2008-507-Minutes for Meeting March 19,2008 Recorded 4/2/2008FICIAL NANCYDESCHUBLANKENSHIPTES COUNTY CLERKDS CJ 70080501
COMMISSIONERS' JOURNAL
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.orc
MINUTES OF WORK SESSION
DESCHUTES COUNTY BOARD OF COMMISSIONERS
WEDNESDAY, MARCH 19, 2008
Present were Commissioners Dennis R. Luke, Michael M. Daly and Tammy
Melton. Also present were Dave Kanner, County Administrator; David Inbody,
Assistant to the Administrator; Scott Johnson, Sheri Pinner, Lori Hill and Barrett
Flesh of the Mental Health Department; Roger Lee of EDCO and one other
citizen. No representatives of the media were present.
Chair Luke opened the meeting at 1:30 p.m.
1. EDCO Quarterly Update.
Commissioner Luke suggested that the EDCO update be scheduled every six
months instead of quarterly.
Roger Lee provided a handout with information on projects that are underway,
the local economy and trends.
In regard to industrial lot size, Mr. Lee said that five acres and over is
considered large. Lots this size or smaller are very hard to find.
In regard to Juniper Ridge, the City and ODOT will consider County
recommendations and suggestions but the County has no authority to make
decisions on how the area develops. Decisions can be appealed, however. The
same issues apply to development in La Pine and potential traffic impacts and
the need for a traffic signal. There is a hearing scheduled for March 25 in La
Pine regarding this situation.
2. Mental Health Strategic/Biennial Plan Update.
Scott Johnson introduced his management team, and provided a PowerPoint
presentation regarding the status of various programs, funding and other issues.
Minutes of Administrative Work Session Wednesday, March 19, 2008
Page 1 of 3 Pages
He said there are some requirements to present the Mental Health Biennial Plan
to various groups and obtain feedback. The Strategic Plan was already
approved but there are now amendments to consider.
He said that a departmental survey was done in 2005 and another completed
recently.
In regard to confidentiality issues, Commissioner Melton asked if there can be
done at the legislative level to assist people who need help but because of
current law, the agencies that might be able to help them are unable to do so.
This is of special concern when someone is in imminent danger. Mr. Johnson
stated that this is getting a lot of attention and his team is well trained to do
whatever they can in this regard. The crisis intervention team is doing effective
work now.
Commissioner Melton asked about how the new Medicare billing process will
be handled. Ms. Hill stated that long term it will help decrease the amount of
billing.
He and his staff updated the Board on where the State mental health facilities
will be. It is unclear where and how many local facilities will eventually be
developed.
A copy of his presentation is attached for reference.
Sherri Pinner pointed out that the Department has an FTE that is not budgeted;
some of the FTE has been deleted but they are .32 FTE over. They are going to
transfer funds as appropriate. (A copy of the memo is attached.)
3. Other Items.
A survey problem in the La Pine area has become an issue again. The County
was not involved in the survey, which was evidently done in an erroneous
fashion and affects many properties. The Board asked if a facilitator could be
arranged to look into the situation. The properties would have to be surveyed
again and new deeds recorded; however, if one person will not sign, it becomes
a problem as no one could be forced to do so.
Commissioner Daly said that the people there feel it is a County responsibility
because the plats were approved decades ago.
Minutes of Administrative Work Session Wednesday, March 19, 2008
Page 2 of 3 Pages
Mr. Kanner said that the County just records what is given to them and tax lots
created. The surveyor was hired by the developer. A surveyor contacted by the
residents quoted a price of $10,000 a lot to do the survey now, per one of the
residents. Many of the lots are vacant and some are not buildable.
It is not the County's responsibility but the Commissioners would like to help if
possible. Some of the lots have improvements on them that would encroach on
another lot, and a few might have roads running right through them.
Being no./urther discussion, the meeting adjourned at 3: 30 p.m.
DATED this 19h Day of March 2008 for the Deschutes County Board of
Commissioners.
ATTEST:
Recording Secretary
Luke, Chair
Minutes of Administrative Work Session Wednesday, March 19, 2008
Page 3 of 3 Pages
Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
WORK SESSION AGENDA
DESCHUTES COUNTY BOARD OF COMMISSIONERS
1:30 P.M., WEDNESDAY, MARCH 19, 2008
1. EDCO Quarterly Update - Roger Lee
2. Mental Health Strategic/Biennial Plan Update - Scott Johnson
3. Other Items
PLEASE NOTE: At any time during this meeting, an executive session could be called to address issues relating to ORS 192.660(2) (e), real
property negotiations; ORS 192.660(2) (h), pending or threatened litigation; or ORS 192.660(2) (b), personnel issues
Meeting dates, times and discussion items are subject to change. All meetings are conducted in the Board of Commissioners' meeting rooms at
1300 NW Wall St., Bend, unless otherwise indicated.
If you have questions regarding a meeting, please call 388-6572.
Deschutes County meeting locations are wheelchair accessible.
Deschutes County provides reasonable accommodations for persons with disabilities.
For deaf, hearing impaired or speech disabled, dial 7-1-1 to access the state transfer relay service for TTY.
Please call (541) 388-6571 regarding alternative formats or for further information.
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ECONOMIC DEVELOPMENT
FOR CENTRAL OREGON
Economic Development for Central Oregon
Quarterly Report to the Deschutes County Commission
March 19, 2008
The impacts of the national housing slowdown are beginning to spread more broadly across
Oregon, the tri-county area and Deschutes County. As EDCO predicted in December of last
year, we are seeing ongoing layoffs by several of the region's wood and building products
manufacturers in 2008, and more could be announced as housing starts nationwide have
plunged over the past six months. Thus far, Crook and Jefferson Counties have been most
heavily impacted by these workforce reductions, and we expect February unemployment rates
to exceed 10% in those counties. Of the roughly 8,000 manufacturing jobs in Central Oregon,
3,500 are in wood products manufacturing, and most of these are producing products for the
residential building sector. The economic picture is definitely not all doom and gloom, as
several companies in this sector continue to grow market share, production and employment
including Tri-Star Cabinets (specialty cabinets for golf pro shops), Structus (drywall corners) and
Jeld-Wen (windows and doors).
Additionally, EDCO sees good reason for optimism here in Central Oregon given that we have a
record number of local companies (35) in our portfolio that are looking to either expand their
facilities, purchase new equipment or increase employment. One of these just announced
earlier this week is Cessna, which expects to add 150 jobs this year and a total of 300 over the
next two years. Our numbers are off slightly for pending recruitment projects but we are
working on bolstering our efforts in this arena to keep a steady deal flow.
On February 14th, EDCO hosted celebrated national economist Alan Beaulieu from New
Hampshire-based Institute for Trends Research as our 2008 Annual Luncheon keynote
speaker. Beaulieu provided a realistic, fact-based analysis of the national and global economy
that made a forceful case that the economy would not be in recession for 2008, but that a more
severe recession than recently experienced is on the way for 2009 and 2010, followed by a
strong recovery in 2011-12. Citing several structural issues which were illustrated in graphs and
tables, he said that the recession would be virtually impossible to avoid and that it would be
more global in nature. His presentation was an equal mix of bad news and good news - the
U.S. still leads the world in several important areas (productivity, innovation, exports and per
capita GDP) and that recessionary times just make us more competitive. He also noted that
some areas of the country would not experience the full brunt of the recession - and that
Oregon and our region of the state could be among those.
RECRUITMENT PROJECTS
EDCO continues to work actively to recruit new, high-wage jobs and companies to the region.
Since last quarter's report, we have several new projects - some are very large scale (multi-$
billion, 1,000 jobs each). As noted in August, EDCO has developed its own system for tracking
business development projects that both enables us to keep in regular contact with these firms
as well as to accurately group them by the type of project and stage of progression to
completion. Even when companies have made public announcements about their intentions to
move or expand, EDCO considers only those that have built or occupied facilities in the tri-
county region and which have hired employees to be "done deals". All others are grouped
under "pending projects" according to their timing and propensity to come to fruition. Listed
below is a sampling of the projects we are working on specifically within communities in
Deschutes County. Company names for most pending projects have been omitted due to
confidentiality requirements.
Done Deals (Relocated to or started in Deschutes County in the last Quarter)
■ Picturesque Window Manufacturing, a new fabricator of custom windows for
commercial applications, specifically glass replacement, has moved into a new facility in
Redmond. Currently most of this work must be sent to the Portland area. The company
will employ three people and the project resulted in a capital investment of $320,000.
Pending Recruitment Projects in Deschutes County (partial list)
■ The steel structure is going up on ODS Companies', new $25 million, Class-A office
building in Bend's Old Mill District to house a claims processing center and the region's
first dental hygiene school. This project, which EDCO has been working on the past two-
plus years, will initially create more than 70, new, well-paid positions with full benefits
and more than 120 total over time. www.odscompanies.com
We continue to work on incentive logistics and other relocation details for the new
corporate headquarters of Les Schwab Tire Centers. The building, which is about the
same stage in construction as ODS, is expected to be occupied in fall of this year. It will
be the region's largest Class-A office building (125,000 sf) for an estimated $25 million
capital investment. The project will initially result in more than 325 family-wage jobs for
Deschutes County and employment could eventually grow to more than 500. EDCO
worked behind the scenes for nearly two years on this project to beat out competing
metros of Sacramento, CA; Reno, NV and Portland-Vancouver.
A medical device manufacturer from southern California is moving forward on
relocating its entire operation to Bend. The company is in the process of purchasing an
industrial park-zoned lot in Northwest Crossing to build a new 10,000 sf headquarters,
lab, assembly and warehouse space at an estimated cost of $1.5 million. This company
is just another good example of a recruitment that would not have happened without
EDCO's efforts. We have assisted the company with detailed information on business
cost, taxes, industrial land, and the building process. The company will employ 20
people at wages from $16 -$40 per hour, most of which will be hired locally.
EDCO is working on several highly confidential large-scale projects in Deschutes County
in the alternative/renewable energy sector. For most of these projects, we are
competing globally for both the capital investment (multiples of $100 million), significant
numbers of jobs (400-1000) and high paying jobs ($60,000+). These projects are
inherently complex and require significant infrastructure (water, sewer capacity, power,
natural gas). EDCO has been the lead on preparing proposals for these opportunities in
coordination with the City of Bend and City of Redmond.
RETENTION EXPANSION
EDCO spends considerable time working with our existing manufacturing and technology-based
companies throughout the tri-county area, and certainly spends most of our time and efforts
here in Deschutes County simply because that is where the majority of these employers are
located. Given the rising cost of light industrial and commercial land, tight workforce, and
relative cost of housing vis a vis other comparable metros in the West, EDCO is seeing these
projects also more frequently as retention projects. Here is a rundown of recent and current
projects in Deschutes County:
Expanded in Deschutes County
■ The principal of Industrial Concepts, recently completed a new 10,000 sf facility in
Redmond of which the business occupies roughly 5,000 sf. Industrial Concepts is an
industrial machine shop supplying manufacturers both inside and outside the region.
Currently at two employees, the company expects to add at least one employee over the
next year.
■ Rocky Mountain Products moved into its new 50,000 square foot production facility
this month. The company made a capital investment of $3.75 million and expects to
nearly double its 2007 employment of 19 to 36. The new FDA approved facility will
enable the company to enter new markets, including pre-prepared and frozen foods
sector www.rockvmountainproduct.com.
Pending Expansion & Retention Projects in Deschutes County (partial list only)
Bend-based Ameritech Machining Mfg. has started construction on property in
Redmond to build a new 25,000 sf manufacturing facility. EDCO was able to keep the
company in Deschutes County and the tri-county area following a search for solutions by
Ameritech that would allow the company to grow substantially. The company has
already added nearly 20 people to its existing workforce of 20 and expects to be to a
total of 50 employees by the end of 2008. www.ameritechmachinemtq.com
Cessna Aircraft Corporation www.cessna.com announced expansion plans for the
Bend Airport plant only a few months following purchase in bankruptcy court. The
company officially announced that it would be growing its workforce by 150 positions
over the next 12 months, and the company has disclosed to EDCO that it expects a total
of 300 more people at the plant within three years to keep up with demand for aircraft.
EDCO is working working with the company, COCC, and COIC on a workforce training
grant to help train new hires.
Epic Air www.epicaircraft.com, designer and manufacturer of high performance turbine
and jet aircraft, continues to expand its operations at the Bend Airport, and is now up to
150 employees after starting operations only four years ago. EDCO is working closely
with the company on construction of an additional 300,000 sf of manufacturing space it
would like to begin Spring of 2008, complete and occupy before the end of summer. We
have been working both with Epic and Lancair in Redmond, both of which are impacted
by a recent decision by the Federal Aviation Administration (FAA) to have a moratorium
on courtesy inspections of new kit aircraft models. Additionally, the FAA is considering
new rules for kit aircraft that could have serious negative impacts on our local
manufacturers. We are working with Senator Wyden's office on providing some
influence on the FAA in their administrative decision-making process.
