2005-1339-Minutes for Meeting September 14,2005 Recorded 11/22/2005�v't�3 c
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p { 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, SEPTEMBER 14, 2005
Mental Health Department Conference Room
Present were Commissioners Michael M. Daly and Dennis R. Luke; Commissioner
Tom De Wolf was out of the office. Also present were Mike Maier, County
Administrator; Anna Johnson, Commissioners' Office; and Scott Johnson and
program managers of the Mental Health Department. No representatives of the
media or other citizens were present.
The meeting began at 3: 30 p. m.
Please see the agenda and backup documentation (copy attached) for information
on the items discussed.
No formal action was taken by the Board at this meeting.
Being no further items addressed, the meeting adjourned at 4:30 p.m.
DATED this 14th Day of September 2005 for the Deschutes County Board
of Commissioners.
ATTEST:
Recording Secretary
Tom DeWolf, Chair
-,-
renis R. Luke, Commissioner
DESCHUTES COUNTY OFFICIAL RECORDS CJ 1005■1339
NANCY BLANKENSHIP, COUNTY CLERK
COMMISSIONERS' JOURNAL 11/22/2005 04;44;17 PM
2011101111111111111111111111111
Deschutes County Mental Health
BOCC Monthly Meeting - Proposed Agenda
September 14, 2005
Location: Commissioner's office
1l�/My first year at DCMH (see Progress Report on my goals)
State A&D Equity Plan - Our Response
Strategic Plan - I will bring a draft, request for BOCC adoption late October
MHO Business Plan - proposed process
Embargoed draft to key players for last edits
Revision
Report to Advisory Board for 10/19
Meeting with consumers
Meeting with Commissioners - special meeting (also cover Strategic Plan)
Question: meeting with Crook and Jefferson before or after
5. School Mental Health Services - update? Meeting with School District?
6. Alternatives to Incarceration - site visit: King County system - we will likely
schedule a meeting to discuss the results (if it is warranted)
7. Drug Court - Judge Sullivan meeting to kick off planning
8. Other
a. Federal grant application for meth NOT FUNDED; we will apply again
b. Federal grant app. for Family Drug Court. pending
c. Federal Indirect Rate - critical policy matter. Status?
To: Deschutes County Commissioners, Mike Maier
From: Scott Johnson
Date: September 12, 2005
Subj: One -Year Report - 2004-2005 Priorities (at time of hire)
We agreed on my first year priorities in September 2004. This report summarizes progress on those
priorities. It also identifies challenges and opportunities over the next 2-3 years.
Summary: The Department has made considerable strides in the last year. We have developed
a 3 -year financial plan, reopened on Fridays and returned 80+ staff to full time status. We have
a healthier reserve, a clear sense of direction and an awareness of areas to be improved. Our
four -year strategic plan has been developed by our Strategic Planning Committee for your
consideration. Once adopted, the Plan will help us remain focused over the next several years.
The Department management team continues to work well together. They are dedicated,
knowledgeable professionals. Generally, the staff seems to be less discouraged when
compared to the effect of cutbacks in hours and services in 2002 and 2003.
There are many program successes. Sage View is operational. Horizon House is full. Bridge
Program funding was reinstated for one additional year. County and Redmond support saved
school mental health services in the larger districts (all but 5 schools). The crisis team was
reconstituted (following resignations) and now operates out of the main clinic. We continue to
work out of several Redmond sites and will move into the LaPine Service Center this fall.
Challenges remain. Long term financial projections (3-5 years out) are not favorable; we will
reduce our reserves and may reduce our county employed staff through attrition. Medicaid
funding may decline further. The important statewide reform of the children's system (high need
children) lacks new resources. Expenses are increasing more than revenue and the state
budget is not likely to provide any immediate relief. Growth in the county exceeds our
capacities. Acute care costs are up with Sage View on line. We will need to better manage
access to acute care services (for our OHP and indigent clients) A redesign of the state hospital
will occur but it is unclear if added resources will come to Central Oregon. Finally, we may need
to enter into difficult policy discussions about our core services and our manner of operation.
A&D equity help is at least two years away.
Areas where we most need your support:
1. Adoption of our Strategic Plan; full support of its implementation.
2. Board attention to our most costly areas: acute care; children's services (high need kids).
3. Resolution of the ABHA question; and full support of the option chosen.
4. Continued investment in our work. 1
5. Support for alternatives to incarceration as part of a comprehensive justice approach. 2
6. Continuing advocacy and grant writer help for addiction treatment resources.
7 Attention to benefit and indirect costs; realistic levels given our operating revenue.
Help in pursuing an electronic medical records system over the next 2-3 years.
