150 Cross Street Akron, OH Annual Report Performance Improvement & Compliance Program

Transcription

1 150 Cross Street Akron, OH 443 Annual Report 20 Performance Improvement & Compliance Program

2 Programs & Services Community Support Services, Inc. serves as the premiere non-profit mental healthcare provider for Summit County, Ohio and for surrounding communities. The agency offers a wide variety of programming to provide effective treatment and opportunities for recovery to residents with severe and persistent mental illnesses. Following are brief descriptions of the many services the agency delivers. ACT Services CPST Counseling Assertive Community Treatment involves weekly, or even daily, treatment interventions to assist clients in achieving/maintaining independent living. ACT Services are provided by the Assertive Community Treatment (ACT) Team and by the Intensive Treatment Team (ITT) to clients with co-occurring mental health and physical health issues; and by the SAMI PACT Team to clients with co-occurring substance use and mental health issues. Community Psychiatric Supportive Treatment is an essential service provided to almost all of the agency s clients. Community Rehabilitation Specialists work with clients to develop Individualized Service Plans, including interventions such as daily living skills training, resource acquisition, medication management, advocacy and supportive contacts, etc. - coordinating care and services to achieve the most effective outcomes. Counseling includes both individual and group sessions led by licensed clinicians to provide more in-depth and focused attention on unique issues. Counseling often is provided over a shorter term to address temporal concerns and crises. Crisis Intervention Crisis Intervention (CIT) staff responds to requests for immediate intervention for individuals who may be experiencing acute mental health symptoms. Sheriff s Deputies and Police Officers from most local municipalities have been trained in Crisis Intervention. The CIT staff works with deputies and police personnel to provide interventions that promote mental health treatment as a diversion from the criminal justice system. Engagement Services Engagement Services provides Outreach CPST using various resources to locate and engage clients who have not consistently participated in treatment. Once re-engaged, clients learn to minimize treatment barriers in order to transition to traditional CPST and psychiatry services. Forensic/MH Ct ITS HO Team Intake Forensic & Mental Health Court teams serve clients involved with the criminal justice system. Forensic services are for individuals deemed Incompetent to Stand Trial or Not Guilty by Reason of Insanity. The team remains involved throughout clients inpatient competency restoration or during Conditional Release. Mental Health Court is a specialized program that assists individuals facing qualifying misdemeanor charges in Akron Municipal Court. Intensive Treatment Services offers an array of recovery-based therapies including group sessions that provide psycho-education and promote the development of social skills, functional abilities, coping mechanisms, and other tools that enhance independence. Homeless Outreach is a CPST team that identifies and engages homeless persons who may benefit from mental health treatment. The HO Team works with clients until they are ready to transition to traditional teams or until they are referred to or engaged in other treatment. Intake workers conduct Clinical Evaluation/Assessment interviews with persons referred for public mental health treatment. Intake workers determine a person s eligibility to receive services at either Community Support Services, Inc. or at Portage Path Behavioral Health and help new clients set their initial appointments at the appropriate agency. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 1