Breedlove Guitars continues to move forward on completion of its new production
facility and headquarters on an industrial lot in Bend's Northwest Crossing development.
EDCO helped find the site for the company, which had searched in vain for nearly two
years. We also connected Breedlove with industrial revenue bond financing through the
State of Oregon for construction of the new plant and offices.
www.breedloveguitars.com
Following an exhaustive search of possible sites in Bend PV Powered has located a
facility for their combined headquarters and production in facility at the former Oregon
Woodworking plant on Brinson Road. The company is growing employment by nearly
100% annually as it expands to meet market demand for its grid-tied solar power
inverters. EDCO is helping to coordinate state economic development and workforce
incentives for the new operation. Average wages at PV Powered are nearly double of
those of the average wage of all employers within Deschutes County, and it is expected
that the company will exceed 100 employees within the next 18 months.
Aircraft Rubber is consolidating its Bend and Redmond operations to a new, 100,000 sf
facility in Redmond, on land sold by Deschutes County to the City of Redmond. The
new $4.5 million plant will facilitate growth in employment by at least five people.
www.aircraftrubber.com
■ A local aerospace company is in the process of dramatically growing the size of its
operations as it has been named an exclusive overhauler of helicopter aircraft. The
company could double its current employment of 15 people, and require expanding plant
space by up to 70,000 sf.
• Precise Flight, the region's first aerospace/aircraft company, is experiencing rapid
growth as a supplier of a family of products (lights, braking, oxygen systems, etc.) to
other aircraft producers including Cirrus, Cessna and Columbia. EDCO played a role in
a recent workforce training grant to help the company gain preferred status as a certified
Lean supplier. www.preciseflight.com
Combined, EDCO is currently working on 58 pending projects for both recruitment and
retention/expansion throughout the tri-county area, which represents $2.7 billion in new capital
investment and nearly 4,453 new, family-wage (or higher) jobs.
Deschutes County Rural Enterprise Zone
EDCO has spent considerable time in the past quarter working on statistical research, notices,
meetings, and preparation of application materials for a new enterprise zone that would include
the City of La Pine and the Bend Airport. Since our last update to the Commission, the City of
La Pine unanimously approved moving forward with preparing the application, and we have
received a support letter from several businesses and the La Pine Industrial Group (LIGI). We
have requested that the Board of Commissioners approve a resolution at the March 26th work
session, and are seeking a similar resolution later that day from the City of La Pine. Application
materials are being competed next week for submission by the end of the following week (April
4th).
3.19.8 BOC Work Session
Meeting Topics
2009-11 County MH Biennial Plan draft
to BOC for adoption in April
2008-13 County MH Strategic Plan draft
to BOC for adoption in May
2008 DCMH Staff Survey
Small FTE correction matter
The Challenge of Limited Resources,
Community Need and Difficult Choices
• 161,736 Oregonians (a serious/severe mental illness)
• Only 36% of uninsured Oregonians with a serious mental
illness receive help (no help for an estimated 19,222)
• Here, 10-20 calls for help daily; we help 4,000+ ea. yr.
• Our jail: 17-20% of inmates with serious mental illness;
80% addiction; 500 bed jail: incarceration of 85-100 m.i.?
• Seniors population up 63% from 2005 to 2015 v 27%;
seniors served up 9.6% from 05-06 to 06-07
• Pre commitment investigations up 61% 04-05 to 06-07
1
The Deschutes County 2009-11
"Biennial Implementation Plan"
(Oregon law requires)
Draft submitted to state; under review by groups
7 recommendations to DHS (Bob Nikkel)
1. Fund "community system of care" for the uninsured
2. Adopt an Investment Policy (to assure equity)
3. Target co-occurring disorders, seniors, alt. to inc.
4. Support children's wraparound system
5. Increase productivity by streamlining requirements
6. Help prevent risk of Medicaid "overpayments"
7. Improve and accelerate AMH contracting processes
Link to contracts (Board order planned)
2008-13 DC MH Strategic Plan
• Vision, mission, values
• Proposed policies
• Environmental trends
• 2008-2009 Work Plan
• Longer term priorities
• Three-year financial forecast
2
Environmental Trends
Highlights
1. Seniors
5. Emergency preparedness
10. Contracting capability; performance
11. Documenting encounters
16. Competitive pay (stable workforce)
26. County and state revenue: help for the uninsured
28. Medicaid regulations; risk management
30. State Hospital - community investment?
32. Housing and residential program development
33. Jail expansion - growing services as well?
Children & Families (highlights)
o Chemical dependency: > treatment for indigent teens;
o Children's services:
Develop early psychosis program for 28 young people;
Sustain wrap-around help for 30-60 high need children;
Maintain low use of psychiatric residential services;
Increase intensive community treatment options;
Sustain school and clinic services county-wide
Determine treatment capacity needed at KIDS Center.
o New funding: Seek resources for school services.
3
Adults (highlights)
o Acute and Crisis Care: Increase Crisis Team services;
analyze commitment investigation/commitment trends;
evaluate Mobile Crisis Team; sustain Sage View indigent
care; begin developing crisis respite options.
o Chemical Dependency: Increase addictions treatment
for adults in justice system, parents in child welfare
system and adults with co-occurring disorders.
o Criminal Justice: Expand MH Ct (25) & Jail Bridge (75)
and law enforcement training; sustain Drug Court.
o Employment: Increase Supported Employment (65)
o Housing: Develop 10-bed secure and 8-bed non secure
(Telecare); reopen 5-bed forensic (Springbrook);
potentially increase transitional and supported housing.
DID & Senior Services (highlights)
o Client Safety: Provide protective services and abuse
investigations that keep clients safe; respond to reports;
make alternative arrangements as needed.
o Developmental Disabilities:
Expand case management and respite services;
Provide family support to reduce out of home placement;
Monitor group and foster home services.
o Senior Services: Measure current and needed capacity
to serve a growing population; expand as able;
requesting additional funds.
4
Business Services (highlights)
o Electronic Record: Initiate needs assessment; identify
software options; complete business plan and feasibility
study by 2009. Resources needed to implement.
o Licenses: Complete state process to renew service
licenses including alcohol and drug treatment/prevention
and mental health treatment.
o Sound financial management: Prepare budget consistent
with Strategic Plan; update three-year financial forecast;
balance budget; update unit cost study.
o Contracting: Improve document management and
contract monitoring; develop contract specialist position.
2008 Staff Survey
• Replicated 2005 survey. You are receiving all the data.
• 79 of 119 responded (66%). 27% < 2 years
• Not confidential but anonymous.
Data is positive; many areas show improvement.
• 68% communication within Department improving; many
areas 70-80% show DCMH the same or improving
• 48% supervision improving.
Concerns? 46% staff development somewhat weak/weak
Concerns? 37% informing public somewhat weak/weak
Concerns? Paperwork, regulations, needs exceed $
Next step: teams helping to build an Action Plan by June
5
Wrap Up
❖ Board questions or suggestions?
❖ Biennial Plan adoption in April
❖ Strategic Plan adoption in May
❖ Program budgets in May
❖ Improvements to address survey results
❖ Implementation over the next five years
6
Deschutes County Mental Health
To: Board of Commissioners
From: Sherri Pinner
Business/operations Manager
Date: March 19, 2008
Subj: Increase FY 07-08 Budgeted FTE
Deschutes County Mental Health (DCMH) will be requesting a transfer of
contingency to cover .32 FTE for FY 07-08. The Finance Dept. request
that the Board be made aware of the circumstances and that they give a
verbal approval prior to the appropriation transfer being presented as
an agenda item.
Below is a brief description of the matter.
DCMH had a MHS I budgeted as a .75 FTE for FY 07-08. An employee was
hired for that position in May/June 2007 as a 1.00 FTE. In July there
should have been a request for an additional .25 FTE. This shortage
went undetected because the .75 FTE was combined with an available
unfilled FTE that was designated for another program. This situation
was discovered in November 2007 when an employee was hired for the
position that was unfilled.
Additionally, there was a .25 FTE for a MHS I that was to be deleted
during the FY 07-08 budget process, but was overlooked. Seeing this
available, DCMH combined .07 of this position with a .93 FTE to create
a 1.00 FTE for a RHIT Supervisor, leaving a .18 MHS I unfilled and
available.
It was while researching the first scenario that the second scenario
was discovered. The .18 MHS I unfilled FTE has since been deleted and
we are currently .32 FTE (.25 + .07) over budget.
Tracking DCMH FTE is a complicated task and I hope to implement some
safeguards to prevent situations such as this from occurring.
DESCHUTES COUNTY
MENTAL HEALTH
2009-2011 BIENNIAL
IMPLEMENTATION PLAN
Draft
March 14, 2008
AMH: This Draft Biennial Plan and the Draft Strategic Plan are now under review by several
community groups. We expect a final plan to be adopted by the Deschutes County Board of
Commissioners in April, 2008. A copy of the final plan will be forward to AMH at that time.
Contact information:
Scott Johnson , Director
Deschutes County Mental Health (DCMH)
541.322.7502
scottjohnson@co.deschutes.or.us
DESCHUTES COUNTY MENTAL HEALTH (DCMH)
2009-2011 IMPLEMENTATION PLAN
Table of Contents
Letter to Bob Nikkel, DSH Addictions & Mental Health Division
General Guidelines
Licensure/Approval
Services to Diverse Populations
Standard Plan Requirements
County Contact Information Form
County Planning Process
Current Linkages with State Hospital System and Mental Health Acute Care Inpatient Providers
Residential/Detoxification Services Coordination
Coordination of Addictions Treatment with the Criminal Justice System
High Priority Needs
Allocation and Use of Resources Provided by AMH
Attachment 1: List of Subcontracted Services for Deschutes County
Attachment 2: Board of County Commissioners Review and Approval
Attachment 3: Local Alcohol and Drug Planning Committee Review and Comments
Attachment 4: Local Mental Health Advisory Committee Review and Comments
Attachment 5: Commission on Children and Families Review and Comments
Attachment 6: County Funds Maintenance of Effort Assurance
Attachment 7: Planned Expenditures of Matching Funds (ORS 430.380) and Carryover Funds
Attachment 8: Review and Comments by the Local Children, Adults and Families District Manager
for the Department of Human Services
Attachment 9: Review and Comments by the Local Public Safety Coordinating Council
Prevention Plan
Attachment 10: Prevention Strategy Sheet
Problem Gambling Services Plan
Children's Mental Health Services Plan
Older Adult Mental Health Services
Deschutes County Mental Health Strategic Plan 2008-2013
Page
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March.14, 2008
Mr. Bob Nikkel, Administrator
Oregon Department of Human Services
Addictions & Mental Health Division
500 Summer Street NE, E86
Salem, OR 97301-1118
Mental Health Department
2577 NE Courtney Drive, Bend, Oregon 97701
General Information/TDD (541) 322-7500
FAX (541) 322-7565
Scott Johnson, Director
Subject: Cover Letter with Deschutes County Mental Health's 2009-11 Biennial Plan
Dear Bob:
The Draft Deschutes County Mental Health 2009-11 Biennial Implementation Plan is enclosed as well as
the 2008-2013 Draft Deschutes County Mental Health Strategic Plan. I am including this cover letter
with additional information on our work in Deschutes County and several recommendations of interest to
our county. As approved by AMH, a final Biennial Plan with all sign-offs and adopted Strategic Plan will
be forwarded to Len Ray in April.
PROGRESS TO REPORT:
First of all, I want to thank your office and you, personally, for your support and assistance on
several matters that affect our State and County. Two recent actions by the State of Oregon will have
a measurable impact on our mental health and addiction treatment services in our county and region.
Comparable funding of "need" for health care access-Passage of HB 3067 coupled with your
decision to fund behavioral health services based on the need (including projected population) in each
County has helped assure Oregonians they can expect more comparable services and capacities in all
areas of our state. While services remain limited, they are focused on mandated populations and those in
greatest need. We can now begin to think systemically with an agreement that we have invested State
resources more comparably throughout Oregon. In time, elected officials, providers and advocates will
gain a better understanding of what that level of funding will buy.
Adult Treatment Child & Family Program Developmental Disabilities Seniors Program Medical Records
Mental Health, Alcohol & Drug Mental Health, Alcohol & Drug PHONE (541) 322-7554 PHONE (541) 385-1746 FAX (541) 322-7567
FAX (541) 322-7565 FAX (541) 322-7566 FAX (541) 322-7566 FAX (541) 388-6617 (Protected Health Information)
Quality Services Performed with Pride
Mr. Bob Nikkel, Administrator
March 14, 2008
Page 2
Funding a community system that supports the State Hospital-Secondly, the 2007 Legislature began
an investment in the community system of care in an effort to invest in essential local services to
complement development of the new State Hospital system. Your leadership and the work of your staff
helped a broad coalition of stakeholders craft the Community Services Work Group report and begin to
define, objectively, the needs for and cost of core best practice programs to serve people without access to
behavioral health care in this state.