I Base funding; consideration of school service needs and contracting system needs.
2 E.g Bridge Program, mental health and family drug courts, housing options, crisis training.
S:\Mental_Health\Scott\Scott's Priorities one year rpt.doc 9/13/2005
Goals and additional detail:
a. Familiarity with staff and the organization. 2004-05 Goal: Dedicate time to the management
team and individual managers. Meet periodically with program teams. Individual staff
meetings with staff by January 2005. Learn systems and processes.
Progress: On Track; ongoing process. I meet weekly with Management Team and individual
managers. As much as possible, I meet with new staff and hold exit interviews with those
leaving our employ. I have met with most staff through individual meetings at least once or
at least through team meetings periodically.
2005-2006. Maintain communication and contact with staff and assure sufficient support
and assistance to the Program Managers.
b. Strategic Plan. 2004-05 Goal: Complete preliminary plan by December 2004 with service
benefits, better public access and increased hours. Complete a full plan (including program
priorities and a business plan) for adoption by summer 2005. Include work on evidence
based practice, staff development and performance measures.
Progress: On Track. Phase 1 of the Plan was adopted by Commissioners and Advisory
Board. The full plan has been approved by the Strategic Planning Committee in August and
is being referred to the Advisory Board and Commissioners. The Plan includes
recommendations for evidence based practice, staff development and measurement of
performance as well as a Plan to address recommendations from recent audits.
2005-2006. Implement as many 2006 priorities as possible given our resources; begin to
make improvements called for in our Audit Action Plan. Update 3 -year financial plan in the
spring of 2006.
c. Sage View. 2004-05 Goal: Provide support for January 2005 opening of the crisis resolution
center. Complete negotiations to consider alternative to LLC, including CHC ownership of
facility, management of program and DC investment in services.
Progress: On Track. Sage View opened in 2005 with ownership and management transferred
to SCMC. A 5 -year county/hospital service agreement is in place with funding levels through
June 2006. We have formed a Central Oregon Acute Care Council to plan services, review
use, and manage resources. We worked with ABHA to relocate the ABHA utilization manger
to Central Oregon to improve service and support. An Acute Care Reserve has-been
established with the $290,000 repayment of county funds. Our shared advocacy resulted in
$450,000 of added indigent funding and another $450,000 expected this year.
2005-2006. Recent acute care costs exceeded past amounts and our budget. Strengthen
the utilization management process with monthly reviews of service use and expenditures.
Contain OHP costs to assure outpatient services are not compromised by acute care costs.
Guide the development of complementary, effective and more affordable services to limit
hospital / SV admissions and lengths of stay.
d. Children's System of Care Initiative. 2004-05 Goal: Prepare for 2005 start as well as a general
plan through 2008. Resolve how best to manage risk and responsibility. Emphasize
evidence -based practice.
S:\Mental_Health\Scott\Scott's Priorities one year rpt.doc 9/13/2005
Progress: On Track, multi year reform. CSCI begins October 1, 2005. It will affect services for
high need OHP children and families, eventually other children as well. Participating actively
(with Suzanne Donovan) in planning and preparation. Like acute care, developing a
Central Oregon regional approach with Crook, Jefferson, Cascade Child Center, Trillium and
ABHA as key partners.
2005-2006 Help promote and develop a Central Oregon system while working with ABHA.
Reduce residential care placements/length of stay over several years; work with families,
children's advocates, Trillium and Cascade Child Center to develop alternatives including
individual child/family plans, work with community, in home and in school services. Manage
risk associated with this reform.
e. Managed Care. 2004-05 Goal: Review our involvement in ABHA; assess benefits. Consider
other mho options, benefits and risks. Work with leadership to determine our best managed
care option and what changes, if any, we might want to propose.
Progress: On Track. Business Plan nearing completion. We will benefit from Commissioner
resolution of whether to pursue an alternative to participating in ABHA, perhaps as soon as
October.
2005-2006: Decision by the Deschutes County Commissioners (requires State approval) with
the State of Oregon and ABHA member counties. Pursue one of three options: 1) strengthen
5 -county ABHAs, 2) form MHO that services 3 counties or 3) form a single county MHO. Any
change would become official in 2007 or 2008 with planning initiated in 2006.
f. Mental Health, Alcohol & Drug Advisory Board. 2004-05 Goal: Create significant role for the
MHADAB in guiding the organization, developing policy and advising both the County
Commissioners and the Director.
Progress: On Track, ongoing process. Becky Wanless (chair) and Leo Mottau (vice chair).
