1. Statewide Project #2 Behavioral Health Navigator STARK COUNTY Nicole Caudill, MSW, LSW Hospital and Community Liaison Crisis Intervention and Recovery Center, Inc.

2. Hospital & Community Liaison History and Purpose

3. History The Hospital and Community Liaison position was created in collaboration with, and funding from, the MHRSB of Stark County to serve as a conduit between Heartland Behavioral Healthcare (HBH) and community-based behavioral healthcare organizations under the umbrella of the MHRSB.

4. Purpose 1. Provide leadership to the Stark County Bed Day Management Team and oversee the utilization management of HBH, in collaboration with the MHRSB and community-based behavioral healthcare providers under its umbrella, for those clients on Stark County rolls. 2. Attend and participate in care coordination with HBH Treatment Teams and practitioners. 3. Provide Diagnostic Assessment and CPST Services for non- linked individuals admitted to HBH to include linkage to a behavioral healthcare provider of their choice.

5. Purpose cont. 4. Coordinate Hospital Collaborative Meetings to include MHRSB, Private Hospitals and community-based behavioral healthcare providers for individuals who utilize Emergency Departments for non-medical emergencies. 5. Serve as a behavioral healthcare navigator for individuals admitted to private hospitals and facilitate step-downs to the Crisis Stabilization Unit at the Crisis Center from various settings.

6. Overarching Goals 1. Reduce hospitalizations and recidivism rates 2. Increase cross-system collaboration and care coordination 3. Facilitate referral and linkage 4. Coordinate collaborative discharge planning 5. Provide education and resource information to individuals, families, and cross-system partners 6. Increase access

7. Core Responsibilities 1. Provide leadership to Stark County Bed Day Management Team 2. Oversee utilization management of HBH 3. Monitor Length of Stay 4. Coordinate and lead Hospital Collaborative meetings 5. Establish and maintain professional, cross-system relationships

8. Core Responsibilities 6. Cross-system navigation approach 7. Coordinate ongoing referrals and linkage for non- linked individuals 8. Provide ongoing engagement and monitoring until formal linkage transpires 9. Integrate stage-based Interventions and Motivational Interviewing into practice 10. Provide outreach and transportation

9. Core Responsibilities 11. Attend/Participate in daily treatment team meetings 12. Provide transportation to follow-up appointments 13. Conduct follow-up calls 14. Complete Diagnostic Assessments and Individualized Service Plans 15. Facilitate Crisis Stabilization Unit Step-Downs from an inpatient level of care 16. Facilitate emergency housing as needed

10. Case Examples with Collaborative Partners A. Domestic Violence Project & Community Services of Stark County B. NAMI of Stark County (Family Meeting) C. Quest Recovery Services (Residential) D. Community Outreach / Transportation (CSU)

11. By The Numbers Fiscal Year 2014 – 1 st Quarter One hundred and ten (110) individuals were admitted under “Civil Commitments”(Stark County) 41% were “Non-Linked” prior to admission The Hospital and Community Liaison engaged 100% of “Non-Linked” upon admission The Hospital and Community Liaison facilitated referral and linkage for 80% of these individuals

12. To Learn More Contact: Nicole Caudill, MSW, LSW (330) 452-9812 (Extension 155) nicolec@circstark.org