Critical, core services improved-For Deschutes County, these two actions are resulting in a multi-
faceted investment strategy that includes supported employment, additional residential program options,
more ECMU and PSRB residential capacity and a new early psychosis program for adolescents and
young adults. We have also stabilized funding for our regional acute care system, mobile crisis team and
mental health court while expanding jail diversion (reentry) services and case management. Lastly, new
addiction treatment funds will support addictions treatment services for individuals in jail and after jail
release and for parents and/or guardians with children in the child welfare system. The justice system
project comes with shared funding by our Deschutes County Sheriff, significantly improving our
continuity of care for people with addictions in the justice system.
RECOMMENDATIONS:
Since the 2009-2011 Biennial Plan is intended to help chart our course for the future, we want to
offer a set of recommendations for your consideration. I would encourage you analyze the
information from all Local Mental Health Authorities and develop a Community Improvement Plan for
the next several years. Improvements are needed in several key areas.
Fund the Community System of Care for the uninsured. With support of the Governor,
Legislature and Dr. Goldberg, implement the Oregon State Hospital Community Services Work
Group Report and the Central Oregon Community Services Work Group Report. Articulate
clearly and consistently that the Oregon State Hospital Master Plan will fail without a sizable
investment in community services. We simply cannot shorten length of stay and fund community
placements without State investment.
2. Adopt an formal AMH Investment Policy. Fund community mental health based on the
Kessler formula (or other formal methodology) and a population forecast every biennium. A
clear policy must be in place to drive the calculation of need and costs in an objective manner.
This will help assure the legislative intent in HB 3067 will be realized. Without a clear policy
and consistent application, or with a change in leadership, fast growing counties could quickly
fall behind again. We expect our county to experience a continuing influx of 7,000-9,000
residents annually. Our Strategic Plan includes a three-year financial forecast and a realization
that our local resources will decline and service levels will diminish without further State
investment.
TarEet co-occurring disorders seniors' services and alternatives to incarceration. Particular
attention is needed in these areas given the State Hospital census projections and changing
demographics in State and community jail and corrections programs. We need system change
and development efforts in these areas including advancement of a project with our
Page 2 of 81
Mr. Bob Nikkel, Administrator
March 14, 2008
Page 3
Chemical Dependency Organization, State help in expanding senior services (through concepts
like SB 1075) and methods to dramatically expand alternatives to incarceration as this county
increases the size of the local jail and forensic needs with the State hospital increase.
Additional note: Our reference to co-occurring disorders relates to alcohol/drug work as well as
needed improvements in our state and community capacity to work with cases that include both
developmental disabilities and mental health. From our perspective, there is a need for SPD and
AMH to work together to facilitate and help pay for services for co-occurring DD/MH cases.
4. Support local efforts to implement Oregon's children's wraparound program. It is critical
that we alleviate systemic barriers to services and better align resources to help children in need
of this level of care. We continue to work closely with community partners (school districts,
child welfare, juvenile services) but struggle to fully integrate services and blend resources. In
particular, our school partners continue to express concerns.
5. Pursue an initiative to increase productivity in community mental health through a
streamlined set of Administrative Rules and greater emphasis on client care. In conjunction
with the Division of Medical Assistance Programs (DMAP), seek ways to simplify medical
records and paperwork to maximize clinical time for direct client care. We request a clear
package of rule changes (linked to cost of care), an electronic record system, sample treatment
plans (that assure compliance) and DMAP support for a more efficient records system and
streamlined processes. Clear standards and review tools would also help local programs be more
efficient, effective and accountable and improve the site visit process. We are particularly
interested in tools that will greatly increase clinician productivity (more hours for direct care)
while meeting a streamlined set of rules and responsibilities.
Work with DMAP to limit risk of overpayments. As reported by AMH, the system lacks
resources to meet the needs of indigent Oregonians. Current Medicaid auditing and calculations
of overpayments threaten to erode some of the very resources that offer a foundation we can build
on to increase the capacity of our system. An aggressive technical assistance program is needed,
with the support of MHOS, to limit any risk and loss of critical federal resources. We are also
appreciative of plans to launch a Medicaid Work Group in the coming weeks.
7. Improve and accelerate the AMH contracting processes. Delays in the development of
contract amendments have limited the ability of counties like ours to move quickly to invest
resources and demonstrate progress prior to the 2009 Legislative Session. In Deschutes County,
we are only now beginning hiring, contract amendments and RFPs in several areas. As of today,
we continue to wait for an amendment for the early psychosis project.
Page 3 of 81
Mr. Bob Nikkel, Administrator
March 14, 2008
Page 4
In closing, we are very appreciative of the work of AMH on behalf of residents of Central Oregon and our
entire state. We are hopeful you will act on these recommendations as well as those in other County
Biennial Plans as you prepare for the next biennium and the future of our mental health system in Oregon.
We look forward to working with you in this process.
Sincerely,
Scott J s n, Director
Deschutes County Mental Health
cc: Len Ray, DHS Addictions & Mental Health Division
Deschutes County Commissioners Melton, Daly, Luke; Dave Kannner, County Administrator
Dolores Ellis, Chair, & Members, Deschutes County Addictions & Mental Health Advisory Bd.
Central Oregon legislators Sen. Westlund, Rep. Burley, Rep. Whisnant
Gina Nikkel, AOCMHP
Robin Henderson
Enclosures:
Deschutes County 2009-2011 Biennial Implementation Plan (draft)
Deschutes County 2008-2013 Mental Health Strategic Plan (draft)
Page 4 of 81
GENERAL GUIDELINES
1. Licensure/Approval
Deschutes County Mental Health (DCMH) is certified by the State of Oregon Office of Mental Health
and Addiction Services. The current Certificate of Approval for mental health services is valid until
June 9, 2008. The current Certificate of Approval for alcohol and drug services is valid until June 30,
2008. The current Certificate of Approval for children's ICTS services is valid until September 28,
2009.
2. Services to Diverse Populations
As noted in the 2007-2009 Biennial Plan, DCMH will seek to maintain alcohol and drug treatment for
ethnic and minority populations through our own services and investment in groups such as BestCare
Treatment Services, Serenity Lane, Rimrock Trails, and Pfeifer & Associates.
While we recognize more work is needed in this area, we will struggle to make the improvements that
are needed without resources. At a minimum, we will actively work to attract qualified
bilingual/bicultural staff over the next several years as called for in our Strategic Plan. Any assistance
possible from AMH and higher education institutions to recruit and train qualified professionals will
be- greatly appreciated.
Page 5 of 81
STANDARD PLAN REQUIREMENTS
1. County Contact Information Form
1. County Contact Information
County: Deschutes County
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Name and title of person(s) authorized to represent the county in any negotiations
and sign any agreement:
Name Dave Kanner Title County Administrator
Name Scott Johnson Title Mental Health Director
2. Addiction Treatment Services Contact Information
Name Lori Hill Adult Treatment Program Manager
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend Oregon 97701
Phone Number (541) 322-7535
Fax (541) 322-7565
E-mail lori-hill@co.deschutes.or.us
3. Prevention Services Contact Inforiiiation
Name Robin Marshall Prevention Coordinator
Agency Deschutes County Commission on Children & Families
Address: 1130 NW Harriman Suite A
City, State, Zip: Bend Oregon 97701
Phone Number (541) 322-4802
Fax (541) 325-1742
E-mail robin_marshall@co.deschutes.or.us
Page 6 of 81
4. Mental Health Services Contact Information
Name Scott Johnson Director
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7502
Fax (541) 322-7565
E-mail scottjohnson@co.deschutes.or.us
5. Problem Gambling Treatment Prevention Services Contact
Infort-nation
Name Fred Doolin
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend Oregon 97701
Phone Number (541) 322-7507
Fax (541) 322-7565
E-mail fred-doolin@co.deschutes.or.us
6. State Hospital/Community Co-Management Plan Contact
Information
Name Lori Hill Adult Treatment Program Manager
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7535 Fax (541) 322-7565
E-mail lori_hill@co.deschutes.or.us
Page 7 of 81
2. County Planning Process
2001-2010 Comprehensive Communit (Plan-Deschutes County's social service system has a rich
tradition of collaborative and integrated planning and program development efforts between local
agencies, systems and community members. This work is ongoing and occurs within the framework
of the comprehensive 2001-2010 Deschutes County Community Plan compiled by the Deschutes
County Commission on Children & Families (CCF). DCMH and our local (and integrated)
Addictions and Mental Health Advisory Board contributed to numerous sections and had primary
responsibility for the mental health and chemical dependency sections of the plan. CCF also
publishes a Report Card every three years reporting to the community on our progress on critical
priorities in the Community Plan.
Deschutes County Mental Health Strategic Plan-In the fall of 2004, the Deschutes County Mental
Health, Alcohol & Drug Advisory Board commissioned a Strategic Planning Committee composed of
Advisory Board members, County officials and the DCMH Management Team to develop a four-year
Strategic Plan to establish a financial plan and priorities for the next several years. Information was
solicited from numerous groups, both formally and informally, in the preparation of this document.
The Plan was adopted by our Advisory Board in 2005 and by the County Commissioners in 2006.
We are finalizing an update to this Strategic Plan for 2008-2013. The Strategic Plan draft is included
as part of this Biennial Plan. Our Commissioners are likely to adopt this plan update by May, 2008.
Consumers and Family Members-There are a number of consumers, family advocates and
representatives of NAMI of Central Oregon on our Advisory Board. These individuals are involved
in the development, review and approval of our Strategic Plan. The Directors of the three community
mental health programs in Central Oregon meet with the NAMI Board at least quarterly.
Central Oregon Plan to Complement the State Hospital-In December, 2006 the Central Oregon
region published a plan titled "A Regional System to Support the Oregon State Hospital Master Plan,
Critical Community Service Needs & Plans For Central Oregon 2007-2013." The plan was adopted
by the Deschutes County Board of Commssioners and many other groups. The Plan was also
included in the State Community Services Work Group Report to help illustrate advancements needed
in the community system of care if the new Oregon State Hospital System is to be successful.
2009-2011 State Biennial Implementation Plan-This document is a synopsis of ongoing and recent
developments and priorities for our county and the people we serve. Since the Strategic Plan is the
primary document used to measure our progress and assist us in prioritizing resources and program
development activities, much of that material is referenced and reflected in this submittal.
Professional Advisory Council and Other Stakeholder Groups-By statute, Deschutes County has a
Council of more than 20 community providers to advise the Commission on Children & Families
(organizer of the Community Plan) and to help coordinate and improve the local service delivery
system. DCMH participates on this Council.
DCMH also works closely with many groups in planning and service coordination. Examples
include:
Addiction treatment providers
Bend-La Pine, Redmond and Sisters School Districts
BestCare Treatment Services and Jefferson County (regional matters)
Cascade Child Center
Cascade Healthcare Community
Page 8 of 81
Consumers and family members
Deschtues County Addictions and Mental Health Advisory Board
Deschutes County Addictions Committee
Deschutes County Adult Parole and Probation
Deschutes County Commission on Children & Families
Deschutes County Juvenile Department
Deschutes County Local Public Safety Coordinating Council and public safety officials
High Desert Education Service District
KIDS Center (child abuse assessment and intervention)
Local Developmental Disabilities Planning Committee
Lutheran Community Services Northwest and Crook County (regional matters)
NAMI of Central Oregon
Oregon Department of Human Services Regional Office
Cultural Competency and Service to Minority Populations-DCMH is making an effort to identify
ways to improve our services and accessibility to minority populations. Strategic Plan references
follow:
"Increase the public's access to services and the quality of our services for county residents who face
language or cultural barriers.
1) "Bilingual staff-Develop a bilingual (Spanish speaking staff) capacity within all department
programs, including reception staff. Long-term goal, resources may be required." The
Department has few bilingual staff at this time.
2) Translation of Materials-Assure that key print and web information is available in
Spanish." All application materials including the statement of client rights and
responsibilities, the release of information form, and the document describing the reason for
seeking service are available in Spanish. Several brochures regarding mental illness and
substance abuse are also available in Spanish.
Page 9 of 81
3. Current Linkages with the Oregon State Hospital system and Mental Health Acute
Care Inpatient Providers
We are fully committed to a high level of coordination between Deschutes County Mental Health and
acute care services for consumers who are residents of Deschutes County, particularly for indigent
clients and members of the Oregon Health Plan.
Central Oregon Acute Care Council-The Council was formed in 2005 to help develop and support
an expanding regional acute care system for the benefit of residents of Crook, Deschutes and
Jefferson counties. The Council includes representatives from Cascade Healthcare Community, the
Addictions & Mental Health Division, Accountable Behavioral Health Alliance, the three Central
Oregon community mental health program, NAMI of Central Oregon, one or more local public safety
officials and other community representatives. This group also oversees use of our SE 24 resources
to assist indigent mental health consumers needing acute care help in Central Oregon.
Sage View-This Bend. sub-acute secure inpatient facility for adults needing stabilization and short-
term treatment for mental health issues was opened in February, 2005, by Cascade Healthcare
Community, our largest hospital system in Central Oregon. Deschutes County Mental Health staff
work regularly with Sage View clients and staff.