3 Liaison Med/Som Med Clinic PC RES VOC/EMPL Liaison workers provide CPST services to clients of Portage Path Behavioral Health or during clients transition between Community Support Services and Portage Path Behavioral Health. Medical/Somatic comprises community nursing, clinic nursing, psychology, outpatient psychiatry and inpatient psychiatry. Med/Som, together with CPST, provides the core services of the agency to optimize care. The Medication Clinic serves clients prescribed injectable psychiatric medications and clients in need of urgent evaluation or walk-in services. Clinic staff specially trained to address pharmacological issues may guide clients through Ohio s Central Pharmacy and other patient assistance programs to ensure continued availability of medications. The Margaret Clark Morgan Integrated Care Clinic offers physical healthcare and preventive screenings. The Primary Care Clinic (PC) is joined by a laboratory and Klein's Pharmacy on-site. Primary Care staff includes a physician, a nurse practitioner, a registered nurse, a podiatrist and a medical assistant. University of Akron advanced nursing students train in the PC while Northeastern Ohio Medical University (NEOMED) pharmacy students train in Klein s Pharmacy. The BeST (Best Practices in Schizophrenia Treatment) Center conducts research and tracks outcomes related to integrated physical and behavioral healthcare. Residential Services includes three Group Homes and two Safe Havens operated by Community Support Services, Inc. The department assists clients with placement into Proprietary Group Homes and offers Housing Assistance (HAP) and Loan Assistance (LAP) Programs. Vocational/Employment Services provides work readiness assessment, job coaching, skills building, placement, etc. Additionally, services purchased by the Bureau of Vocational Rehabilitation (BVR) are provided through a program called Work Tech. The VOC/EMPL department is working with the State of Ohio s Coordinating Center of Excellence (CCOE) for Supported Employment as well. The pie chart below shows a breakdown of the 193,614 service hours provided in 20. Service Provision by Program Psychiatry 4.3% VOC/EMPL 18.0% Counseling 1.5% Group Homes 9.3% Primary Care 0.4% Peer Support 2.2% Other RES 5.2% Nursing 3.3% Ind CPST 37.0% ITS 4.4% Group CPST 14.4% Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 2

4 PERFORMANCE IMPROVEMENT & COMPLIANCE COMMITTEE: The Performance Improvement and Compliance (PIC) Committee monitored adherence to the 20 Performance Improvement (PI) Plan, including indicators designed to address Ohio Department of Mental Health (ODMH) requirements, and standards established by both the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Accreditation Association for Ambulatory Health Care (AAAHC). Additionally, the 20 PI Plan included indicators related to agency policies and procedures and to specific goals of programs or services. The PIC Charter outlines the responsibility of the PIC Committee to provide oversight to agency committees and tasks groups. The PIC Committee reports to the Program Planning & Evaluation Committee of the Board of Directors for Community Support Services, Inc. As continuous improvement is a foundation of the agency, the PIC Committee regularly assesses its processes and seeks opportunities to enhance the performance improvement and compliance functions of the committee. The recently established Contracts & Risk Management Committee and the Credentialing Committee began to identify their respective objectives. Additionally, the Recovery Advisory Council began to meet on a regular basis in an effort to provide clients and family members an opportunity to be involved in the Performance Improvement process. The Performance Improvement Program would like to extend a heartfelt thank you to members who served on standing committees during 20: Agnes Andrasak Vicki Arnold Deborah Roberson Jim Bournival Kay Bowman Sue Bussey Janine Casey Janet Catalano Terry Dalton Crystal Dunivant Carol Eddy Renee Elder Suzanne Frohme Jon Garey Jessica Gilger Marianne Goldyn Marva Grant Ann Grueneberg Kim Hartman, RN Patricia Henderson Rob Hermanowski Dorothea Hilson Tammie Jackson Cindy Johnson, RN Joyce Johnston Jan Jones Perry Jordan Jim Karpawich, PhD Ricka Laramore Ragan Leff Steve Maddox Kimberly Maluke Kim Meals Jayne Miner, RN Penny Moore Tim Mullender Linda F.R. Omobien Duane Perry Denise Ronk Michael Sales Beverly Saunders Eileen Schwartz, MD Shaunta Scruggs Frank Sepetauc Kim Shontz Danielle, Sims, PhD Steve Singleton Louise Smith Lee Snyder Keith Stahl Jan Swartzel Fran Thomas Pam Tracy Roxanne Troyer Doug Wagner Lora Walker Carol White Bruce Winer Some of these individuals served on more than one committee, and some people who served on Task Groups may not be listed. To all of these, we express deep appreciation for your commitment to the high standards of quality Community Support Services achieves through your participation and efforts. Thank you. This report endeavors to present to stakeholders what Community Support Services, Inc. is and how it serves Summit and surrounding counties in Ohio through excellence in service provision as a result of continuous performance monitoring and quality improvement. The following information is categorized alphabetically according to PIC subcommittee. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 3

