The Thresholds South CCBHC population of focus includes children with SED and their families, adults with SMI, and individuals with SUC or COD in Chicago's South Side neighborhoods. The CCBHC will provide a comprehensive array of evidence-based services to fill service gaps and treat behavioral health needs, monitor the physical health concerns of people receiving services, and coordinate care to address social determinants of health and increase engagement in services. Our geographic service area comprises neighborhoods that are densely populated and diverse; of the 798,361 individuals living in the service area, 34% of youth and 21% of adults live below the federal poverty line, 3% are veterans, and 12% have limited English proficiency (US Census Bureau, 2021). Over 88% of Thresholds South's current clients with SMI identify as Black/African American, an estimated 45% have obesity, and over 25% have type 2 diabetes. The CCBHC service area is in the 95th percentile for behavioral health related hospital admissions and emergency department visits in the state, and has high rates of opioid overdose, hypertension, heart disease, and stroke, all of which can be attributed to structural racism, public safety concerns, food insecurity, lack of preventative care, and cultural stigma associated with seeking behavioral health treatment.
With CCBHC grant funding, Thresholds South CCBHC will build upon our current programs for adults with SMI by initiating services for children and families, expanding outpatient therapy services, providing SUD treatment, and addressing the physical health risks that contribute to repeat hospitalizations, medical comorbidities, and early mortality among our population of focus. The goals and objectives of the Thresholds South CCBHC will focus on 1) achieving compliance with CCBHC certification criteria and implementing all required activities, 2) increasing access to evidence-based behavioral health services for the population of focus, 3) improving health indicators for individuals at risk for or experiencing physical health comorbidities, and 4) increasing client engagement across CCBHC services.
Thresholds South CCBHC will serve an unduplicated total of 825 individuals across the four-year grant period: 300 in Year 1, 150 in Year 2, 175 in Year 3, and 200 in Year 4. Using evidence-based practices such as Assertive Community Treatment, Trauma-Focused Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Illness Management and Recovery, Individual Placement and Support, and Integrated Dual Diagnosis Treatment, Thresholds South CCBHC will meet the behavioral health needs of individuals and families, improve their health outcomes, and reduce disparities in access to care.