Central Oreizon Hold Rooms-Deschutes County residents benefit primarily from expanded hold
room capacity (5 beds) in Bend at St. Charles Medical Center and from a transport hold room at the
system's Redmond hospital. In Bend, consumers with acute mental health needs are placed in St.
Charles Medical Center. Once stabilized, clients are transfered to Sage View when that is deemed
benefical and necessary.
Wait List Reduction Project-We coordinate placements with any state hospital facility for Deschutes
County residents in need of long-term care. DCMH staff work closely with each of the out-of-area
facilities to coordinate intake, care and discharge planning. Central Oregon counties continue to
make every effort to reduce our use of out-of-area facilities by using our limited local options.
Development of viable community systems remains a high priority for Central Oregon.
Utilization Management Improvements-The Central Oregon region has a utilization manager hired
by ABHA as our shared mental health organization. The manager oversees, authorizes and helps
coordinate services, admissions and discharges for indigent and OHP consumers at any acute or sub-
acute facility serving our clients. DCMH staff are actively involved in this process as well, including
care coordination and transition planning.
Other Services and Changes Since 2007-2009-While the general system has seen notable
improvements, respite care options remain insufficient. We are continuing to evaluate and explore
options for other step-down and respite services and other sub-acute care. All available SE 24 and
Oregon Health Plan resources are invested in the system at this time.
A note of caution: Indigent resources provided through the State of Oregon, while increased, may
still be inadequate to meet acute care needs in our region over the next several years. Our three-year
investment plan for these resources is not sustainable, requiring selection of our more effective
strategies or additional investment by the State of Oregon.
Page 10 of 81
4. Residential/Detoxification Services Coordination
When detoxification and/or residential alcohol/drug treatment is needed, the DCMH case manager
will facilitate admission to the appropriate treatment facility and will maintain contact with the client
and the facility's treatment staff. The treatment facility will coordinate ongoing outpatient care with
the DCMH case manager when the client is ready for discharge from the facility.
5. Coordination of Addictions Treatment With the Criminal Justice System and Drug
Court Referral Process
SE 66 funding goes to local alcohol and drug outpatient providers, and the corrections population is
identified as one of the priority populations for these services. DCMH recently released a Request for
Proposals, in cooperation with the Deschutes County Sheriffs Office, to provide ongoing addiction
treatment services both while incarcerated and sustained upon release from the jail. SE 66 funding
also helps to support the Bridge Corrections Program wherein DCMH staff work with the local Adult
Jail and Parole & Probation department to connect clients with a serious mental illness and co-
occuring addictions problem to treatment and other social services.
Deschutes County Family Drug Court Referral Process:
Any community agency that is involved with a defendant who is a potential candidate for the
Deschutes County Family Drug Court (DCFDC) program can refer a case to the program. If the
referral meets the admission criteria, it is processed in the following way:
■ The referral is forwarded to the DA's Office and DHS for review. The DA's representative and
DHS representative determine whether the referral is appropriate for the DCFDC based on
criminal and DHS history.
■ If deemed appropriate by the DA and DHS, the referral is then sent to the DCFDC Judge and the
treatment team for consideration.
■ If deemed appropriate by the DCFDC Judge, a hearing is scheduled for the referred party to
appear in front of the DCFDC Judge in order for the court to provide information about the
program and determine if the referred party is interested in participating in the program.
If the referred party is interested in participating, the contracted treatment provider on the team
conducts an initial alcohol and drug treatment screening to determine whether the referral is
appropriate for the level of care offered by the DCFDC program.
■ After the treatment screening occurs, the treatment team meets to discuss the referral then snakes
a recommendation to the DCFDC Judge regarding whether to admit the referred party into the
program.
• If the DCFDC Judge decides to admit the participant into the program, the participant is eligible
to begin services with DCFDC immediately after he/she is accepted into the program.
Deschutes County Family Drug Court Admission Criteria:
The participant must have an active dependency and/or criminal case.
The participant must have a child(ren) that he/she is responsible for parenting. The child(ren) can
be in the custody of the participant, DHS or other relative placement at the time of DCFDC entry.
The participant must have an active substance abuse problem as demonstrated by one or more of
the following: current drug related criminal charges, a dependency case resulting from drug
related circumstances, a history of positive drug tests administered by DHS and/or the probation
Page 11 of 81
department, or pending probation violation proceedings resulting from drug related
circumstances.
The drug abuse problem may involve methamphetamine, other drugs, alcohol, or a combination
thereof.
6. High Priority Needs
Program Priorities:
a. Acute Care & Crisis Services-Increase Crisis Team staffing. Analyze data and trends for
commitment investigation and civil commitments. Evaluate performance of new Mobile Crisis
Team. Increase use of Acceptance Commitment Therapy. Increase payment for Sage View
indigent care. Develop crisis respite option(s). Resources needed for respite options.
b. Chemical Dependency-Increase addictions treatment services for adults in the justice system,
parents in the child welfare system, indigent adolescents and adults with co-occurring disorders.
Measure utilization and benefit.
c. Children's Services-Develop early psychosis program using team approach (28 young people
ages 12-30). Sustain Children's System of Care for children with significant mental health needs
by offering wrap-around services; maintain low use of psychiatric residential services; increase
intensive community treatment options. Seek resources for school services. Deternline treatment
capacity needed for KIDS Center and role in functional family therapy. Resources needed for
school services.
d. Senior Services-Measure current and needed capacity to serve this growing population.
Participate in statewide advocacy to increase geriatric services. Document performance and
benefit. Resources needed.
e. Criminal Justice-Grow alternatives to incarceration; complement County jail expansion. Assist
with in jail mental health program planning and interface. Participate in jail Reach In Program.
Expand Mental Health Court (25 clients) and Bridge Corrections Program (75 clients); strengthen
data collection. With Sheriff s Office, expand addictions treatment during and after
incarceration. Sustain Family Drug Court. Continue law enforcement training; support Crisis
Intervention Training. Resources needed for Bridge, MH Court, and CIT.
f. Developmental Disabilities-Expand case management and respite services for DD clients and
their families. Participate in State discussions of County role(s) in DD services; promote primary
role for County in planning, services and system coordination.
g. Emergency Preparedness-Adopt a County behavioral health plan by December, 2008 including
role(s) of DCMH. Include staff readiness, support to vulnerable populations, help for first
responders and public education. Enlist help of others. Resources needed.
h. Employment-Expand DCMH Supported Employment Program based on best practice. Provide
vocational services to 65 clients. Add two employment specialists (1.75 FTE).
i. Housing-Increase bed capacity in the County. Help Telecare develop a 10-bed secure'program
and an 8-bed program. Work with Springbrook to reopen a 5-bed home for Psychiatric Security
Review Board clients. Help Housing Works develop transitional housing for people with mental
illness. Develop a DCMH housing specialist position by 2009. Pending: Expand supported
housing and homeless outreach. Resources needed for supported housing, homeless outreach,
transitional housing and housing vouchers.
j. Cultural Competency and Service-Develop multiple strategies to increase access to services for
people of color; emphasize the Latino community. Resources needed.
Page 12 of 81
Resiliency and Recovery Based System; Client and Family Involvement-Encourage people to
take control of their lives and participate fully in the community. Involve clients in services, program
development, evaluation, education and advocacy.
a. Resiliency and Recovery Model-Promote resilience, recovery, and self-sufficiency for our
clients. Include client recovery-oriented goal(s) in treatment plan and progress notes.
b. Participation and Leaders Seek participation of clients and family members on decision
making committees. Promote and support consumer leadership.
c. Evaluation-Emphasize client involvement in quality improvement. Review Deschutes County
client satisfaction survey results. Gain feedback from non-OHP clients as well.
d. NAMI-Collaborate with NAMI of Central Oregon on projects of mutual interest including the
Peer to Peer Program and training for law enforcement. Resources needed.
Accountability, Access and Public Benefit-Strive for excellence. Emphasize best practice,
compliance, quality improvement, and productivity. Conduct outreach, offer local services; reduce
wait lists and no shows where possible.
a. Medicaid Compliance-Assure compliance with key Medicaid rules (2007 Fraud & Abuse
Training). Consult with ABHA, the Division of Medical Assistance, and the State Audits
Division. Manage project through a DCMH Medicaid Work Group. Resources needed.
b. Contracting-Improve DCMH document management and contract monitoring. Develop a
contracts specialist position. Resources needed.
c. MMIS Replacement-Participate in. Oregon's upgrade of its Medicaid Management Information
System (claims processing and provider payments). Use new system in 2008. Assure DCMH
systems and processes interface effectively.
d. Community Report-Publish an annual report on our services and performance.
e. Web Site-By June, 2009, update Department web site; include service, performance, and
resource information. Consider use of Network of Care system. Resources needed
f. Performance Review-Review data at least quarterly including productivity, quality measures,
chart improvements, complaints and critical incidents. Review Oregon Change Index data and
Devereux Assessment Tool data.
g. Access-Analyze access to services. Seek equitable access for indigent and OHP clients in north
and south Deschutes County. Re-examine mobile crisis region in 2009. Participate in plans for a
County Redmond campus. Sustain school services in Redmond and La Pine. Seek resources to
serve a growing seniors community. Resources needed.
h. Electronic Records-Initiate 2008 needs assessment and seek software options that meet our
needs and resources. Complete feasibility study and business plan in 2009. Consider acquiring a
new information system to support treatment, reduce paperwork, document services and secure
revenue. Resources needed for implementation.
i. Licenses-Complete state processes to renew service licenses including alcohol and drug
treatment and prevention (expires June, 2008), mental health treatment services (expires June,
2008) and children's intensive services (expires September, 2009).
Sustainability, Stewardship and Resource Development-Sustain core services, meeting the needs
of a growing community whenever possible. Manage resources wisely and balance our budget while
meeting our legal and contractual obligations.
a. Sound Financial Management-Prepare a 2008-2009 budget that supports the Strategic Plan.
Update the three-year financial plan semi-annually; using operating funds and reserves to balance
the budget and cover essential costs.
Page 13 of 81
Encounters-Document services at levels that meet or exceed revenues used. Annually, calculate
service unit costs based on expenses and within Medicaid rules.
New Funding-Work with the County grant writer to seek new resources for 1) seniors mental
health, 2) school-based mental health, and 3) alternatives to incarceration. Resources needed.
Help for Oregon Health Plan Members-Assure access to services, document encounters and
participate fully in our mental health and chemical dependency organizations. Seek ways to increase
penetration rate, manage limited resources, and meet State compliance requirements.
7. Allocation and Use of Resources Provided by AMH
DCMH uses State resources according to the guidelines laid out in the AMH/Deschutes County
Financial Assistance Agreement. These resources are used to provide in-house and subcontracted
services. The increase in use of subcontracted providers relates primarily to alcohol and drug
treatment services for those involved in the criminal justice or child welfare system. Resources are
used to increase and improve the use of evidence based practices by training DCMH staff in
Collaborative Problem Solving, Acceptance Commitment Therapy, Motivational Interviewing, and
Seeking Safety. All these techniques are used in many of the different services we provide. There
are no reallocations to service elements.
Page 14 of 81
Addictions and Mental Health Division - Attachment 1
LIST OF SUBCONTRACTED SERVICES FOR DESCHUTES COUNTY
For each service element, please list all your treatment provider subcontracts
on this form. In the far right column indicate if the provider delivers services
specific to minorities, women, or youth.
Provider
Approval/License
Service
AMH Funds in
Specialty Service
Name
ID Number
Element
Subcontract
BestCare Treatment
93-1269087
66
$140,000
Bilingual in Spanish
Services
Commission on Children
93-6002292
70
$180,000
Youth
& Families
Gayle Woosley
200050099NP
22
$140,000
Youth
Joseph A. Barrett
MD 24477
20, 25, 30,
$60,000
35
Marc Williams
MD 22829
20, 25, 30,
$400,000
35
Pfeifer & Associates
93-1254885
66
$140,000
Rimrock Trails Adolescent
93-1019081
66
$85,000
Youth
Treatment
Cascade Healthcare
93-0602940
24
$1,000,000
Community, Inc.
Page 15 of 81
Addictions and Mental Health Division - Attachment 2
BOARD OF COUNTY COMMISSIONERS REVIEW AND APPROVAL
County: Deschutes
In accordance with ORS 430.258 and 430.630, the Board of County
Commissioners has reviewed and approved the mental health and addiction
services County Biennial Implementation Plan for 2009-2011. Any comments are
attached.
Name of Chair: Dennis R. Luke
Address: 1300 NW Wall Street
Bend, Oregon 97701
Telephone Number: (541) 388-6570
Signature:
Date:
Page 16 of 81
Addictions and Mental Health Division - Attachments 3 and 4
ADDICTIONS AND MENTAL HEALTH ADVISORY BOARD
(Combined Local Alcohol & Drug Planning Committee and Local Mental Health Advisory Committee)
REVIEW AND COMMENTS
County: Deschutes
See attached roster.