5 CLIENT CARE MONITORING COMMITTEE: The Client Care Monitoring (CCM) Committee heard eleven challenging cases during 20, and thirty-nine deaths were reported. One Death Investigation was requested and recently completed. CCM recommended a procedure change when clients present at Portage Path Psychiatric Emergency Services (PES) and are not admitted to the Crisis Stabilization Unit (CSU). The procedure advises the staff to call the Administrator On-Call (AOC) and discuss the situation. The AOC may then contact PES directly to advocate that the client be admitted or, at least, observed for a period of time. CCM recommended that the new security contract address how security guards handle clients with weapons. Staff had expressed concern about their own and visitor safety because the practice had been to return weapons to clients upon their (evident) departure from agency grounds. Security guards are now retaining all confiscated weapons and turning them over to the Facilities Director. Presentations by staff greatly improved in 20 due to Supervisors providing additional assistance to their staff, but CCM was under-utilized this year. The Performance Improvement Program will develop ways to ensure that challenging cases are presented at CCM so this valuable clinical resource is used appropriately. Supervisors will be reminded about the benefits and use of CCM at a January Supervisors meeting, and they will be encouraged to consider CCM when discussing difficult cases with their staff. Primary Mental Health Diagnoses for Agency Caseload Schizophrenia & Psychosis 61.9% Mood-Related Disorders 30.7% Delirium, Dementia & Other Cognitive Disorders 1.2% Personality-Related Disorders 0.5% Anxiety-Related Disorders 1.9% Substance-Related Disorders 3.8% This pie chart shows the distribution of the agency caseload by CPST team for a single point in time (October 20). SNW 13.2% ACT Tm 3.4% SAMI PACT 3.3% ITT 2.5% LIT/CIT 6.7% SNS 13.6% CPST Caseload Distribution NFN.6% SFW.7% Forensic 3.4% Homeless 0.3% PHR 2.2% NNC 13.7% NFW 15.2% Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 4

6 The upper portion (orange tones) of this graph shows service contacts provided at community locations. Location of Service at Client's Home Other Comm Location PD/Court/Jail General Hospital at Agency The lower portion (green) shows service provision at the agency such as Physician Services, Groups, Counseling and Vocational. CLIENT RIGHTS: Client Rights issues are monitored by the ROC Committee, and this section provides details of Client Rights activity during 20. One hundred forty-seven (147) complaints were filed in 20. The Client Rights Advocate provided training, including abuse/neglect material, to new hires and interns. A video presentation that explains Client Rights procedures is available to individuals with cognitive issues, and visually impaired persons may make use of an audio version. Table 1: Grievances/Complaints by Subject DEPARTMENT Another Client CPST Payeeship/Finance Med/Som Front Desk/Support Residential Vocational Whole Agency Other Outside TOTAL Table 2: Grievance/Complaint by Source 20 Grievance/Complaint Originated from: Client/Family 127 Staff 9 Ohio Legal Rights 1 Other Agency 0 ADM Board 7 Other 3 Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 5

7 Table 3: Grievance/Complaint Resolutions RESOLUTIONS Explanation Given Referral Made Treatment Revised Staff Correction/Discipline Policy Recommendation Withdrawn/No Response Below is a graphic representation of the data in Table Complaints/Grievances by Subject Annual Comparison Client CPST Payeeship Finance Med/Som Support Res Voc/Empl Agency Other Outside CONTRACTS & RISK MANAGEMENT The Contracts & Risk Management (C&RM) Committee met one time during 20. A tool to monitor contracts was developed and is currently being used as a living document. Additionally, it was decided outside of the committee, to scan contracts to assure that all contracts are documented. This seems to be working well and will be continued moving forward. Contracts are still being reviewed and approved as needed albeit the committee is not meeting regularly. Development of C&RM protocols have not occurred as expected but will be a priority in 2012 so as to address risks within the organization as they relate to operations. CREDENTIALING The Credentialing Committee redefined its processes for awarding privileges to independently licensed staff, adopting a widely used standardized application through the Council for Affordable Quality Healthcare (CAQH). The committee implemented a process to ensure that disclosure statements were retained on file for appropriately licensed staff. The PIC Committee appointed Credentialing with direct oversight of the agency s Peer Review processes, and as such, the committee approved a refined process for the completion of CPST Peer Review. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 6

