have successfully integrated mental health systems across schools, primary healthcare and community organizations
  • Services developed through the initial grant investment have been largely sustained
  • CMHI 2.0, ILCHF committed $12.6 million to 5 new communities to build integrated systems for children’s mental health care

Children’s Mental Health Initiative 1.0

Children’s Mental Health Initiative 1.0
ILCHF Investment

$11.27 million

4 Communities

$2.85 million

Adams County Children’s Mental Health Partnership (ACCMHP), serving Adams County

$2.85 million

Community That Cares (CTC), serving Carroll,
Lee, Ogle, and Whiteside counties

$2.85 million

Livingston County Children’s Network (LCCN), serving Livingston County

$915,000

Cross-site evaluation

$2.85 million

The Children’s MOSAIC Project (MOSAIC), serving the city of Springfield

In 2009, ILCHF identified the following five guiding principles for CMHI:

Engage community-based professionals and families to collaboratively create a child-centered and family-focused system of care.
Leverage existing networks of community-based service providers to supply evidence-based and culturally sensitive services.
Ensure the capacity to prevent, identify, and treat children at risk for, or with, existing mental illness.
Incorporate the concept of a medical home, with integrated behavioral and pediatric healthcare, as the focus of services.
Include comprehensive plans to educate and engage all who play active roles in the lives of children, with a particular emphasis on mental health, healthy development, and stigma.

8 Years

1 planning year

6 implementation years

1 mentoring year

Accomplishments & Lessons Learned

Every CMHI 1.0 community now incorporates the five guiding principles with varying levels of intensity and success.

ILCHF was committed to learning from and sharing the successes, challenges, and failures of each unique CMHI 1.0 project. To that end, each community wrote a manual describing its efforts, including problems, solutions, and strategies. The manuals are a rich resource of information about the extra- ordinary work in each community.

In synthesizing the key findings presented here, the Foundation draws upon extensive reports from the sites, third party evaluators, and ongoing relationships with key personnel at each site. Five primary elements of the projects discussed below are:

SYSTEMS INTEGRATION

CMHI 1.0 was very successful in significantly improving the level of systems integration in all four communities over the first six years of the project. Survey instruments sent to each service provider in the community provided ratings of all other providers in terms of their level of integration and partnership. Integration of human resources, funding, overall impact, 
and communication were assessed. The scale rated collaboration elements on a scale from one (informal relations) to five (full integration). All four communities achieved statistically significant improvement in their systems integration.

SUSTAINABILITY

CMHI 1.0 systems have been sustained, even as grant funding gradually decreased. 
From the onset of CMHI 1.0, ILCHF was concerned with sustaining enhanced mental health services and overall integrated systems of care beyond the grant period. All four communities utilized grant funds to pilot and implement the integration of mental health screening and services into both medical and school settings. These mental health services are now sustained through an array of funding mechanisms and strategies.

MENTAL HEALTH SCREENING

Mental health screening in schools and primary care practices are routine in all four CMHI communities. CMHI communities succeeded in dramatically increasing the rates of children being screened for developmental and mental health concerns. In 2010, at the start of the project, fewer than six percent of children were screened. By 2016, nearly half of all children in the communities were screened. In 2017, the Quincy Public Schools began screening all children during school registration. In 2018, Springfield public schools began screening all children in selected grades. For the CMHI communities, mental health screening is now routine for families and is part of the expected experience in medical care and school settings.

EVALUATION

CMHI incorporated a complex evaluation—including a cross-site evaluation and four local evaluations—producing varied but useful results. Systems integration data gathering produced useful results. The longitudinal cohort study encountered significant challenges in connection with enrolling and retaining children in the study, as well as difficulties in gathering data. These challenges have significantly informed the evaluation plan for CMHI 2.0.

ADVOCACY

Policy and advocacy capacity building was successful. ILCHF funded a collaboration between the CMHI 1.0 communities and the Sargent Shriver National Center on Poverty Law (Shriver Center). Shriver Center provided CMHI communities with technical assistance on policy advocacy, including the skills to navigate the Medicaid reimbursement system. The communities and Shriver Center worked together to devise education, legal advocacy, and problem-solving mechanisms that resulted in a significant strengthening of the children’s mental health system overall. The successes were primarily in the areas of insuring Medicaid reimbursement during the state budget impasse; expanding the available array of mental health services and increasing reimbursement rates; problem-solving around Medicaid coverage lapses for clients; and Medicaid plan changes.

Next Steps

Based on its experience with CMHI 1.0, ILCHF has learned that the most effective means of impacting the lives of children and families is to support the system of care at the community level. CMHI 1.0 produced impressive outcomes related to the successful integration of child-serving systems within the local community. CMHI 1.0 reduced the burden of emotional distress and mental illness. The services that were developed through the initial grant investment have been largely sustained.

ILCHF is committed to continuing its investment in the Illinois children’s mental health system: Children’s Mental Health Initiative 2.0 (CMHI 2.0) is a $12.6 million seven-year investment in a second round of system of care development grants. In July 2018, ILCHF awarded planning grants to five Illinois communities to develop and implement a children’s mental health system of care.

Children’s Mental Health Initiative Communities Served

CMHI 1.0 Communities

  • Adams County Children’s Mental Health Partnership (ACCMHP), serving Adams County
  • Community That Cares (CTC), serving Carroll, Lee, Ogle, and Whiteside counties
  • Livingston County Children’s Network (LCCN), serving Livingston County
  • The Children’s MOSAIC Project (MOSAIC), serving City of Springfield

CMHI 2.0 Communities

  • Centerstone, serving Perry, Franklin, Jackson, and Williamson counties
  • Community Foundation of Kankakee River Valley, serving Kankakee County
  • Heritage Behavioral Health, serving Macon and DeWitt counties
  • Kane County Health Department, serving Kane County
  • Primo Center for Women and Children, serving homeless youth and families in Chicago

Children’s Mental Health Initiative Timeline

September

  • ILCHF releases Planning Grant RFP

2009

May

  • 13-month CMHI Planning Grants awarded to five communities

2010

August

  • Five-year grants awarded to four CMHI Communities
  • Adams County
  • Carroll, Lee, Ogle, and Whiteside Counties
  • Livingston County
  • City of Springfield

September

  • Year one implementation begins

2011

January

  • Year two implementation begins

2013

January

  • Year three implementation begins

February

  • ILCHF invests an additional year of funding of up to $300,000
    for each community, to address unpredictable challenges in
    systems change, thus adding a sixth implementation year

2014

January

  • Year four implementation begins

August

  • CMHI Advocacy Planning Project Grant of $80,000 awarded to
    Sargent Shriver National Center on Poverty Law (Shriver Center)
  • Advocacy Planning Project Grants of $5,000 each awarded
    to the four CMHI communities

December

  • Stabilization Grants of up to $175,000 each awarded
    to the four CMHI communities

2015

January

  • Year five of implementation begins

October

  • Advocacy Planning Project Grants of $5,000 each awarded
    to the four CMHI communities

2016

January

  • Year six (final year) of implementation begins

August

  • ILCHF Board authorizes up to $10.1 million for CMHI 2.0
    planning, implementation, and evaluation

October

  • Mentoring Grants of $75,000 each awarded to the four
    CHMI communities

2017

January

  • Mentoring year begins

June

  • CMHI 2.0 Planning Grants of $200,000 each awarded to
    five new communities for planning, implementation, and evaluation

August

  • CMHI Advocacy Planning Project Grant of $160,000 awarded
    to Shriver Center

October

  • CMHI 2.0 planning year begins

2018

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