In accordance with ORS 430.342, the Deschutes County Addictions and Mental
Health Advisory Board (AMHAB), a combined Local Alcohol & Drug Planning
Committee and Local Mental Health Advisory Committee established in
accordance with ORS 430.630(7), recommends the state funding of alcohol and
drug treatment services as described in, and further recommends acceptance of, the
2009-2011 County Implementation Plan. Further AMHAB comments and
recommendations are attached.
Name of Chair: Dolores Ellis
Address: 2577 NE Courtney Drive
Bend Oregon 97701
Telephone Number: (541) 322-7504
Signature:
Date:
Page 17 of 81
DESCHUTES COUNTY MENTAL HEALTH
ADDICTIONS AND MENTAL HEALTH ADVISORY BOARD
2008 ROSTER
Name
Address
Phone Number
Dolores Ellis, Chair
19492 Sugar Mill Loop, Bend, OR 97702
617-5901
Pat Croll
120 SW 17`h Street, Bend, OR 97702
388-2577
Chuck Frazier
1363 NW City View Drive, Bend, OR 97701
617-1020
Chuck Hemingway
1715 NE Sonya Court, Bend, OR 97701
318-1897
Glenda Lantis
2534 NE Jenni Jo Court, Bend, OR 97701
385-8645 (H)
318-3753 (W)
Alison Lowe
2190 NW Canal Blvd, Redmond, OR 97756
548-5578
David Marchi
2058 NW Pinot Court, Bend, OR 97701
383-3150
Mary Martin
60823 Windsor Drive, Bend, OR 97702
385-6879
Jennifer McKague
2325 NW Antler Court, Redmond, OR 97756
504-0083
Kristin Powers
2576 NE Lynda Lane, Bend, OR 97701
385-6144 (H)
693-5855 (W)
Beth Quinn
61247 King Solomon Lane, Bend, OR 97702
419-6521
Lee Ann Ross
3062 NW Underhill, Bend, OR 97701
312-2568
Nancy Ruel
P. O. Box 3668, Bend, OR 97707
593-7493 (H)
317-9623 x 233 (W)
Julie Rychard
P. O Box 1678, La Pine, OR 97739
420-3741 (H)
749-2158 (W)
Marianne Straumfjord
569. North Tam Rim Drive, Sisters, OR 97759
549-1455
Bert Swift
64750 Saros Lane, Bend, OR 97701
617-8754
Pat Tabor
63360 Britta St., Building 2, Bend, OR 97701
383-4385 (W)
617-1255 (H)
Patricia von Riedl
1875 NE Purcell, #100, Bend, OR 97701
317-0586
Darrel Wilson
19810 Connarn Road, Bend, OR 97701
382-3796 (H)
548-2611 (W)
Page 18 of 81
Addictions and Mental Health Division - Attachment 5
COMMISSION ON CHILDREN & FAMILIES REVIEW & COMMENTS
County: Deschutes
The Deschutes County Commission on Children & Families has reviewed the
alcohol and drug abuse prevention and treatment portions of the county's Biennial
Implementation Plan for 2009-2011. Any comments are attached.
Name of Chair: Renee Windsor
Address: 1130 NW Harriman Street
Bend Oregon 97701
Telephone Number: (541) 385-1717
Signature:
Date:
Page 19 of 81
Addictions and Mental Health Division - Attachment 6
COUNTY FUNDS MAINTENANCE OF EFFORT ASSURANCE
County: Deschutes
As required by ORS 430.359(4), I certify that the amount of county funds allocated
to alcohol and drug treatment and rehabilitation programs for 2009-2011 is not
projected to be lower than the amount of county funds expended during 2007-
2009. The County Budget process occurs annually and future revenue available to
Deschutes County is uncertain. The County has consistently supported mental
health and other human services with County General Fund resources. This
information is available in June of each year at the time of budget adoption.
Scott Johnson, Director
Signa
3.4.8
Date
Page 20 of 81
Addictions and Mental Health Division - Attachment 7
PLANNED EXPENDITURES OF MATCHING FUNDS (ORS 430.380) AND
CARRYOVER FUNDS
County: Deschutes
Contact Person: Sherri Pinner, (5411322-7509
Matching Funds
Source of Funds Amounts Program Area
None
Carryover Funds
AMH Mental Health Funds
Carryover Amount from
2007-2009
Planned Expenditure
Service Element
New resources for the
Central Oregon acute
care system
Sage View and other
acute care services
2007-2011
24
AMH Alcohol & Drug
:Funds Carryover Amount Planned Expenditure Service Element
from 2007-2009
None
Page 21 of 81
Addictions and Mental Health Division - Attachment 8
REVIEW AND COMMENTS BY THE LOCAL CHILDREN, ADULTS
AND FAMILIES DISTRICT MANAGER FOR THE DEPARTMENT OF
HUMAN SERVICES
County: Deschutes
As Children, Adults and Families District Manager for the Department of Human
Services, I have reviewed the 2009-2011 Biennial County Implementation Plan
and have recorded my recommendations and comments below or on at attached
document.
Name of District Manager: Patrick Carey
Signature:
Date:
Page 22 of 81
Addictions and Mental Health Division- Attachment 9
REVIEW AND COMMENTS BY THE LOCAL PUBLIC SAFETY
COORDINATING COUNCIL
County: Deschutes
The Local Public Safety Coordinating Council has reviewed the 2009-2011
Biennial County Implementation Plan. Comments and recommendations are
recorded below or are provided on an attached document.
Name of Chair: Judge Michael Sullivan Presiding Judge
11 th Judicial District
Address: 1100 NW Bond Street
Bend, Oregon 97701
Telephone Number: (541) 388-5300
Signature:
Date:
Page 23 of 81
PREVENTION PLAN
Deschutes County's prevention efforts are effective due to the strong community-based input received.
Oversight by the Addictions and Mental Health Advisory Board (AMHAB) and the local Commission on
Children and Families (CCF), in addition to the input of the Deschutes Prevention Partners Coalition and
rural coalition members, has allowed a melding of separate community plans and needs into one
comprehensive county plan. The Deschutes County Prevention Team has been involved in all aspects of
local Partners for Children & Families planning and fund allocation process. The Prevention Coordinator
assists in the allocation of monies in order to fund prevention projects through SB 555.
The current Deschutes County Ten-Year Community Plan cites reduction of eighth grade alcohol, tobacco
and other drug use as one of the long-term outcomes. The comprehensive plan submitted to the State
OCCF for eighth grade alcohol, tobacco and other drug use outlines expectations of our family
management skills training programs, evidence-based school curricula, advocacy and policy making and
other projects, activities and mobilization to address this outcome.
Community mobilization will be conducted through support to local prevention teams. The vast majority
of funds needed to support these adult and youth teams comes through the Drug Free Communities grant
and the Safe and Drug Free Schools state dollars. However we will use a small portion of AD 70 funds to
assist the rural coalitions with prevention focused projects and activities. These rural prevention
coalitions, supported by Prevention Team staff, conducted their initial needs assessments in 2001-2002
and update their strategic plans annually. The individual rural coalitions have identified priorities and
continuously implement strategies to reduce adolescent substance abuse to address the community's
needs.
Deschutes County will keep focus on social and health consequences of underage alcohol and other drug
use through the implementation of evidence-based middle and high school programs for youth and/or
their families, public awareness of the issues county-wide, support of local surveillance operations, and
youth-led projects.
Public awareness about alcohol, tobacco and other drug use will continue to be woven into all prevention
work within the county. In the past the Prevention Team has sponsored various trainings on curricula and
issues surrounding alcohol, tobacco and other drug use and will continue to do so as funding is available.
Although this is not a major component of our plan, we will continue to educate the community through
our local prevention teams, press releases, town halls and trainings. Deschutes County currently uses the
following Substance Abuse and Mental Health Services Administration programs. These programs are
coordinated through several different agencies and are not necessarily funded through AD 70 or
prevention funds.
Model:
Communities Mobilizing for Change on Alcohol
Guiding Good Choices
Incredible Years
Life Skills Training
Project Towards No Drug Abuse
Second Step
Strengthening Families
Functional Family Therapy
Healthy Families America
Preparing for the Drug Free Years
Effective: Promising:
Big Brothers/Big Friendly PEERsuasion
Sisters Nurturing Parenting Programs
Preschool and Toddler
School-Aged Children
Families in Recovery
Spanish Families
Making Parenting A Pleasure
Page 24 of 81
The support and advocacy for implementation and continuation of evidence-based curricula in both
middle and high school will be continued. The goal is to continue implementation of Friendly
PEERsuasion at its current sites and assist in implementation at other sites through mobilization efforts.
By providing the curriculum and free training to the sites, we have found it has been easier for the schools
and other youth serving organizations to implement the program.
The annual Youth Conference will be held in the fall at the local Fair and Expo Center. Past conferences
have hosted more than 350 youth and advisors who spend the day attending prevention-focused breakout
sessions and a school-team debrief meeting to assist in integrating the day's message into a prevention-
focused activity with an action plan. Teams are asked to submit their prevention plan activity, and in
recent years over 70% of teams completed their activity! Planning for the conference is a collaborative
effort and includes local agencies, businesses, fraternal organizations and community volunteers. A small
amount of AD 70 funds is used to support the conference, with over 75% of the needed revenue received
through community donations.
The county will continue to support alcohol and drug assessments for school-aged youth through other
funding sources. By providing assessments to youth within the school system or in their local
community, we have broken down one of the many barriers to identification and referral. Youth
completing the assessments are tracked to keep data on the percentage of youth following the
recommendations received based on the assessment.
Deschutes County contracts with Latino Community Association, which is a telephone and face-to-face
information referral` service. They also provide oral and written translation service to individuals and
programs throughout the county. Through partnerships with community programs, cultural awareness
activities and Cultural Competency trainings provided by the Latino Community Association, the entity
has developed a strong collaboration of efforts throughout the county. Each contractor receiving CCF,
JCP, AD 70 or County funds is encouraged to attend cultural competency training each fiscal year. All
local programs are notified of cultural competency trainings as they are made available.
As state and federal funds shift, the ability to continue on-going professional development for staff will
become more available. Staff will be attending the two mandatory Prevention Coordinators meetings at
the state level, and the National CADCA conference (as long as federal funds are available) and will
continue to attend the statewide prevention conferences as they are provided. The County will also keep
in mind the WestCAPT internet classes and other free or inexpensive trainings that may be available in
the future.
The quarterly meetings of the Deschutes Prevention Partners Coalition, the blending of efforts through
Commission on Children and Familes, Juvenile Community Justice, Tobacco Free Alliance; Addictions
and Mental Health Advisory Board, and the many other collaborative efforts underway within our
community facilitate coordination of prevention efforts within the county. It is because of these important
linkages that we are able to effectively examine and respond to issues around substance abuse, violence
prevention and healthy lifestyles in Deschutes County.
AD 70 Budget 2009-2011
Personnel
Community coalitions
Evidence cased curricula for MS/HS and/or families
Gender specific curricula
Youth Conference and youth team
Retailer training/Reward Reminder Program
Professional development
Total
$39,500
16,500
10,000
10,000
8,500
2,000
1,000
$87,500
See details below.
Page 25 of 81
Provider Name
Approval/
Service
AMH Funds
Specialty Service
License ID
Element
in Subcontract
Number
BestCare Treatment
93-1269087
AD 70
$ 5,500
On-going implementation
Services
of direct services programs
for community coalitions
La Pine Park and
93-1314045
AD 70
$ 5,500
On-going implementation
Recreation
of direct services programs
for community coalitions
Sisters Organization
93-1214147
AD 70
$ 5,500
On-going implementation
for Activities and
of direct services programs
Recreation
for community coalitions
Total
$16,500
2009-2011 Prevention Funding Plan Baseline Budget Narrative:
The following explanation is based on an annual budget. Budget numbers for 2009-2010 and 2010-2011
will remain the same.
Personnel/Staff ($39,500 annually) will cover the project coordination for the Youth Conference,
oversight of evidence-based curricula throughout Deschutes County, school alcohol and drug assessment
services. Personnel dollars will fund a portion of the salaries of the County Prevention Coordinator,
Robin Marshall, and the AD 70 Program Contact, Julie Spackman.
Community Coalitions ($16,500 annually) will be divided equally among and used to support three
separate rural coalitions in the communities of La Pine, Sisters and Redmond. These funds will be used
to advocate for and implement research-based prevention programming at the community level.
Evidence-Based Curricula ($10,000 annually) will be used to purchase curricula, provide trainings and
supplies for middle and high school evidence-based practices for all participating sites.
Gender-Specific Curricula ($10,000 annually) will be used to purchase curricula, provide _trainings and
supplies for middle and high school evidence-based practices for all participating sites.
Annual Youth Conference and Activities ($8,500 annually) will be used for Youth Conference and
team activities to contract for alcohol, tobacco and other drug prevention speakers; youth team projects
and other general costs necessary for an effective prevention event for youth.
Accessibility to Alcohol ($2,000) will be used annually to offer, in partnership with OLCC and Tobacco
Free Alliance, at least one training to retailers in Deschutes County.