8 HEALTH & SAFETY COMMITTEE: Drill/Inspection Results There were 63 work order requests generated by 82 vehicle and 60 building safety inspections. All deficiencies were corrected. There were 120 fire drills or alarms at agency facilities with no major deficiencies or recommendations. There were 50 emergency drills conducted at agency facilities with no problems or recommendations. Examples of these drills include Severe Weather, Sudden Illness, and Power Failure. Infection Control 2 staff completed the Essential Learning course for Infection Control, including information about blood-borne pathogens and universal precautions. Incident Reporting The Safety Director reviewed 192 Major Unusual Incident reports filed during reports were discussed at Health & Safety Committee meetings. 60 Annual Comparison of Reported Incidents Suicide/Suspected Suicide Severe Suicide Attempt Suicide Threat Patient Death Alleged Criminal Act(s) Property Damage/Loss Injury Physical Aggression Verbal Aggression Alleged Abuse/Neglect Illness Medication Error Automobile Accidents Other AWOL Alarm 20 Total 20 Total 20 Total 20 Total 20 Total Fall Infection Control Non-Participation in Drill Seizure 0 This graph depicts a comparison of types of incidents reported each year, The Safety Director monitors the category Other, which is detailed at quarterly Program Planning & Evaluation meetings. The graph shows that new categories were added in 20 based on this monitoring. INCLUSION COMMITTEE: In 20, the Inclusion Committee launched an effort to ensure all agency staff had a greater understanding of the Inclusion Core Values. More than 50 hours of training were completed with nearly all employees attending two sessions focused on increasing staff s understanding of the value of inclusion and the practical implications of the newly defined core values. Additionally, the Inclusion Committee championed ongoing support for training of the organization s management team with an emphasis on the core values. Lastly, a discussion was initiated regarding the development and implementation of a 360 evaluation focused on the inclusion core values. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 7

9 20 Population Demographics Approximate Agency Caseload = 2,390 Community Support Services, Inc. provided service to more than 5,000 unique individuals during 20. The following graphs and charts depict data for the agency s Active caseload as of November 20. Living Arrangements Correctional Fac 0.7% Nursing Home 6.5% Group Home 5.1% Homeless 2.3% Own Home/ Apt 59.4% w/friends-family 14.4% Other/No Data.7% The Monthly Household Income percentages are based on only those clients who reported income. The percentages for Income Source are based on those clients who reported income who also reported the source of that income. MONTHLY HOUSEHOLD INCOME Below $ $ $ $ , $1, $1, $2, % 70.4% 13.4% 3.5% 2.9% 5.6% 73.3% 15.7% 2.9% 2.4% INCOME SOURCE Wage/Salary SSI SSD Family/Relative Retirement Welfare/TANF 5.4% 40.5% 45.6% 3% 4.1% 1.4% 4% 39% 51.1% 1% 4.2%.6% According to the US Census Bureau 20 American Community Surveys, the racial composition of Summit County is 82.2% White, 14% African American,.2% Native American/Alaska Native, 1.9% Asian, 1.2% Hispanic and.5% Other. 61.9% Client Ethnicity 35.9% 0.6% 0.5% 0.8% 0.3% African Amer White Asian Hispanic Other Native Amer Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 8

