Howard County will be served by Four County’s Certified Community Behavioral Health Center designation

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Mental health continues to be a top priority for the public and private sectors in Indiana, and Howard County recently gained a major ally in the fight for sanity. 4C (Four County) Health was awarded the designation of Certified Community Behavioral Health Center (CCBHC) for the community by the State of Indiana.

4C’s CEO Carrie Cadwell disclosed the development to the Howard County Board of Commissioners as part of the organization’s annual report on July 1. The designation, which coincides with 4C’s 50th anniversary, means mental health services will receive a significant boost locally.

“What's really cool is the state is transforming the mental health system into what's called Certified Community Behavioral Health Centers, which is an expanded continuum of services for crisis and other things,” said Cadwell. “4C has been awarded that for Howard County, which in our world means that we were here to stay anyway, but now we are really here to stay and even expand.”

Cadwell explained that the CCBHC designation means 4C will expand its continuum of care in Howard County, doubling its workforce in the process. It currently employees 59 professionals in the community. Those new workers, and the organization, will be tracked by state regulators on 21 different quality of care metrics, and the results of that tracking will be published for public consumption.

“It really gives a good, robust indicator of the quality of care,” said Cadwell.

Last year, 4C provided services to 2,310 people with its Howard County resources. Of those, 1,492 were Howard County residents. This accounted for more than 48,000 uses of services. 4C actually took 744 inpatient admissions for care, 60 percent of which were new, first-time admissions.

The remaining 40 percent were readmissions, which Cadwell proposed isn’t unusual as relapses and reoccurrences of mental afflictions are not uncommon.

“If you've had one episode of depression, it's likely you'll have a second at some time in your life, a third and so forth,” said Cadwell.

4C has operated in Howard County since 2015, with 82 percent of its consumer base relying upon Medicaid, Medicare, and the Healthy Indiana Program (HIP) for covering costs. The remainder are privately insured or self-pay.

As part of 4C’s expansion of services, it will be much more prevalent in local schools. The organization already provides mental health services to Kokomo School Corp. and Northwestern Schools. Cadwell disclosed that they have entered agreements with Eastern and Taylor schools for the 2024-25 school year as well.

Cadwell then pointed out that the Board of Commissioners had asked about increasing adult services when she gave 4C’s annual report in 2023. Those increases are happening, she said.

“You guys asked when are we going to provide services for adults with serious mental illness,” said Cadwell. “We started an assertive community treatment team here in Howard County about a year and a half ago. That's a specialized 24/7, 365 treatment for adults that are diagnosed with schizophrenia, bipolar disorder, more serious and persistent mental illness.

“We also intend, under our CCBHC designation, to open a clubhouse for those adults with serious mental illness here in the community. We’re excited about that.”

Cadwell added that 4C continues to provide services at Sargent Place, which provides apartments to the local homeless population in cooperation with Advantix Housing. It also provides services to Howard County’s Robert J. Kinsey Youth Center.

Beyond this, 4C recently opened its Howard County service locations to walk-in traffic.

“Now, Monday through Thursday, you can walk into a 4C Health building between 9:30 a.m. and 1:30 p.m. and get started in treatment,” said Cadwell. “We intend to extend that to all days of operation, including the full day, so that people don't have to call and wait two weeks to get into a place.”

Cadwell then turned to 4C future plans, explaining that it intends to establish a “clubhouse” in Howard County for adults diagnosed with serious mental illness where they can receive services, again, without an appointment.

Services at this level are heavily dependent upon personnel, and 4C is working to create its own workforce and support by offering training.

“We have been providing mental health first aid, which is a type of training for folks to learn about mental health and receive certification,” said Cadwell. “It’s a free training we offer. We've gotten to do a lot of different training here in Howard County, along with QPR, which is a suicide prevention training.

“We have a grant that will cover that for the next couple of years, so we're going to continue to offer that anywhere to anyone who wants to be trained and certified in either one of those things. It's really geared towards lay community members, so that they know how to respond to their loved ones and their friends.”

Howard County Commissioner Jack Dodd expressed appreciation for 4C’s efforts, but still had a concern when it came to services provided.

“Do you provide services for homeless?” Dodd asked/

“I love that question,” Cadwell said in response. “About a year ago, we applied for a grant through SAMHSA (Substance Abuse and Mental Health Services) because we want to develop street outreach teams.

“That grant got turned down a year ago, but literally two months ago, I got contacted by SAMHSA. They said, ‘Your score is high enough. We somehow found money. We think we want to fund this. So, I think we're about 90 percent sure we're going to receive that funding. I should find out in the next 60 days.”

Cadwell explained that the street outreach teams would target the homeless population, specifically those suffering from substance abuse addiction or severe mental illness. The teams would be equipped with backpacks filled with basic necessities to share, and the goal will be to guide the people they find to additional services as well as to help find housing for them.

“Even if that is a struggle up front, and (the homeless) don't want to do that, our teams will just keep working with them to try to get them there,” said Cadwell.

Commissioner Jeff Lipinski thanked Cadwell and 4C for their efforts in Howard County.

“You guys were always very good, but I think you've expanded a lot of programs and are doing a great job, expanding even further,” said Lipinski. “I appreciate it.”