Professional Development/Training ($1,000 annually) will be used to allow attendance at two AMH
sponsored prevention meetings, web access training, and other inexpensive workshops throughout the
fiscal year.
Page 26 of 81
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PROBLEM GAMBLING SERVICES PLAN
Deschutes County Mental Health will continue to provide gambling treatment and prevention services to
residents of Deschutes, Crook and Jefferson counties in the next biennium.
While treatment services historically were provided primarily in Bend, we have been able to increase and
improve access by providing services in Madras and in Prineville as well. It is clear that on-site services
in those communities improves the accessibility of our gambling services in those outlying areas. The
plan is to continue this in the 2009-2011 biennium.
Minimal revisions are expected in our existing gambling prevention plan. The focus will continue to be
on targeted media campaigns, both radio and television, to reach a large segment of the Central Oregon
community. In addition, we will continue to provide regular education to a variety of agencies and
groups in the community to increase awareness of problem gambling and treatment referrals.
One particular focus will be on expanding and improving our targeted focus of gambling prevention
education to adolescents within Deschutes County. We will also continue to request that a small amount
of prevention dollars be designated for treatment enhancement (currently 10%) to assist with special
needs, primarily focused on case management and dual diagnosis (e.g., medication management) services
when needed.
Page 28 of 81
CHILDREN'S MENTAL HEALTH SERVICES PLAN
Families and youth are engaged in planning and service development in a variety of ways.
Clients are active participants in collaborating with the provider in their own treatment planning.
Clients also participate by completing the Oregon Change Index (OCI) questionnaire, which
encourages consumer feedback about services received. In addition, our clinicians offer a
Devereux Assessment Tool (DSMD) with child, parent and teacher input to assess mental health
concerns and to determine the efficacy of our interventions. As part of the Children's System of
Change Initiative (CSCI), all children and families involved in Intensive Children's Treatment
Services (ICTS) are involved in determining treatment services with a community involvement
focus. All services are consumer driven. We also encourage input from the Deschutes County
Addictions and Mental Health Advisory Board as well as the Central Oregon Regional Advisory
Board (for the CSCI).
We emphasize the strengths inherent in all cultures and examine how our system of care can
more effectively deal with cultural differences and related treatment issues. We view cultural
competence as a developmental process. We are sensitive and strive to adapt services in
response to cultural mores, appropriateness and efficacy of interventions. We try to include the
minority family and community in developing resources, setting goals, and outlining action
steps. Additionally, a certain percentage of staff attends cultural competency classes on an
ongoing basis. We have adjunct on-call staff available who are fluent in a variety of foreign
languages, and interpreters are provided at no charge to the consumer.
Clients give us feedback on where their needs are not being met; and we try, depending on
budget constraints, to assess and meet those needs. We stay current with new evidence based
practices and have an agency committee who looks at new developments and how we may
implement them into best practices. We provide significant staff training throughout the year
with an emphasis and focus on child development in the context of family. We look at grant and
other funding opportunities. We have just begun a new eighteen month pre-psychosis program
providing comprehensive education and direct services to youth and their families.
Community collaboration and engagement is a primary focus of the Child and Family Program.
As part of the CSCI, we collaborate strongly with other community partners. We collaborate for
ICTS with Cascade Child Center, the Bend-La Pine and Redmond school districts as well as
Maple Star and DHS for foster placement services. We coordinate our alcohol and drug
prevention services with the Commission on Children & Families. We coordinate our work
frequently with law enforcement, Juvenile Justice and other County departments, and other
providers such as Cascade Healthcare Community. We strive for area involvement, not only in
Deschutes County, but for the entire Central Oregon region. We work closely and
collaboratively with Jefferson County and BestCare Treatment Services, as well as with
Lutheran Community Services in Crook County, all with the goal of ensuring services and
supports are comprehensive and well coordinated.
Coordination and continuity of care is achieved through the following services to ensure that
children and youth remain at home, in school, and out of trouble.
Page 29 of 81
Alcohol and Other Drug: Provide evaluations of youth to determine need and level of
services through comprehensive assessment including the use of American Society of
Addiction Medicine Patient Placement Criteria (ASAM-PPC). Contract with community
providers to offer intensive outpatient services. In conjunction with Deschutes County
Commission on Children and Families, provide intensive prevention outreach services
through Towards No Drug Abuse (TNDA) program in school settings.
2. School Based Services: Currently provide on-site therapy and alcohol/drug counseling
services in twenty-seven public schools (15 elementary, 6 middle and 6 high schools) in the
community. Sufficient funding is necessary to assure mental health and addiction services
are available in Deschutes County schools at least one day per week. Availability is
declining, and the number of public schools services requested continues to increase due to
population growth. Safe School Assessments have been provided as follows: 74 referrals
and 299 service hours in the 2005-2006 school year; 86 school referrals and 436 hours in the
2006-2007 school year. We project at least a 10% to 15 % increase in Safe School
Assessment referrals in upcoming years.
3. Clinic Based Services: We have continued the effort to assure community-based outpatient
services at a level that will limit a wait list and assure we meet a growing community need.
These services mitigate the need for higher cost residential and hospital placements in the
coming years. We offer individual, family and group therapy. Sufficient funding to assure
mental health and addiction services are available in Deschutes County is of great importance
as current staffing is stretched between school based services and covering clinic needs. We
provided 303 new intake screenings in 2007 in addition to clients we already were serving.
This does not include new intake screenings for children we see in the school settings. We
also provide mediation services for families in transition.
4. Children's System of Change Initiative: There is a need for Intensive Children's Treatment
Services resources sufficient for service needs of Levels 4, 5, and 6. We have developed a
comprehensive wrap-around model and care coordinator roles given limited resources.
Resources for care coordination as currently practiced are inadequate to be sustainable. As
no local Psychiatric Residential Treatment Services (PRTS) is available since Trillium's local
services ended, there is an increased demand in this area and focus on keeping children in the
community. Currently, we are contracting with Cascade Child Center for day treatment
services. We remain active in partnership with Cascade Child Center and with Crook and
Jefferson counties and ABHA in trying to sustain a small PRTS program in Central Oregon.
We are working more collaboratively with a local foster home placement agency, Maple
Star, to assure needed services are available. More support is needed to continue these vital
services.
Services to victims of abuse and neglect: Continuation of treatment services at the KIDS
Center at a level that will limit wait list and assure help for victims of abuse. Sustainability
and expansion of services is dependent upon sufficient funding. Currently working on JDS
grant focusing on youth suicide prevention.
Page 30 of 81
OLDER ADULT MENTAL HEALTH SERVICES
The Seniors Mental Health Treatment Program receives less than $9,000 annually to serve people 65 and
older who have mental health issues. Our managed care organization and our County general fund dollars
add to that amount so that we can have 2.5 FTE serving this population. There are currently 450 clients
opened in this program. Due to the staffing shortage, we can serve only the most acute situations which
leaves many others seniors to deal with depression, anxiety, substance abuse and other mental health
issues without services. Those families who try to help out with their family members in need of help
often end up needing help themselves.
Senator Gordly's report on Senate Bill 1075 states that seniors experience a higher rate of mental illness
and addiction than the general population. National figures indicate 15%-25% of those over 65 have
mental health problems requiring intervention. For Deschutes County that would mean between 4,000-
5,000 seniors would be expected to be in need, and we are able to serve less than 10% of them. The
population of those over 65 is expected to grow at almost three times the rate of the general population.
With no additional funding, the gap between the available service and the need for that service continues
to grow. Although today seniors represent 13.7% of the population, they account for 25%-30% of all
successful suicides. Suicide is often the consequence of failing to provide services to this population. As
the number of those unable to access services grows, so will the number of people who end their lives in
isolation and desperation.
In addition to needing more staff service hours there is also a need to provide targeted training to the staff
who work with older adults. The combination of medical and mental health issues presented by this
population requires specialized training that is becoming increasingly difficult to access. The State is no
longer providing these training opportunities, and with limited funding it is difficult to access this training
through the private sector.
In an attempt to provide additional service we have looked to using volunteers and interns to provide
some services to the seniors in less acute situations. This can provide additional service hours but
requires staff time to train, monitor and support the volunteers and interns. We would like to add a
position that could provide these needs and increase our ability to connect with people living in isolated
situations.
We need to find a way to double our current staffing and look to triple it by the 2009-2011 biennium in
order to keep pace with the anticipated growth. If we can better meet the needs of this population, we can
expect lower costs for medical interventions, reduction in the number of suicides among the senior
population and improved quality of life for those at the end of their lives.
Our Enhanced Care Outreach Services (ECOS) program has been very successful in dealing with a small
number of high needs seniors who are very difficult to serve in the residential programs. Unmet mental
health needs have meant seniors in residential care were often in almost constant transition. Through
these targeted services we have been able to break the cycle of multiple placements and difficult
relationships with providers and other residents that often lead to the need for stays at Oregon State
Hospital (OSH). We have been able to bring home Central Oregonians who were placed at the State
Hospital and have not had to make new placements there. Preventing that first placement at OSH keeps
clients much more successful in their residential programs. This is a very cost effective program as the
cost for one individual in the ECOS program is about $1,200 per month while a stay at the State Hospital
is over $15,000 per month. The success of this program relies on the ability to provide intensive
treatment (low staff-to-client ratio) and a good working relationship with our local SPD program. The
ECOS program needs to be able to grow and maintain the staffing ratios as the population grows.
Page 31 of 81
A.
Biennial Plan supplement
AMH: Deschutes County Mental Health uses a Strategic Plan to guide our work. The
Plan covers a longer time frame than the Biennial Plan and includes work not required
by nor described in the Biennial Plan. Please regard this draft plan as a supplement to
our 2009-2011 Biennial Plan. You will find numerous mental health sections as well as a
section on addictions work. The final, adopted Strategic Plan will be submitted to AMH
when adopted, most likely in April or May.
Deschutes County
Mental Health
Strategic Plan
2008-2013
April, 2008
Our mission
To provide high-quality and integrated client-centered
services that will enable those we serve to strengthen their
lives and roles in the community.
Deschutes County Board of Commissioners
April, 2008 (scheduled for adoption)
Deschutes County Addictions & Mental Health Advisory Board
April, 2008 (scheduled for adoption)
The purposes of this Strategic Plan are threefold:
1. To strengthen our organization for the benefit of our community;
2. To focus our efforts on projects and services that will benefit the people we serve; and
3. To inform and enlist the support of the public and our community partners.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 1
ACKNOWLEDGEMENTS
With gratitude to
The staff of the Deschutes County Mental Health Department and the Department's contractors
and community partners for their dedication to the clients we serve.
The Deschutes County Board of Commissioners
Dennis R. Luke 2008 Chairperson
Tammy Melton 2008 Vice Chair
Michael M. Daly Commissioner
Members of the Strategic Planning Work Group
Dolores Ellis,
Chair, Deschutes County Addictions & Mental Health Advisory Board
Chuck Frazier
Addictions & Mental Health Advisory Board; Governor's Seniors Commission
Glenda Lantis
Addictions & Mental Health Advisory Board
Alison Lowe
Addictions & Mental Health Advisory Board
Leo Mottau
Addictions & Mental Health Advisory Board (2007)
Roger Olson
NAMI of Central Oregon Board
Lindsay Stevens
Addictions & Mental Health Advisory Board (2003-2006 check)
Bert Swift
Addictions & Mental Health Advisory Board
Contributing Deschutes County Staff
Sherri Pinner
DCMH Operations Manager
Kathy Drew
DCMH Developmental Disabilities and Seniors Program Manager
Barrett Flesh
Child & Family Program Manager
Lori Hill
Adult Treatment Program Manager
Kathe Hirschman
Senior Administrative Secretary
Scott Johnson
DCMH Director
Marty Wynne
Deschutes County Finance Director (three-year financial forecast)
Special thanks
to the many staff, volunteers and community partners
who also contributed their time and ideas to this plan.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 2
TABLE OF CONTENTS
Page
Common Acronyms Used In This Plan
A. Executive Summary, Will be updated
B. Overview Will be updated
C. Our Vision, Mission, Core Values
D. Policies
E. Environmental Trends and Challenges
F. SWOT Analysis
G. 2008-2009 Work Plan
H. Longer Term Priorities 2008-2013
1. Consumer and Family Involvement
2. Organizational Development
3. Business Services
4. Program Development (General) -Quality, Access, Services and Productivity
5. Child and Family Services
6. Adult Mental Health Treatment and Support Services
7. Seniors' Mental Health Services
8. Chemical Dependency
9. Justice System Services and Alternatives to Incarceration
10. Developmental Disabilities Services
1. Appendices
1. Financial Plan 2008-2011
2. Local Mental Health Authority Responsibilities
3. Deschutes County Goals & Objectives
4
5
7
8
9
12
15
17
19
21
25
27
29
32
34
36
38
44
46
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 3
COMMON ACRONYMS USED IN THIS PLAN
ABHA Accountable Behavioral Health Alliance, our five-county managed care
organization for mental health services for Oregon Health Plan members.