10 Where do clients of Community Support Services, Inc. live? Cuyahoga Co. 1% Portage Co. 1.8% N orth of Akron. 12% N E of Akron 2% In Akron. 76.7% M edina Co..1% SE of Akron..9% SW of Akron 5.2% Stark Co..3% Widowed 3% Marital Status of Clients Never Married 61% Married 14% Divorced 22% Community Support Services, Inc. serves a caseload composed of 47.3% female clients and 52.7% male clients. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 9

11 Client Education Level Graduate + 1% Some College/ Trade School 16% Some HS or Less 34% Associate/Bachelor 7% HS Diploma/ GED 42% Clients by Age Range Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20

12 RECOGNITION & REWARDS COMMITTEE: The Recognition & Rewards Committee developed and hosted several new events in 20 including a celebration of Black History Month, a Breakfast Buffet, an Ice Cream Social and a Relaxation-based Health Fair. Ongoing programs and events include the Supervisory Discretionary Fund, the Executive Council BBQ, a Halloween Party, a Thanksgiving Luncheon, and a Holiday Dinner Party. Members of the committee recognized that, although events were well received throughout the year, the committee had begun to take on the identity of an events-planning group. Moving forward into 2012, the members plan to redirect their focus on program-related, broader recognition efforts. RECOVERY ADVISORY COUNCIL In 20, the agency developed the Recovery Advisory Council. Clients, family members, and other support persons were encouraged to join the Recovery Advisory Council in order to provide a line of communication between these stakeholders and the agency s administration. The primary emphasis has been on helping the Recovery Advisory Council participants understand their role in this group. The Recovery Advisory Council also has reviewed agency marketing materials and satisfaction surveys to offer their perspective on these materials. In late 20, a planning meeting was held with the Recovery Advisory Council to identify priorities for The Recovery Advisory Council looks to recruit additional participants in an effort to be more reflective of the persons served by Community Support Services. RESEARCH, OUTCOMES & COMPLIANCE COMMITTEE: The Research, Outcomes & Compliance Committee met four times during 20 to monitor compliance to agency standards and PI Plan Indicators. The committee reviewed reports on fifty-six (56) indicators during the year. Several indicators came under review to determine their appropriateness and tracking burden in comparison to their value. The committee recommended modification or replacement of indicators related to Safe Havens, CPST Hospital Contacts and Hospital Readmissions, Homeless Outreach, Mental Health Court, Primary Care and Vocational/Employment Services based on these reviews. Additionally, indicators for the Counseling and Crisis Intervention programs were developed and approved. Five (5) research proposals were reviewed. Four (4) were approved with the fifth still under consideration pending receipt of additional information. The University of Akron was approved for: Investigating Atherosclerotic Progression in Impoverished Mentally Impaired Patients Who Utilize Holistic Nurse Practitioners as Their Primary Care Providers. The purpose of this research is to determine if using holistic natural care can slow the accelerated rate of cardiovascular aging in economically challenged individuals utilizing mental health and primary care services. Rutgers University requested an addition to earlier research conducted on the Mental Health Court program, and the committee anticipates approving this with minor changes to the logistics of the study. NEOMED was approved for: The Community Mental Health Research Initiative: Consumer Questionnaire to Assess Physical & Mental Health Co-Morbidity. The purpose of this study is to better understand how people with mental illness experience symptoms and how other social and environmental factors impact health. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20