Board functions as our Quality Management Committee (quarterly) to look at our
performance. Continuing to seek a more significant Board role in the Department's policy
and programming. With your support, we'll continue to see more community involvement in
decisions about our direction.
2005-2006: Initiate nomination process to set membership for 2006 with Wanless likely to
remain as chair. Review bylaws to strengthen role; recruit with expanded responsibilities in
mind. Appointments and any bylaws changes require Commissioner approval.
g. Evidence -Based Programs. 2005-06 Goal: Identify our current strengths and
accomplishments in this area. Identify and begin implementing program development
priorities for evidence -based practice, including associated training and development.
Progress: On Track. Report (analysis) and priorities included in the Strategic Plan. A number
of EBPs are already in use in the Department. Oregon law will require higher levels of EBPs
and documentation over the next several years
2005-06: Survey staff to identify, implement and train on our highest priority EBPs. Offerings
will include educational / skills development opportunities that support our work with the
children's system of care initiative, acute care, recovery, brief therapy and motivational
interviewing, to name a few.
S:\Mental_Health\Scott\Scott's Priorities one year rpt.doc 9/13/2005
h. Accountability / Quality Improvement. 2004-05 Goals:
1. DCMH Results: Emphasize service quality and high utilization. Clarify and strengthen
functions, processes and reports. Progress: Cited in the Strategic Plan; quarterly reviews
of performance; plans underway to produce a 2006 Report Card.
2. Audit: Work with County Auditor on analysis and improvements, as needed, in business
practices including finance systems and procurement process. Progress: 7 audits and 3 -
year improvement plan completed. Some recommendations will require resources.
3. Staff Development: Work to achieve consistent and beneficial performance reviews with
attention to staff development and performance concerns, if any. Progress: Cited in the
Strategic Plan including training and support needs. Biennial survey will be conducted.
L State Relations: 2004-05 Goal: Develop / sustain working relationships with state officials.
Participate actively in the 2005 legislative process. Priority issues will include equity (both
alcohol/drug and mental health) and Children's System of Care.
Progress: Under way; ongoing process. Completed Salem day -long orientation at OMHAS.
Several contacts with Bob Nikkei, OMHAS Director as well as our Central Oregon legislators.
Attendance at periodic AOCMHP meetings (County mh directors) and ABHA Board and
planning meetings. Very time consuming process.
Cc Becky Wanless, Chair, Deschutes County Mental Health, Alcohol & Drug Advisory Board
DCMH Management Team: Canfield, Donovan, Drew, Hill, Hirschman
S:\Mental_Health\Scott\Scott's Priorities one year rpt.doc 9/13/2005
September 14, 2005
Robert E. Nikkel, MSW, Administrator Karen Wheeler, Policy Manager
OMHAS OMHAS
500 Summer Street NE E86 500 Summer Street NE E86
Salem OR 97301-1118 Salem OR 97301-1118
Re: Feedback on Proposed Alcohol and Drug Equity Funding Principles
Request for response and possible meeting
Dear Bob and Karen,
Thank you again for your attention to the issue of equitai �atc,�nd Federal
funding for addiction treatment services in Orego We hapreciated your
recognition of the problem and your concerted is to 41,
f�,n solution. We have
also appreciated the opportunity to have inpu o this prc`
Our response to the proposed Principles (your 8/31 °�rrspondence) , ached for
5.
consideration. We are also enclosing a copy of th ,°�e i email from Sc�ota$>Johnson
on this subject (July 28, 2005), also at a time y u were see input. Since you have
asked for our perspective, we are su `
p p pportive p#ke proposet rinciples with three
caveats, that:
1. Reasonable financial adjustmen a 'filling in the viltiwy') begin this biennium;
2. Changes are comprehensive (a , ate resources rna ed locally); and
3. We have confidence in a date Iain that a full itt mentation of the formula
will be accomplished.
��,�. «six
We recognize the need egornans i gid ed counties must be balanced
against the needs in area `__; are relatively e ter funded. We also recognize the
entire s sty�d5 nfusi , K new resources to better address a critical health,
treatme d pub I ss, n this State.
L we would apprecict- , resp60e to this correspondence and would welcome
rsonal visit to discuss tr ment needs in our area. We would like to invite our
legis ,yrs, representatives ,:she City of Bend and members of our Public Safety
C that meeting si they too have offered their perspective during the
2005 ssi .',nN.
Thank you.
