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The Cuyahoga County agency that funds mental health and addiction services is launching a new process to better evaluate which programs to invest in and which ones to leave behind as it attempts to balance its own budget.
Jason Joyce, the chief executive officer of the Alcohol, Drug Addiction and Mental Health Services board (ADAMHS), said his agency and nonprofits need to figure out a way to stretch shrinking public dollars to ensure the viability of the critical safety net services.
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“We’re looking at a system reset, not just a sort of typical funding cycle, right?” Joyce said in an interview with Signal Cleveland. “We’re going to go through and make sure that, ‘Hey, what are the programs that we’re supporting right now? Do they align with our goals? Can we afford them?’”
The county board has an annual budget of around $72 million and funds dozens of programs that are administered by nonprofits. The services they provide include everything from responding to people having a mental health crisis to providing housing support to preventing substance use among children.
But this year, the ADAMHS board was forced to make across-the-board cuts to those programs, regardless of size, effectiveness or outcomes.
With less money expected next year, Joyce wants to instead award money to nonprofits based on criteria such as performance and community needs. This summer, every organization the board funds will have to apply for funding through a competitive process. The application is open to all nonprofits, including those that don’t currently get money from the board.
The new system-wide process “naturally” creates uncertainty for providers applying for money, wrote Elaine Gimmel, the executive director of EDEN Housing, in an email. She’s worried more organizations will be competing for increasingly limited resources.
“That makes this an even more challenging landscape and raises the very real possibility that existing programs could be reduced or, in some cases, not funded at all,” Gimmel wrote.
Total funding for providers is expected to drop from around $37.5 million this year to between $30 to $34 million next year, Joyce said. The board is seeking to balance its budget after years of spending more money than it received from funders. Financial pressure also increased as a result of the board’s plans for a new crisis center combined with recent cuts to Cuyahoga County’s health and human services levy.
Other providers said the new plan a step in the right direction, by moving the board toward strategic decisions about what to fund. The board recently published a draft of its request for proposals, which is the document describing what sort of programs the board wants to fund. It lays out 12 different categories under which agencies can propose programs, such as crisis services or outpatient services. It also specifies 10 criteria on which each proposed program will be judged, including the organization’s experience, cultural responsiveness, and how the service aligns with the county’s behavioral health needs.
Christine Robinson, chief executive officer at the nonprofit Stella Maris, which receives ADAMHS funding, described the request for proposal as “sensible.” Robinson previously worked at an ADAMHS board in Lorain County and said that frequent requests for proposals are the norm.
The board is requesting feedback on the request for proposal from providers, community members, clients, family members and others. A survey to weigh in on the proposal is open until April 24.
Joyce said plans to revamp the network of behavioral health providers started before he arrived as the new CEO last November. The board had already hired a consultant to study how well the agency worked and its financial sustainability. The consultant presented the assessment in March.
It found the board operated a large behavioral health system – contracting with more providers than five other peer counties in Ohio – but financial pressures and workforce shortages required a “disciplined shift” toward prioritized funding and long-term financial planning.
The new funding process is a step toward this, Joyce said.
Community members also told the consultant that navigating mental health and addiction care is one of the most significant challenges within the current network of providers the ADAMHS board funds. That includes difficulties in transitioning between levels of care – for example, a person might start at a detox unit then move to outpatient care.
Under the new request for proposal, programs will be judged by their ability to coordinate with other providers, such as by having partnerships with hospitals or other behavioral health organizations. So Joyce hopes the new system will address some of those concerns.
More coordination doesn’t automatically mean getting rid of the majority of mental health and addiction service providers, Joyce said. He said he wants to ensure that Cuyahoga County will still have a robust network of multiple behavioral health agencies.
“It’s not about shrinking it down so much that there’s just only a handful of players, and you can coordinate that way,” Joyce said. “Because I think there’s something lost within the system if you do it that way.”
The ADAMHS board will hold a public Zoom session March 16 at 12:30 p.m. to discuss the request for proposal. Information is available here.
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