2005-573-Minutes for Meeting February 09,2005 Recorded 3/28/2005DESCHUTES COUNTY OFFICIAL RECORDS
NANCY BLANKENSHIP, COUNTY CLERK CJ 2005473
COMMISSZONERS' JOU NAL 03/28/2005 03:44:58 PM
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DESCHUTES COUNTY CLERK
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A Deschutes County Board of Commissioners
1130 NW Harriman St., Bend, OR 97701-1947
(541) 388-6570 - Fax (541) 388-4752 - www.deschutes.org
MINUTES OF DEPARTMENT UPDATE —
MENTAL HEALTH DEPARTMENT
DESCHUTES COUNTY BOARD OF COMMISSIONERS
WEDNESDAY.) FEBRUARY 9, 2005
Deschutes County Health Department, 2577 NE Courtney Drive, Bend
Present were Commissioners Michael M Daly, Tom De Wo�fand Dennis R. Luke.
Also present were Mike Maier, County Administrator; and Scott Johnson, Mental
Health Department. No representatives of the media or other citizens were
present.
The meeting began at 4:15 p.m.
Please see the agenda and backup documentation (copy attached) for information
on the items discussed.
In regard to the ABHA (Accountable Behavioral Health Alliance) proposal,
Commissioners Luke and DeWolf indicated they are supportive at this point, until
shown otherwise. They indicated no commitment is to be made to Jefferson
County at this time.
No formal action was taken by the Board at this meeting.
Being no further items addressed, the meeting adjourned at 4:45 p.m.
Minutes of Department Update — Mental Health Wednesday, February 9, 2005
Page I of 2 Pages
DATED this 9th Day of February 2005 for the Deschutes County Board of
Commissioners.
Tom DeWolf, Chair
ATTEST:
Recording Secretary
issioner
is R. Luke, Commissioner
Minutes of Department Update — Mental Health Wednesday, February 9, 2005
Page 2 of 2 Pages
1�
Deschutes County Mental Health
BOCC Monthly Meeting - Proposed Agenda
February 9, 2005
1. Department Challen-ges
a. Thrift Store theft
b. Staff illness and loss
2. Criminal Justice
a. We need to strengthen our work in this area
b. LPSCC recommendations requested.
c. Early intervention? expand deferred sentencing?, drug court?, focused treatment
capacity?, crisis intervention training for LEAs?
3. Children's System of Care
a. EBP agenda: OHP children, high need, significant emotional disturbances
b. Policy: Central Oregon system, some ABHA oversight
c. Creation of services with Jefferson and Crook
d. Financing: awaiting actuarials. Risk, maybe no new resources
4. Managing Acute Care / Inpatient Costs - Costs likely up (growth; Sage View)
a. Reminder: we are creating an Acute Care Reserve
(Sage View $290,000,$400,000 loan repayment)
b. Equity issue - Acute Care Indigent $ - request to state (copy of letter at meeting)
potential legislative matter if not addressed
c. Hospital / residential acute designations to be resolved.
d. Sage View contract negotiations - completed after item b. resolved.
e. ABHA Inpatient - policy discussion - moving to separate risk pools (our interest)
5. Strategic Plan Phase 11 topics (copy at meeting)
6. MHO
a. ABHA response to white paper coming soon
b. Bernstein meeting will be scheduled: 1) capitation, 2) 05-06 budget, 3) response
c. Commencing with Business Plan (reminder: completion summer 2005)
7. Pendinq
a. Samhsa grant - $1.5 m. 3 -county grant submitted to feds (meth treatment)
b. Federal Indirect Rate - critical policy matter. Samhsa example.
c. Completion of my first evaluation
b. Custody evaluations - request for fee adjustment will be coming.
c. Children's services $51,000 grant received - proposal pending.
d. Givens audit.
e. June 2005 Mental Health and Alcohol & Drug State Audits
f. $30,000 state repayment - relocation of manufactured structure; pd by County.
2005 / BOCC monthly January
January 27, 2005
Robert E. Nikkel
Office of Mental Health & Addiction Services
Oregon Department of Human Services
500 Summer St. NE E-86
Salem OR 97301-1118
Re: Request for Acute Psychiatric Inpatient resources for Central Oregon
DearBob,
Thank you again for participating in our community meeting this past Friday and for your support
of our community's new Sage View facility. As discussed, we are now writing to ask for further
State investment in our regional mental health system. Such an investment will directly benefit
the State of Oregon as you prepare for possible changes at Eastern Oregon Psychiatric Center
(EOPC) and Oregon State Hospital.
As a starting point to planning and contract development, we are proposing a dollar amount
ranging from $451,440 1 to $627,000 2 of the State biennial funding designated for acute
psychiatric inpatient services. The funds will directly benefit indigent clients from Central
Oregon. Admittedly, it has been challenging to gather sufficient utilization and cost data in this
time frame to determine an exact amount. At the same time, we are confident that a joint
effort in this regard will help us arrive at a figure that corresponds to the work and your
experience with other systems in Oregon.