13 BeST Center was approved for: High Yield Cognitive Behavior Therapy for Individuals with Psychosis (HYCBt-p). The purpose of the study is to review the effectiveness of HYCBt-p by Community Rehabilitation Specialists. This is a continuation of a study started in the previous year. The Ohio Department of Mental Health was approved for: Ohio s Direct Workforce Initiative and Health Care Integration: Exploring Job Roles & Competencies. The purpose of the research is to explore emerging job requirements of direct service workers (DSW) associated with innovative Primary and Behavioral Health Care Integration (PBHCI) Programs for adults with severe and persistent mental illness. This graph shows the compliance ranges for the items reported in the quarterly Compliance Chart Reviews. # of Indicators within Compliance Ranges % Compliant 90-99% Compliant 80-89% Compliant Below 80% Compliance Utilization Reviews during the year included New Admissions, Primary Care, Crisis Intervention Services, Group Home Transitions, Nursing Services, High Utilizing Clients, Counseling Services, Payeeship, and a Review of Cases Closed within 12 Months. The table below shows the number of cases that came under scrutiny during 20. Some cases might have been reviewed under more than one process, so the total number (2,649) does not represent a unique case count. Process # of cases # of cases Process reviewed reviewed Nursing Services Review 48 New Admissions Review 50 Compliance Chart Review 343 Primary Care Clinic Review 46 Crisis Intervention Review 43 Counseling Services Review 42 Homeless Outreach Review 84 Psychiatry & CPST during Inpatient Stay 323 Closed Cases Review 37 High Utilizer Review 50 Client Care Monitoring Processes Payeeship Review 67 Group Home Transitions Review 28 Peer Reviews 1477 Transcription was reviewed for timely completion of Psychiatry documentation on 300 dictated tapes. Psychiatry and CPST during Inpatient Stay had not been reviewed during 20 due to technical issues. 3 cases were reviewed early in 20 for clients who experienced inpatient psychiatry stays during 20 to confirm appropriate levels of service during psychiatric crises. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 12

14 This graph shows quarterly percentage rates for the presence of current Treatment Plans in reviewed records. 0 Presence of Current Tx Plan Client Participation in Tx Planning This chart shows two variables for the level of client involvement in Treatment Planning. The thicker purple line shows % of reviewed charts that contain Treatment Plans with client signatures. The thinner green line shows % of charts with progress notes documenting client role in Treatment Planning, which is no longer measured. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 13

15 This graph depicts one of the measures used to determine if client Treatment Plans align with reality Service Provision according to Tx Plan The 3 rd Quarter 20 dip resulted in an agency decision to re-instate Treatment Planning by the assigned CRS. The following graphs show data related to various assessments that help guide the course of treatment. This bar graph depicts the rates for compliance to providing regular AIMS testing for clients prescribed anti-psychotic medications. Y 36.3% Regular AIMS Testing Y 28.6% Y 32.3% Y 26.0% Y 63.0% 0.0%.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 14

16 Ongoing assessments are conducted at treatment onset and at predetermined intervals during treatment, including Health Histories conducted by nursing staff. This graph shows the annual compliance for completion of Health Histories and their review by psychiatry staff with the clients. 0 Health Histories Y- Y- Y- Y- Y- Review Presence This graph shows hospital utilization for psychiatric inpatient care, an average daily census for each quarter. 25 Psychiatric Inpatient Census Averages Psychiatric Inpatient is defined as an active client who is admitted to a psychiatric unit at St. Thomas Hospital or Akron General Medical Center who is attended by an agency psychiatrist Fourth Third Second First Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 15