AMHAB Deschutes County Addictions & Mental Health Advisory Board, a 19-member
citizen Board appointed by the Deschutes County Board of Commissioners (the
Board) to advocate, plan educate and offer guidance to the Board and the
Deschutes County Mental Health Department.
DCMH Deschutes County Mental Health Department
OHP Oregon Health Plan, the program through which many Oregonians eligible for
Federal Medicaid health services receive assistance.
PSRB Psychiatric Security Review Board, the Board responsible for forensic clients who
have committed felonies but for reason of insanity are housed at the Oregon
State Hospital or are managed in the community but mental health programs like
Deschutes County Mental Health Department
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 4
Deschutes County Mental Health
2008-2013 Strategic Plan OLD / TO BE UPDATED
NOTE TO SCOTT: Mention that our reserves will be drawn down to minimum within the time
period of this plan and that we need to start now to think about what we'll do when that
happens (from 2/20 Work Group meeting)
A. EXECUTIVE SUMMARY
Deschutes County offers essential services to the residents of
Oregon's fastest growing county. County sponsored health,
human services and public safety programs benefit children,
families and people challenged by a disability, mental illness,
or addiction. Deschutes County's Mental Health Department
is on the front line of this effort to help local residents in need.
This Strategic Plan for the Mental Health Department clarifies
as many as 7,350
Deschutes County
adults and 3,150
children may need
mental health services
in 2006."
our vision, mission and values. It also includes our program
priorities for the next four years. It is an ambitious agenda in uncertain times. Our ability to
be successful in carrying out this plan will depend on the talent of our staff, the support of our
County Commissioners, State and Federal funding and the help of our community partners,
advocates and clients themselves.
How great is the need for our services? Our Department helps more than 5,000 County
residents annually-adults with mental illnesses, children with emotional problems, people
with disabilities, people challenged by depression or crises in their daily lives.
The President's New Freedom Commission estimates 5-7% of adults have a serious mental
illness and 7-9% of children have a serious emotional disturbance. Based on those estimates,
as many as 7,350 Deschutes County adults and 3,150 children may need mental health
services in 2006. Many more will need addiction treatment services or support and
assistance with a developmental disability. Some will get private or public help; far too
many will receive nothing at all.
Our County government and its community partners will become increasingly challenged
trying to respond to this need in a growing community. Difficult choices lie ahead. Who will
be eligible for services? Which services are most beneficial? What can we afford to do?
How can we change to be more effective and efficient in our work?
Our services provide a lifeline for people on the fragile Oregon Health Plan, people with
disabilities or mental illnesses and people of limited means. At best, our services stabilize and
strengthen people, offering dignity, hope, self-sufficiency-a better quality of life. Cutbacks
in services risk hopelessness, crises, costly hospitalizations, incarceration and even suicide.
"The public mental health system in Oregon has serious problems I The Governor's 2004
A Blueprint for Action cites many profound shortcomings. They include a public stigma
against mental illness, significant under funding, fragmented services, an inappropriate
reliance on jails and prisons, lack of community resources, insufficient use of early
intervention services and a costly State Hospital in crisis. These seemingly overwhelming
challenges are compounded by calls at the Federal level for cuts in Medicaid funding, the
I Page 7. A Blueprint for Action, Governor's Mental Health Task Force, September, 2004.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 5
critical underpinning of the Oregon Health Plan (OHP), including mental health and
addictions treatment for OHP members in Deschutes County.
On a more positive note, the limitations of our public treatment system and the urgent need
for an overhaul of our State Hospital have received the attention of the Oregon Legislature,
the media and the public. The accomplishments of the 2005 State legislature included
insurance parity to treat mental health issues, passage of a comprehensive
methamphetamine initiative, and the first steps in an overhaul and reinvention of the State
Hospital and further development of our community based service system.
The good news also included a decision by our County Commissioners to enable the
Department to again offer services to the public on Fridays. This return to full service hours
made more than 80 clinicians, therapists, social workers, and support staff available to help
the public five days a week. We have added back these hours through a combination of
new revenue and a plan to put much of our reserves to work helping the community over
the next four years.
In summary, this Strategic Plan provides a framework for our work over the next four years.
Many of the recommendations can be accomplished through current resources; others can
be accomplished only with new revenue. In any case, we are confident that the
improvements and ongoing efforts outlined in this Plan will be highly beneficial to our
community. We invite you to become involved in this process. Your suggestions are
welcomed.
Dolores Ellis, Chair Scott Johnson, Director
Deschutes County Addictions & Deschutes County
Mental Health Advisory Board Mental Health Department
APPROVED this day of 2008 for the Deschutes County
Board of Commissioners.
Dennis R. Luke, Chair
Tammy Melton, Vice Chair
Michael M. Daly, Commissioner
ATTEST:
Recording Secretary
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 6
B. OVERVIEW
The Deschutes County Mental Health Department has developed this Strategic Plan under
the guidance of the Deschutes County Board of Commissioners and the Department's
Mental Health, Alcohol and Drug Advisory Board. This planning effort began in October of
2004 and concludes with adoption of the Plan in the fall of 2005. The Plan extends from
January, 2006 through December, 2009. It includes recommendations that are designed to
improve the Department's effectiveness and benefit to the residents of Deschutes County.
This Strategic Plan and related activities are multifaceted. The Plan addresses a variety of
topics that affect our value to the community, the benefit of our services and the health of
our Department. As a strategic document, it includes recommendations related to our
services, productivity, work environment and finances. It charts our course for the future to
help us better serve residents of our County.
Critical Background Information
Given the dynamic nature of the mental health field, public financing and community
trends, a variety of information was taken into consideration in the development of this Plan
in 2005 and in its update in 2008. These include:
• Alternatives to Incarceration Subcommittee Report to the Deschutes County Local Public
Safety Coordinating Council, February 2007;
• Oregon State Hospital Master Plan, Phase II A Regional System to Support the Oregon
State Hospital Master Plan, Critical Community Service Needs & Plans For Central Oregon
2007-2013, December 2006;
• Community Services Workgroup Report for the Oregon State Hospital Master Plan, March 2007;
• Oregon's Statewide Children's Wraparound Initiative Steering Committee Report to
Governor Ted Kulongoski, December 2007
• Results of the 2005 and 2007 Oregon Legislative Session, both policy and financial;
• Results of the 2005, 2006 and 2007 Deschutes County Budget Processes;
• The emphasis on Evidence Based Practice (SB 267, 2003 Oregon Law);
• The 2003 President's New Freedom Commission Report on Mental Health, 2003;
• The Governor's Mental Health Task Force 2004, "A Blueprint for Action";
• Staff suggestions, including results of the 2004, 2005 and 2008 Employee Surveys;
• Recent State, County and managed care audits of our operations;
• The 2005 opening of Horizon House, transitional housing for people with mental illness;
• The 2005 opening of Sage View and plans to improve local acute care options; and
• The October, 2005 implementation of the Children's System of Care Initiative.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
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C. OUR VISION, MISSION, AND CORE VALUES
Our Vision
"Help is available for everyone in Deschutes County with a mental illness, developmental
disability, addiction, or short-term crisis, regardless of income, culture or where you live in the
County. Help can be found here, in Central Oregon, close to family and friends. Local
government and private agencies work together well and offer a system of affordable,
accessible and integrated services. For our part, Deschutes County Mental Health is regarded
as one of the most effective and helpful county mental health programs in Oregon.
Dramatic strides continue to be made on a national and state level in helping to prevent, treat
or limit the effects mental illness, addiction, emotional distress or a disability. Locally, we are
familiar with these new developments and the most effective programs and practices. We
continue to improve our services and offer training to help local practitioners in their work. All
our services are based on the concepts of resilience, recovery, and self-sufficiency. People are
supported in living as independently as possible, with the assistance of families, friends and,
when needed, public and private service agencies. Supported housing and employment
projects continue to expand and prosper." 2
Our Mission
To provide high-quality and integrated client-centered services that will enable those we
serve to strengthen their lives and roles in the community.
Our Core Values
Our Clients - We believe those we serve should be involved in directing the course of
the services we provide as a component of a holistic approach to resiliency, recovery
and the betterment of their lives. We believe our clients should have access, voice and
ownership.
Our staff - We believe our staff is a valuable resource, and we promote the personal
well-being and professional development of each individual. Through continuing
education, peer review, and teamwork, we support each other in our efforts to deliver
compassionate, accountable services of the highest caliber. We value trust,
professionalism, integrity and mutual respect in all we do.
Our services - We believe the services we provide are an integral part of a healthy
community and that comprehensive care is best provided through service integration,
interagency collaboration, and partnerships with other service agencies.
Our community - We believe the services we provide should be visible and available
to those in need and that public awareness and education are key elements in
community wellness. We strive to make our services visible to the community and to
deliver them in an effective and efficient manner. We encourage feedback and use a
strategic planning process proactively to address the needs of our community.
2 Note: Our vision statement includes language and concepts expressed in other documents including the President's
New Freedom Commission Report, "Achieving the Promise: Transforming Mental Health Care in America" (July, 2003).
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 8
Deschutes County Employee Values
February 2008
As employees of Deschutes County, we are actively involved in efforts to strengthen our work
place and identify ways we can continue to improve and excel. During the development of the
Deschutes County Mental Health Strategic Plan, County Mental Health employees also
participated in two staff surveys. The first was offered to all Deschutes County employees. The
second was the Deschutes County Mental Health biennial staff survey. The following Deschutes
County employee values are arising out of the County process.
As Deschutes County employees, we value:
Integrity, Accountability and Respect
We demand honest, ethical and respectful dealings with each other and with the public.
We keep our promises, admit mistakes, and are courageous in doing what's right. Our
conduct ensures that Deschutes County government earns the trust of the community it
serves.
Professionalism
We are committed to the highest level of competence and professional conduct. We also
recognize that humor, employed in a timely and appropriate manner, is vital to the well-
being of our organization.
Effective and Efficient Use of Resources
We strive to provide cost-effective services according to the community's priorities. We are
committed to finding solutions to problems that use common sense, good judgment and
compassion, keeping in mind what is the best outcome for the community.
Safe and. Enjoyable Workplace
We value a safe work place, and one in which we are honored and recognized for our
talents and accomplishments. We value the free expression of ideas, honest and open
communication, and positive attitudes.
Innovation and Collaboration
We encourage fresh ideas and teamwork among employees and between county
government and the community it serves.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 9
D. POLICIES
1. Resiliency and Recovery Statement (Adopted by AMHAB 3 March 7, 2007)
Deschutes County Mental Health promotes the concepts of resiliency and recovery for
people of all ages who experience developmental disabilities or psychiatric and/or
substance abuse disorders. Policies and procedures governing service delivery will
attend to factors known to impact individuals' resilience and recovery.
The goals of resiliency and recovery based work will be:
I . Maximized quality of life for individuals and families
2. Ability to develop and maintain social relationships
3. Inclusion as a member of the community
4. Participation in community activities of the individual's choice
5. Improved health status and function
6. Success in work, school or living situation
This will be achieved by providing services that are:
1. Client directed. The provider must work in partnership with the client. The individual
needs to identify goals and have control of the resources to achieve these goals.
2. Individualized and client centered. The plan for reaching goals should be designed
to meet the specific needs and strengths of each individual.
3. Empowerment. Services should be delivered to support and educate the individual
to be able to plan for and direct his/her own services.
4. Holistic. Services should encompass all the aspects of an individual's life. Services
should address client identified needs such as housing, employment, community
participation, transportation, family involvement, education and treatment for
health, mental health and addiction issues.
5. Strenaths based. Providers must work with clients to identify the inherent strengths of
each individual and build on those strengths to achieve the identified goals.
6. Peer support. Services should be designed to encourage peer support including
sharing of experiential knowledge and social learning.
7. Respect. Respect should be the basis of all relationships with clients. Treating each
individual with respect, working to ensure that the individual's rights are protected
and working to eliminate discrimination and stigma will assist the individual to regain
or maintain his/her self-respect and encourage the individual's participation in all
aspects of his/her life.
8. Hope. Services should convey the motivating message of a better future. Both the
client and the provider need to believe that things can get better, barriers can be
overcome and goals can be achieved.
3 AMHAB refers to the Deschutes County Addictions & Mental Health
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
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2. County role as the Local Mental Health Authority
By statute (citation), Deschutes County is a Local Mental Health Authority. As a matter of
policy, the Deschutes County Board of Commissioners names the Deschutes County
Mental Health Department (DCMH) as the County's Community Mental Health Provider.
Acting in that capacity, DCMH will provide or contract form critical community
behavioral health (addictions and mental health) services and functions as well as core
Developmental Disabilities services as funded and assigned.
3. A Community System of Care
By policy, Deschutes County supports the concept of a Community System of Care (see
illustration on page through which residents of our County have local access to a
range of mental health services, addictions treatment and services for people with
developmental disabilities. On a case-by-case basis, it is understood that an out of area
placement may be most beneficial though it is not usually as beneficial as an effective
local option that allows continued family and community involvement and a smooth
transition to local services and supports.