Our goal will be to establish a plan and set of deliverables through which we significantly reduce
our region's use of EOPC's acute care beds. This will assist OMHAS, should you choose to
proceed with plans to downsize EOPC during the 2005-2007 biennium.
Our counties would combine these new resources with existing regional SE 24 funds and dollars
from the Deschutes County General Fund (that supported Park Place in the past) to:
1. Fund critical system gaps including medications and transportation. A dedicated fund
would be used to purchase needed medications and to offset the cost of transportation
in a geographic area devoid of a consistent, timely and affordable public system.
Based on 11 Central Oregon admissions 6/04-11/04 at EOPC, 18 days avg. length of stay and a
bed day rate of $475 extrapolated to 24 months of utilization at same rate.
2 The primary change from the $451,440 estimate is an estimated length of stay of 25 days. Local
crisis and community support staff question whether 18 is an accurate figure for C.O. clients.
2. Increase intensive treatment and case management services focused on clients slated
for EOPC referral as well as clients scheduled for discharge. Based on available funds,
our goals will be to divert clients from EOPC placement whenever possible and to reduce
length of stay for other EOPC clients by offering step-down, community based options.
3. Invest in residential options including crisis respite beds and supported transitional
housing. Current housing options are insufficient and unaffordable for our clients. As
resources allow, these supported housing alternatives will be intended to reduce crises as
well length of stays at Sage View and EOPC.
4. Assure stable long-term funding for Sage View, Central Oregon's secure 15 -bed, acute
care residential treatment facility. Cascade Healthcare Community has agreed to
operate on a full capitation basis, assuring service to indigent residents 3 through June
2007. Short-term, we have earmarked former Park Place resources to cover this cost.
Without utilization experience, it is difficult to determine the costs to Sage View for this
work or the full benefit of this resource for our indigent clients.
5. Explore other anticipated service gaps. For example, consideration of the proposed
closure of three geropsychiat(ic wards at OSH and the need for community-based
options.
We recognize that this request is significant. At the same time, an investment in Central Oregon
is both overdue and essential to state efforts to create local alternatives to an overburdened
and costly state system. Additional considerations:
Growth. Central Oregon is the fastest growing region of the State. Growth in Deschutes
County alone is projected to rise by 16.9% from 2003-2008. During the same time period,
Crook could increase 8.9%, Jefferson 8.4%, both well in excess of a projected state
growthof6.2%4. Over an extended time of 25 years, Deschutes County's population is
projected to increase from 116,600 (2000) to 240,811 (2025), an increase of 106%. 5
Inequity. Historically, our region has not received Regional Acute Psychiatric Inpatient
Resources (MHS 24) that have been afforded to other areas of Oregon. It is critical that
this inequity be addressed if our counties are to assist the State of Oregon in reducing
admissions to the state hospital system.
The current funding plan is not sustainable without further investment. While Park Place
resources will address short-term needs, we lack a longer term, regional financial plan to
adequately finance use of Sage View services. A lack of State investment will make it
more difficult for Sage View to serve indigent clients long-term and could destabilize this
program in 2-4 years OR limit access to the indigent population in five years 6. Lack of
3 Assured service for all eligible clients as capacity allows.
4 Commercial atlast.randmcnally.com
5 Adopted Deschutes County 25 -year population forecast, Deschutes County Community
Development.
6 Legal responsibility to serve indigent clients will expire with the conclusion of responsibilities
associated with receipt of Community Development Block Grant funds.
revenue could also (in time) change the payer mix at Sage View, reduce access for
indigent clients and increase the bed day cost for OHP admissions.
Past lack of services. Historically, we have lacked services and facilities to warrant an
increased investment. With the February 2005 opening of Sage View, this circumstance
has fundamentally changed. It is critical that we prepare a broader treatment and
acute care system that include a facility that could reach capacity within 18-24 months.
We are hopeful you will be able to respond favorably to our proposal. It appears we have a
shared understanding of the need. We would propose that a commitment of resources also
include a shared planning process to negotiate contractual terms, a service investment plan
and contract deliverables. Any final decision regarding this matter will, of course, require
consultation and consent from our respective County Boards.
In summary, we are confident that further investment in Central Oregon is warranted and that
our service plans will directly support urgent challenges and needs facing our State. We would
welcome your support and the active participation of OMHAS in our planning and
implementation.
Thank you for your consideration of this request.
Scott Johnson, Director
Deschutes County Mental Health
Rick Treleavan, Director
Best Care Treatment Services
Jefferson County CMHP
Nancy Tyler, Director
Lutheran Community Services NW
Crook County CMHP
Cc Mike Morris, Acute Care, MH & Addiction Services Manager, OMHAS
Strategic Plan
Phase Two Priorities for Consideration
Phase 2
2nd Draft
The Strategic Plan will include an examination of the following topics and may include
finding and recommendations for future action.