17 STAFF TRAINING & EDUCATION COMMITTEE: Staff Education: Staff attended twenty-four internal sessions offered by the agency, totaling hours of training. The total number of attendees for internal sessions was over 438. Clinical and non-clinical staff completed more than hours of external training. The clinical staff completed hours of required CEUs. All staff participated in special trainings on Inclusion during 21 sessions and totaling 1,040 hours. Select staff received training in High Yield Cognitive Behavioral Therapy for persons with Psychosis (HYCBt-p), totaling 2,160.5 hours. Staff completed 2,483 hours of web-based learning. New staff participated in the Employee Orientation program. This representation shows the number of hours staff dedicated to training, with an emphasis on web-based training since 20. Changes in Training Approaches Web-based Hours Internal Hours External Hours Intern Programs: In 20, Community Support Services served as a clinical internship site for thirteen (13) students from varied disciplines including Social Work, Community Counseling and Psychology. These students completed 3,1 intern hours. The dollar value of the work completed by student interns was $66, Equally important, these students become ambassadors of the agency and severe mental illnesses as they continue their professional development and begin their careers in behavioral health. Additionally, through partnerships with the Northeast Ohio Medical University (NEOMED) and the University of Akron, the agency offered several pharmacy and nursing students opportunities to learn about severe and persistent mental illnesses through clinical rotations within the agency. Volunteer Program: Agency staff and clients benefited greatly from the efforts of 5 dedicated volunteers who performed 991 hours of service. The work of the volunteers has a monetary value of $21, These individuals provide ancillary and support services to assist the agency in meeting its goals. In addition to these volunteers, Community Support Services is grateful for the ongoing dedication of our Board of Directors who collectively donated more than 349 hours to the agency in 20. Community Support Services deeply appreciates the work of our dedicated students and volunteers who assist the agency in accomplishing its mission. Thank you! Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 16

18 Public Relations: Community Support Services continued to host Lunch with Leaders sessions in 20 with thirty-three (33) attendees. These events introduce community leaders to Community Support Services while breaking down the stigma associated with mental illness. The Board of Directors of Community Support Services assumed an active role in this process by inviting colleagues to the events. In 20, Community Support Services increased its presence in the community with twelve (12) community presentations reaching 392 people. Additionally, staff and Board members represented the agency at fifteen (15) community events including the Annual NAMIWalk, the WAKR Senior Luncheon series, and Summit for Kids. This graph shows the number of reported Community Presentations over the course of 5 years. 30 Community Presentations # of Presentations Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 17

19 Abbreviations & Definitions AAAHC APRN BCG CARF CCOE CPST CRA CRS CTL HAP HO Inpt Psych Association for the Accreditation of Ambulatory Healthcare Advance Practice Registered Nurse bacille Calmette-Guerin - a type of vaccine for (TB) tuberculosis Commission on Accreditation of Rehabilitation Facilities Coordinating Centers of Excellence Community Psychiatric Supportive Treatment Client Rights Advocate Community Rehabilitation Specialist Clinical Team Leader Housing Assistance Program Homeless Outreach Inpatient Psychiatry ITS ITT LAP LPN MH Ct NH ODMH Outpt Psych PIC RN SAMI PACT/ACT SSD SSI Intensive Treatment Services Intensive Treatment Team Loan Assistance Program Licensed Practical Nurse Mental Health Court Nursing Home Ohio Department of Mental Health Outpatient Psychiatry Performance Improvement & Compliance Registered Nurse Substance Abuse/Mental Illness (Program of) Assertive Community Treatment Social Security Disability Supplemental Security Income ADM Board The Alcohol, Drug Addiction & Mental Health Services Board is the local government entity overseeing the provision of alcohol, drug addiction and mental health services in Summit County. CEU Complaint Education Grievance Recovery Training Continuing Education Units are educational credits necessary to maintain licensing. A complaint is an allegation less serious in nature than a grievance and usually consists of dissatisfaction a client has about a particular service or provider. Optional learning opportunities intended to enhance knowledge and understanding of a variety of subjects that relate to the betterment of Community Support Services, its staff, or the population/ community the agency serves. A grievance is an allegation that one or more of a client's rights have been directly violated, including reports of abuse, neglect and exploitation. A continuous process of empowering clients so they may live satisfying and contributing lives. It is a shared responsibility among clients, family and friends, the treatment team and the community to: 1) Discover or rediscover strengths and abilities, 2) Pursue personal goals, and 3) Develop a sense of self-identity that allows growth beyond diagnosis. Required education, specific to job description, job-related competence, or Community Support Services as an agency. Community Support Services, Inc. Performance Improvement & Compliance Program Annual Report 20 18