Columbia River Mental Health Services (CRMHS)

Organization
Organization Name: 
Columbia River Mental Health Services (CRMHS)
Organization Director: 
Nancy Parker, Executive Director
Program Name: 
Options
Street Address: 
6926 NE Fourth Plain Blvd.
City: 
Vancouver
State: 
WA
ZIP: 
98666
Phone Number: 
(360) 993-3000
Contact
Contact Person: 
Vicki Salsbury
Contact Title: 
Program Manager
Contact E-mail: 
Program
Organization Profile: 

Columbia River Mental Health Services (CRMHS) is a private non-profit community mental health center serving Clark County area residents in Washington State. CRMHS was founded in 1942 and offers a variety of programming, including child and family services, employment services, outpatient and medical services, supported housing, a residential mental health facility, and drug and alcohol outpatient and opiate substitute treatment.

Options began as a program of the Clark County Department of Community Services.  The Department continues to provide support to the Program, but it is now a part of CRMHS. Options also receives support from the Children's Mental Health Initiative, the Youth Commission, Community Mobilization, the Developmental Assets Project, and other sources for mentoring, substance abuse prevention, and suicide prevention programming. Funding from state, federal and local sources help provide support for achieving youth program goals of building "Developmental Assets," creating opportunities for youth voice, and preventing substance abuse, violence, and other social ills.

Program Structure/Design: 

Options was developed by residents of Clark County, Washington in response to the Partnership for Youth Transition initiative of the U.S. Substance Abuse and Mental Health Services Administration. Under the leadership of staff of the Clark County Department of Community Services, funding was obtained and a planning year began in October 2002. The hiring and training of staff began a year later, with service delivery beginning in January 2004. The grant funding ended in September 2006; however, the Options program continues to be funded by a combination of Medicaid and state and county general funds. Small corporate donations, fundraising activities, and grants help cover costs associated with youth who need food, basic hygiene products, or work-readiness-related items.

Options serves young people ages 14 through 24 who are out of the home or at imminent risk of an out-of-home placement. The program targets voluntarily participating youth who meet the criteria of access to care standards for mental health services. Currently, Options serves up to 60 youth at a time. The capacity of the program is determined both by available funding as well as staffing constraints: the program model allows each program transition specialist to provide support to a maximum of 20 individuals. Transition specialists function as traditional case managers, staying in contact with youth, connecting youth to internal and external services and programming, and helping youth coordinate their experience while in the program.

Referrals to the program can come from anywhere in Clark County, including youth themselves, parents, schools, regional support networks for mental health services (RSNs), the juvenile justice system, other mental health agencies, and from within CRMHS. Options often coordinates services with other supports the youth may have such as family members, school personnel, RSNs, or juvenile justice or child welfare staff. The Options program also serves homeless youth. As a result, the program manager has developed strong relationships with the Coalition of Service Providers for the Homeless and the agencies that serve homeless youth.

Once a youth is referred to the program, there is an initial determination of eligibility. Options enrolls eligible youth based on funding and program capacity. Options leverages Medicaid or state-only funding for qualifying youth. Ideally, the Options team therapist conducts the intake to begin developing rapport with the youth. Every youth is assigned to a transition specialist for support. If youth have more acute mental health needs, the therapist may remain as primary clinician. Youth are also referred quickly to begin working with the employment specialist if employment or education is one of their short-term or long-term goals.

States of Operation: 
WA
ODEP Funded: 
No
Innovative Practices
Career Preparation and Work-Based Learning Experiences: 

Options views competitive employment (unsubsidized by program or government funds) as the key to helping youth transition from dependence to independence. The program provides a variety of career preparation opportunities that are age and stage appropriate. Since the program serves a wide age range, younger youth (ages 14 – 15) often focus on building basic skills, academic improvement, career exploration, and youth development activities. Older youth (ages 16 – 24) interested in employment work with their transition specialists to develop plans appropriate to their individual goals, needs, and abilities. Options provides opportunities to learn employment readiness and job retention skills, engage in resume and interview preparation coaching, and participate in job placement assistance. With many job placements, Options employs supported employment strategies, which involve targeted job development, staff connection to supervisors, ongoing job coaching on and off the worksite, appropriate accommodations, and other supports as needed and available.

Connecting Activities: 

In addition to employment-related services, Options provides individualized transition services (commonly referred to as case management), including, community integration and independent living services, community life services, and therapy. Community-based services focus on housing, community life skills, employment, and education. Options also helps youth resolve transportation challenges and identify childcare, when needed. Options’ role is to provide strength-based support—that is, advocacy and guidance in helping youth define and achieve their goals, develop self-sufficiency skills, and otherwise become prepared for life in the real world. Youth voice is strong and family involvement is encouraged and valued.