A. "ESSENTIAL ELEMENTS" (adopted by the Mental Health, Alcohol & Drug Advisory Board)
1 . Mission and Values - Review / update our mission statement and values. Method
for staff input; work on at Advisory Board retreat.
2. Core Services - Identify our core services and priorities to help guide resource
decisions. Management Team, Advisory Board retreat.
3. Financial Plan - Update the 3 -year plan with information from 2005-06 adopted
County budget and 2005-07 adopted State budget. Canfield
4. Evidence Based Practice - Report with findings and recommendations. Work
group (Hill, Drew); staff comment; Advisory Board retreat.
5. Measuring Results - Report with findings and recommendations. Work group
(Mayhill, Hogan); staff input; Advisory Board retreat. Includes the continued
development and benefit of our Quality Improvement system and processes.
6. Client & Family Involvement - Identify ways to strengthen consumer involvement.
NAMI and other consumer perspectives.
7. Staff Development - Report with findings and recommendations. Work group
(Donovan, K. Tamminga); staff input; Advisory Board retreat.
B. COMPARISON OF STATE and FEDERAL REPORTS
Analysis of our work and performance in areas priorities in the 2004 Governor's
Mental Health Task Force Report, A Blueprint for Action and the 2003 President's
New Freedom Commission Report, Achieving the Promise, Transforming Mental
Health Care in America.
C. SPECIAL TOPICS - includes but may not be limited to...
1. Child and Family School -Based Services - Update on plan for school-based services
for children with mental health or substance abuse issues. Donovan, schools
collaboration.
Strategic Plan / Phase Two Priorities
2. Child & Family KIDS Center - Update on plan for treatment services for children
suffering from abuse or neglect. Donovan, KIDS Center collaboration.
3. Child and Family System of Care - Report on this system reform: working with
families to help children with severe emotional disorders. Donovan, Care
Coordinator.
4. Child and Family Sex Offender Treatment - Include community analysis of the need
to treat juvenile sex offenders and services required. Joint project with Juvenile
Dept.
5. Substance Abuse - Report on trends, needs and service priorities including
information on community providers and the proposed focus of Deschutes
County's planning, advocacy and services. K. Tamminga, providers.
6. Eguitable Funding - Continued advocacy for comparable state investment in
services for Deschutes County residents. Special emphasis on alcohol and drug
treatment, acute psychiatric resources to help indigent clients, and general mental
health services
7. Criminal Justice - Deschutes County services and priorities to help people with
mental illness and addiction issues who become involved in the criminal justice
system. With Local Public Safety Coordinating Council.
8. Local Access - Using GIS I and other tools, identify service needs in outlying areas
of Deschutes County. Management Team
9. Managed Care - This section includes both our Mental Health Organization
(Accountable Behavioral Health Alliance) and our Chemical Dependency
Organization. Documentation on benefits, trends and pending considerations.
K. Tamminga, Providers.
10. Hospitalizations and alternatives - Continued development of a system of local
options to help County residents with acute or long-term care needs. Hill, Sage
View staff, State and community representatives.
11. Developmental Disabilities Case Manaaement - Sustaining and improving client/
case management ratios to assure quality services and supports.
12. Developmental Disabilities High Needs - Develop resources to meet low frequency
high intensity needs of clients. Examples: children and adults needing sex
offender treatment (see 44) and children with medical or high physical care needs
that families are not able to manage in their home.
13. Seniors - Examination of the most suitable settings for the delivery of services to
seniors (e.g., medical offices, senior centers.
14. Seniors - Strategic planning for potential downsizing of geropsychiatric bed
capacity at Oregon State Hospital. Drew, Malone, Seniors Team.
I Deschutes County's Geographic Information System
Strategic Plan / Phase Two Priorities
D. OPERATIONAL MATTERS
I . Advisory Board - Strengthen roles /responsibilities of the Board for policy, quality
improvement and strategic direction. Johnson, Wanless, Mottau
2. Contracting System - Strengthen procurement process (training, adherence to
standards and regulations, performance monitoring). Canfield
3. Facilities - Evaluate all facilities and service site locations. Identify facility needs,
opportunities and priorities. Canfield, Managers
4. Organization - Evaluate organization chart for functionality, efficiency, support and
cost effectiveness. Adjust as needed. Johnson, Managers
5. Records - Assure full compliance with HIPAA requirements. Evaluate for
functionality, consistency, use of technology, retention and ease of use. Cady,
Canfield, Managers
6. Redonal Considerations - Identify / support services or initiatives that are best
addressed regionally with a particular focus on Central Oregon. Managers
7. Personnel - If feasible, comparative data on staffing levels compared to other
counties, recent Departmental history and even national standards. Johnson,
Canfield.
8. Sur)r)ort Staff - Assure sufficient support staff to assist clients, clinicians and record
keeping needs of the department. Managers
Strategic Plan / Phase Two Priorities