Tom DeWolf, Chair
Deschutes County Commissioner
Dennis R. Luke
Deschutes County Commissioner
Michael M. Daly
Deschutes County Commissioner
Scott Johnson, Director
Deschutes County Mental Health
Cc Central Oregon legislators Whisnant, Burley, Westlund
Michael Sullivan, Presiding Judge, Deschutes County Public Safety Council
City Council Members, City of Bend
Department of Human Services
Office of Mental Health and Addiction Services
Proposed A&D Funding Equity Principles
August 31, 2005
1. Base Funding for small counties: OMHAS will maintain a base allocation for small
counties. OMHAS will consider a two-tier base level of $50,000 for the smallest
counties and $75,000 for small counties.
Deschutes County response: We concur. The term "small" should be defined so
this element is easily understood by all. For the most rt these counties do not
fluctuate significantly in size. 1.1,
2. Prevalence and Population Factors: The wei I g facto ' ude prevalence at
30% and population at 70%. Data from the " 9 Or obi ho Id survey and
the Oregon Health Teen Survey (conducted "."_su will be u" o determine
substance use and addiction prevalence. The °"; recent cens to
available as estimated by the Portland State Ut of Population Re arch
Center (updated each July) will be used t estimate 'pulation in ea h county.
u
Deschutes County response: (a) We c,ongurwl�he 30/7O�ighting; specific
plans should be made and comm7",",,,611paed to ate the lence
information periodically. Aw
(b) The population element of tli section is an esti § t It is inequitable for fast
growing counties like Wargto�rook, Jefferso nd Deschutes because it
understates the need fo``e ice f s much as `9°
0 percent. In our case, it
understates our popby about y too le. Our recommendation: work
with PSU and counties _timate o ulation in the vears in which service will be
Provided-," ore nt adiusted Population figures in the formula.
e„
3.
it and im lem t ion tate general funds or federal block grant funds
at may be availablVte D" OMHAS 2005-07 or 2007-09 budgets that are
of identified for speograms or services by the Legislature will be used in
le or in part to fill g�Ci in ABED funding equity. Regardless of funding levels,
th w formula for A funding equity will begin to be implemented through
the -09 funding h cation. Funding equity will be achieved through a
phasin^ rocesPmay take several biennia to achieve funding equity
de ii ` tt�¢_ resources that may be available as well as the number of
counties th brought up to the average per capita funding level in each
biennium.
Deschutes County response: This section is ambiguous and it is difficult to respond.
Please understand that we have sought equity in alcohol and drug funding and
mental health funding for 10 years and need greater confidence that a solution is
forthcoming soon. We have 3 requests:
a. We request a specific listing of all current resources that will be subject to the
new A&D equity formula. We would expect that all SE 60 and SE 66 resources
not covered by item b. below would be included.
b. We request a listing of "specific programs or services Identified by the
Legislature". We are unclear what falls into this category. For those projects, if
the funded projects are not explicitly defined (i.e. vendor or county) by the
legislature, we request that the Plan include a provision for a new competitive
funding process or alternative distribution method so other needs in Oreqon
can be considered. This seems warranted given mixed reviews on some
current projects. At a minimum, a formal review of all such projects should be
scheduled with results forwarded to all counties. Ideally, we can learn from
that information and possibly replicate best practices.
c. We request a framework that better clarifies the minimum level of resource
that will be devoted to a rebalance in 2005-07 an , 007-09. We feel that this
is a critical element.
d. We request a date certain when all reso "" identihough item a. above
will be subject to the equity formula. Wh we w re ery� `_. eciative of the
positive steps taken to address mental hep t , to our ledge a full
rebalance has not occurred.
4. Shared accountability and outcomes: As defined in R-glutte (ORS 430.N),
Counties will continue to share responsibil for funding,,,, services through
local matching funds including local awine tax re ues and other local
funds available. The biennial impl WrntatiothV ins define s a'' ed accountability
and outcomes.
Deschutes County
Thank you for your efforts to advance
September 14, 2005
Robert E. Nikkel, MSW, Administrator Karen Wheeler, Policy Manager
OMHAS OMHAS
500 Summer Street NE E86 500 Summer Street NE E86
Salem OR 97301-1118 Salem OR 97301-1118
Re: Feedback on Proposed Alcohol and Drug Equity Funding Principles
Request for response and possible meeting
Dear Bob and Karen,
Thank you again for your attention to the issue of equitable State and Federal
funding for addiction treatment services in Oregon. We hav ,appreciated your
recognition of the problem and your concerted efforts to find a solution. We have
also appreciated the opportunity to have input, this process.