The Options program is located at the Clark County Youth House, a location that is very attractive and accessible to youth who may feel stigmatized going to the mental health center. Program staff are skilled at providing all aspects of mental health clinical operation as well as processes and tools specific to the Options program. Some unique elements of this program are the utilization of the Transition to Independence Process (TIP) and concepts adopted from Bruce Anderson’s work at Community Activators, training and organizational coaching entity.  TIP is a system that assists young people with emotional and/or behavioral difficulties (EBD) in making a successful transition to adulthood. For more information on the TIP model, visit www.tipstars.org. From Community Activators, Options integrated elements of the Five Skills of an Ally (Culture and Core Gift Identification, Creative Problem Solving, Stories from the Other Side, Standing By, and Creating Welcoming Places. According to Community Activators, an “Ally” is any person that finds himself or herself in the position to support or guide a person or group. Options also includes Community Activators’ Core Gift Identification Process, which helps individuals identify and capitalize on their innate strengths, traits, and talents. For more information on Community Activators, visit www.communityactivators.com.

Program duration varies by the individual youth’s needs. Some youth may stay in the program for a few years, while others may get assistance with employment and a place to live and then choose to close out or graduate from the program soon thereafter.

Evidence of Success (Information and Analysis)
Third-Party Documentation: 

An extensive research component, in coordination with Portland State University, was in place during the grant-funded years of the Options youth program. This outcome data is available in the Clark County Options Program Final Report, March 2007.

During the grant period, services used and outcomes were assessed on 51 youth who had been working with the Options program for at least nine months. At the nine-month data collection point, youth had received, on average, 99 hours of face-to-face support, of which about 60% of the service hours were focused on community life skills and other case management activities, about 26% were dedicated to employment, and the remainder were focused on education and housing. Overall, the youth were satisfied with the Options program and the work of the transition specialists, rating their overall satisfaction at 4.2 or higher on a 5-point scale, with 5 being “very satisfied.”

Program impact was assessed in four domains: living situation, educational status, employment status, and criminal justice involvement. Housing remained fairly stable over the nine-month time period, with fewer youth living at home at nine months and more youth living with friends or independently. Numbers living in foster care, in corrections, or homeless remained unchanged. Involvement in educational programs remained high over the nine-month period with approximately 70% involved in either high school, GED, or some other educational programming. By the nine-month point, 10 youth had either graduated from high school or received their GED. Employment status showed strong improvement. At the time of data collection, close to 40% of the youth had worked in some form in the past 90 days.

The most striking positive outcomes were seen in involvement with juvenile justice.There was a significant decrease in the number of youth with at least one substantiated offense (from 61% in the nine months preceding intake to 29% during the nine months post-intake). There was also a significant reduction in the frequency of offenses, from an average of 1.6 offenses during the nine months pre-intake to an average of 0.7 offenses during the nine months post-intake.

Taken together, about 25% of the Options youth showed positive movement in all four domains and another 22% showed positive trends in three domains. The combination of support in managing their mental health and in developing skills of adult living, combined with strong employment support, was successful in stabilizing their living situation, improving their education and employment outcomes, and reducing their involvement with the criminal justice system.

Click here to download the full report on the four-year initial Options project.

Specific “lessons learned” and recommendations from this project include:

  1. Challenge your community, staff, and yourself to allow and embrace true youth voice and youth-driven services. The presence of true youth voice in the planning, implementation, and ongoing evaluation of the program and services is invaluable.
  2. Services and supports must be developmentally appropriate and appealing.
  3. Question existing policy, rules, and regulations.
  4. The realization that our work was about a successful transition into adulthood as opposed to a successful transition into adult services.
  5. As with all relationships, the “engagement” period is critical.
  6. Staff must understand and function in the capacity of an ally.
  7. Do not ignore your data.
  8. Understand both adolescent brain development and adolescent/youth culture.
  9. Develop a strong framework within which to conduct your work.
  10. Work smarter, not harder, including supporting youth to achieve what they want for themselves, not what you want for them.

Options has provided technical assistance to a number of programs across the country. In addition, it was selected as one of five programs across the country to participate in a U.S. Department of Labor’s Office of Disability Employment Policy (ODEP)-supported study to identify promising practices and develop new knowledge regarding effective practices in the workforce development system for helping youth with mental health needs transition to secondary education and/or employment. Options was also honored to be selected for inclusion in Transition to Adulthood published by Brookes Publishing.

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