Our response to the proposed Principles (your 8/31 correspondence) is attached for
consideration. We are also enclosing a copy of theme eaflier email from Sc6*Johnson
on this subject (July 28, 2005), also at a time you were seeking input. Since you have
asked for our perspective, we are supportive of the proposedtprinciples with three
caveats, that:
1. Reasonable financial adjustments('°filling in the valley") begin this biennium;
2. Changes are comprehensive (all sfate resources rnWaged locally); and
3. We have confidence in a date certain that a full implementation of the formula
will be accomplished
We recognize the needs of regonians in undefUnled counties must be balanced
against the needs in areas that are relatively better funded. We also recognize the
entire system needsan infusion of new resources to better address a critical health,
treatment -an publicsafe,..ty issuean,this State.
Easily; we would appreciate, a response to this correspondence and would welcome
akpersonal visit to discuss treatment needs in our area. We would like to invite our
legtsiators, representatives ofthe City of Bend and members of our Public Safety
Councilb that meeting sine they too have offered their perspective during the
2005 sessiom.
Thank you
ow
SENT ,43ar�E
Tom DeW , Chair� Michael M. Daly
Desc es County Commissioner Deschutes County Commissioner
Dennis R. Luke Scott Johnson, Director
Deschutes County Commissioner Deschutes County Mental Health
Cc Central Oregon legislators Whisnant, Burley, Westlund
Michael Sullivan, Presiding Judge, Deschutes County Public Safety Council
City Council Members, City of Bend
Department of Human Services
Office of Mental Health and Addiction Services
Proposed A&D Funding Equity Principles
August 31, 2005
1. Base Funding for small counties: OMHAS will maintain a base allocation for small
counties. OMHAS will consider a two-tier base level of $50,000 for the smallest
counties and $75,000 for small counties.
Deschutes County response: We concur. The term "small" should be defined so
this element is easily understood by all. For the most part these counties do not
fluctuate significantly in size.
2. Prevalence and Population Factors: The weighting factors include prevalence at
30% and population at 70%. Data from the >1100 Oregon household survey and
the Oregon Health Teen Survey (conducted annually) will be us' to determine
substance use and addiction prevalence. The most recent census,data
available as estimated by the Portland State University, Population Research
Center (updated each July) will be used ta,estimate -g ulation in each county.
Deschutes County response: (a) We concur'w' it
7:,.. .
plans should be made and communicated to"
information periodically.
(b) The population element of this section is an
growing counties like Was hin. gton,:Crook, Jeffe
understates the need for service RAN much a,
understates our pope tqn by about -;elf 00 p+w
the 30/70 weighting; specific
the
ihj'ate. It is inequitable for fast
'dnd Deschutes because it
}10 percent. In our case, it
le. Our recommendation: work
3. Timia and implementation. hlw state general funds or federal block grant funds
fhat may be available in,,the DHS, OMHAS 2005-07 or 2007-09 budgets that are
of identified for specific.programs or services by the Legislature will be used in
whole or in part to fill gaps in A&D funding equity. Regardless of funding levels,
Nw
the view formula for AS41 funding equity will begin to be implemented through
a
the ND07-09 funding c IICScation. Funding equity will be achieved through a
phasing�n process I may take several biennia to achieve funding equity
dependi 9 on the resources that may be available as well as the number of
counties that amore brought up to the average per capita funding level in each
biennium.
Deschutes County response: This section is ambiguous and it is difficult to respond.
Please understand that we have sought equity in alcohol and drug funding and
mental health funding for 10 years and need greater confidence that a solution is
forthcoming soon. We have 3 requests:
a. We request a specific listing of all current resources that will be subiect to the
new A&D equity formula. We would expect that all SE 60 and SE 66 resources
not covered by item b. below would be included.
b. We request a listing of "specific programs or services identified by the
Legislature". We are unclear what falls into this category. For those projects, if
the funded projects are not explicitly defined (i.e. vendor or county) by the
legislature, we request that the Plan include a provision for a new competitive
funding process or alternative distribution method so other needs in Oregon
can be considered. This seems warranted given mixed reviews on some
current projects. At a minimum, a formal review of all such projects should be
scheduled with results forwarded to all counties. Ideally, we can learn from
that information and possibly replicate best practices.
c. We request a framework that better clarifies the minimum level of resource
that will be devoted to a rebalance in 2005-07 and:2007-09. We feel that this
is a critical element.
d. We request a date certain when all resouri ei°identified through item a. above
will be subject to the equity formula. While'we were very'9appreciative of the
positive steps taken to address mental health equity, to our knowledge a full
rebalance has not occurred.
4. Shared accountability and outcomes: As
Counties will continue to share responsibi
local matching funds including local bee
funds available. The biennial implement(
and outcomes. Ak
Deschutes County response: W
Thank you for your efforts to
ned in sfatute (ORS 430.359),
)r funding AD services through
J wine tax revenues and other local
ans define shared accountability