4. Strategic Plan and Biennial Plan as Core County Documents
As a matter of policy and by design, the Strategic Plan and the Biennial Plan put forth a
set of principles, policies, priorities and positions that are intended to reflect the direction
of the Deschutes County Board of Commissioners (the Board). Within any statutory or
County guidelines or limitations, the Director and the Deschutes County Mental Health
Department are expected to support and promote such principles, policies, priorities and
positions contained in these plans, subject to any further direction or guidelines set forth
by the Board. A Progress Report on our success in implementing the County Mental
Health Strategic Plan shall be provided to the Board at least biennially.
5. Priority Populations for Deschutes County Mental Health Services
As a matter of policy, Deschutes County will focus its resources on mandated clients 4
and people facing an imminent or emerging crisis. With the balance of any available
funds, the County will provide behavioral health care access to County residents who
are indigent and have no other access to urgently needed mental health, addictions
services and help for people with developmental disabilities. For indigent client groups
and within available funds, services will be offered to people who lack resources, seek
services and are challenged by a serious mental illness and/or addiction. For clients who
are not able to receive services, Deschutes County will make every effort to refer County
residents to other services in our community.
6. Regional Focus When Beneficial
As a matter of policy, Deschutes County, through its Mental Health Department, will use
a regional approach to program development, direct services, resource management
Examples of mandated populations: Oregon Health Plan members assigned to Deschutes County (for both addictions
and mental health treatment), eligible children and adults with Developmental Disabilities, and prioritized populations
associated with Federal, State or local grants.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 1 1
and advocacy when the Department determines that the benefit to our County long
term outweigh any associated costs. Criteria for assigning "benefit" to a regional project
includes a) a "tipping point" whereby we can accomplish something that could not be
done as a single County, b) an ability to increase resources and expand services, c)
greater efficiency or d) improved education and advocacy. These initiatives will often,
though not exclusively, focus on Central Oregon counties but only with the mutual
agreement of all parties. Whenever the Department takes a regional approach to its
work, Department staff will identify the benefit of regionalization.
7. Signature of Contracts, Amendments and Agreement
By Board policy, the County Administrator and the Director of the Deschutes County
Mental Health Department are charged with implementing the County's Mental Health
Strategic Plan and any Deschutes County Mental Health Biennial Plan, as adopted by
the Deschutes County Board of Commissioners. Responsibilities of the County
Administrator include signature of related contracts, amendments and agreements.
Responsibilities of the Director include day-to-day management of the Department,
signature of appropriate contracts or amendments (within County guidelines) and all
efforts to further Strategic Plan and Biennial Plan priorities as set forth by the
Commissioners.
8. Public Safety & Alternatives to Incarceration
As a matter of policy, Deschutes County will seek to develop a comprehensive
prevention, treatment and public safety system that is balanced and that supports best
practice programs and community involvement. The County seeks to provide sufficient
jail capacity and in-jail health services (both current and planned) as well as the best
possible behavioral health services 5 pre and post adjudication. In keeping with our
efforts to support public safety and health care access, the County will develop effective
programs for people with mental illness or an addiction who come in contact with our
public safety or treatment system. For our growing community, the County will use its
resources to expand both public safety and treatment services over time.
5 Behavioral health services are defined as a combination of mental health and addiction screening, assessment,
treatment, case management and other support services offered by and through the resources of Deschutes County.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
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E. ENVIRONMENTAL TRENDS AND CHALLENGES
Many trends and challenges affect our work and our effectiveness. All need to be taken
into consideration as we plan for the future.
POPULATION
Seniors (Senate Bill 781)-Deschutes County is recognized throughout Oregon for our
seniors' mental health services and the work of this team. With changing demographics,
our staff face increasing demands and need greater support and assistance. Oregon's
population age 65 and up is expected to rise by 33% from 2005 to 2015 while the general
population is only expected to increase 13%.
2. Equity-With the passage of HB 3067, population growth was considered in Oregon's
2007-2009 funding of community mental health. This requires continued advocacy,
particularly if there is a downturn in the Oregon economy.
3. The Economy in Oregon-There is an emerging concern that Oregon and our nation
may face a significant downturn, even a recession, in the next few years. Given
Oregon's tax structure, this could reduce State resources for mental health and other
social services.
MANAGERIAL TRENDS
4. Behavioral Health Integration-There is growing recognition that co-occurring disorders
are common and should be treated in an integrated fashion. Administratively, there is
merit in linking our Chemical Dependency and Mental Health organizations if feasible.
5. Emergency Preparedness-Each County's community mental health program, including
DCMH, is expected to play a leadership role in designing and coordinating a behavioral
health response to disasters or other community crises. During such emergencies, help is
needed for special need populations, first responders and other caregivers.
6. Health Care Integration-Our community is benefiting from improvements in health care
for low income individuals including Volunteers in Medicine and the Bend Community
Clinic. Development of a federally qualified health clinic in La Pine is on the horizon.
Cross referrals are critical, and our current ability to respond is limited.
7. Public Confidence and Results-All publicly financed services are facing increasing
pressures to perform and to demonstrate that funds are used effectively. We continue to
seek better ways to inform the public about the benefit of our work.
8. Transportation Problems-The region's limited ability to solve public transportation
problems for our residents' means services must be offered in each community in
Deschutes County. Some progress has been made by the Department; more is needed.
We must continue to offer services in several communities in the County.
9. Audits-We are nearing completion of many recommendations from six external or
internal audits in 2005 and 2006. Our Audit Action Plan contains these
recommendations.
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April, 2008
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10. Contracting-Accountability and County Policies-Greater accountability is needed for
contracted services. County policy requires attention to detail in the preparation and
execution of contracts. Greater monitoring is also needed to assure performance.
11. Documenting Services-Billing and assuring continued Oregon Health Plan funding
sufficient to help our community depends on our ability to document delivered services
and costs completely and in a timely manner. This documentation affects actuarial
calculations for Oregon MHOS.
12. Paperwork-Our clinicians raise legitimate concerns about the required paperwork and
the associated time demands. Efforts are ongoing to meet governmental regulations
and reporting requirements while asking staff to maintain a high level of direct service
time. This issue is threatened by Medicaid audits and documentation requirements.
13. County Goals & Program Budgeting-Beginning in 2007, the County Commissioners have
established County Goals; our Department will focus on several of these. The goals and
a move to "program budgeting" will need our attention over the next several years.
14. Developmental Disabilities-The role of County government in offering and assuring
public services for people with developmental disabilities is under review in a number of
Oregon counties. The outcome of this review is uncertain. Our DD program has been a
core function and set of services in Deschutes County for many years. We will need to
monitor this discussion and encourage a strong role for counties.
15. Evidence Based Practices / Programs (EBP)-Our services must continually evolve based
on research and improvements in behavioral health care practice. We will adapt as
circumstances warrant. Documentation of our EBP work is required in Oregon law.
16. Add competitive pay for clinicians - to be drafted
17. Add safety plan - to be drafted
HEALTH CARE REFORM
18. Children's System Reform-Managed mental health agencies in Oregon are changing
services for children with significant mental health needs. This remains an important but
difficult transition for families, agencies and counties. We lost the local services of Trillium
Family Services; we're hoping for an expanded role for Cascade Child Center. It's our
goal to reduce residential care while offering intensive community options for families.
19. Resiliency and Recovery-There is a national movement to promote "recovery" in the
design and delivery of services. The goals are to engage clients as full partners in the
treatment process and to develop services that promote healing, independence and
support. It is time to begin turning our support of this theme into concrete programs and
services.
20. Managed Care-Change is inherent in managed care, much of it based on actions at a
Federal Level. Our Strategic Plan assumes continued participation in the Accountable
Behavioral Health Alliance (mental health; 5-counties) and operation of our single county
Chemical Dependency Organization (alcohol/drug services).
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
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21. Health care reform-The Healthy Oregon Act (SB 329, 2007) resulted in the formation of
Oregon Health Fund Board and an initiative aimed at expanding access to health care
and the pooling of health care resources. Recommendations are expected from the
Board in the fall of 2008. National changes are even more difficult to predict.
22. Add mention of the parity legislation that has passed
RESOURCES
23. Inpatient Costs-With improvements in our acute care system, we are incurring greater
costs for inpatient services. A more proactive management of the use of these services
will be needed if we are to control these costs and the impact on other services.
24. Electronic Records-There is an increasing trend toward the use of information
technology, reduced paper and greater efficiency. This is encouraging but carries
inherent costs, training needs and adjustments for staff.
25. Cost of County services-Charges to the Department for County services affect our
resources for direct services and the amount of care we can provide. Controlling these
costs wherever possible is critical to our future and our level of service.
26. County 8, State Revenue-For the first time in the last 10 years, Deschutes County
General Fund revenue to sustain the current investment level has not kept pace with
rising costs. If this is not reversed, access to health care for indigent clients will decline.
Similarly, at time of printing, economist predict State General Fund receipts are down. If
the State economy results in a cut in funds for behavioral healthcare, access to health
care for indigent will decline.
27. Health Insurance-Rising costs affect the amount of service we can provide. The most
significant cost increase for our Department is the rise in health insurance for County
employees, up 17%6 annually from 2002-2006. Costs were contained to eight percent in
2007-2008 and are likely to be reduced in the coming year.
NEW INFORMATION
28. Medicaid-Funds to help Oregon Health Plan members have stabilized in the last year
but could decline as some call for cuts in Federal entitlement programs. We need to
monitor the national debate and stay in contact with Federal officials. State and federal
auditors are seeking repayment of funds when they determine insufficient
documentation and compliance with regulations. Repayments could be large.
REGIONAL FOCUS
29. Regional Work-Many of our challenging community issues and service needs are best
addressed in partnership with Crook and Jefferson counties. Examples: a) partnerships
with NAMI of Central Oregon, b) acute care, c) housing/residential programming, d)
advocacy and public education, and e. intensive children's mental health services.
6The 17% reflects the actual increase for Deschutes County Mental Health.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 15
30. Oregon State Hospital-Community Investment?-Two new State Hospitals will be
opened in the next five years. The State is planning for shorter stays and greater focus on
forensic and geriatric populations. Will Oregon develop and finance the necessary
helping systems at a community level? There is great concern that the Oregon
legislature may fail to adequately fund a public, community-based mental health
system.
ACCESS
31. Acute Care Locally-Cascade Healthcare Community has expanded services in Central
Oregon, including Sage View and Psychiatric Emergency Services beds (five) at St.
Charles. This is very beneficial but carries inherent costs and requires a high level of case
coordination, collaboration and financial planning. We lack respite care options. We
are impacted by losses of acute care elsewhere in Oregon (e.g., Mercy Medical unit
closure in Roseburg). County pre-commitment investigations have increased 61% in the 3
years. 7
32. Housing affordability; programs lacking-The State reports that Deschutes County has
had the lowest residential program bed capacity per capita in Oregon. Some progress is
being made but much more is needed across an entire housing continuum.
33. Jail Expansion-Deschutes County is expected to expand the jail capacity by more than
100% by 2011 or 2012. More people with mental health issues and addictions who
commit crimes will be incarcerated. Assuring coordination and collaboration on
behavioral health matters will be critical. It will be exceedingly difficult to expand mental
health services at a corresponding level.
7 Pre-commitment investigations: 191 in 2005-2005; 239 in 2005-2006; 307 in 2006-2007.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 16
F. SWOT Analysis.
An analysis of our department's Strengths, Weaknesses, Opportunities and Threats was
completed as part of the Strategic Planning Process and appears below. It is intended to
help us understand areas to be sustained and supported, others that may require our
attention and challenges or problems that must be addressed or overcome.
Strengths
• Committed, knowledgeable, trained and
motivated staff
• Community partnerships with many
government and nonprofit groups
• A cohesive Management Team
• Improvement in staff morale
• An understanding of core services within staff
teams
• Community and school based services
• Involved and supportive Advisory Board
Opportunities
• SB 329 and any potential for health care
reform at the State or Federal level
• ABHA examination, strengthening our
managed care work
• Using our experience with the DD system to
improve our MH system
• Greater stability through a sustainable
business plan and long-range planning
• Evidence Based Practices; local work on
practices we deem most beneficial
• New partnerships for individualized, wrap-
around services for children
• Input in rewriting Oregon's Administrative
Rules
• A trend toward delivering services differently
(e.g., group work, Children's System of Care
reform)
• Any opportunity to eliminate "silos" or
restrictive funding streams
• Revenue opportunities
• Programming to help people with mental
illness in criminal justice system
Weaknesses (internal)
• Extended waiting list for services
• High need and service demand
• Not enough staff to meet needs nor
support staff help for clinicians
• A need to embrace gradual change
aimed at improvements
• A need to improve organizational
systems, policies, and protocols
• Contract monitoring and reporting
• Greater confidence in billing system
• Chart and scheduling requirements
consistently met
• Staying well connected as we grow
• Use of panel providers
Threats (external)
• Medicaid Audits and any required
repayment to State / Federal Govt.
• Instability and reductions in County,
State and Federal funding
• Greater responsibilities associated with
the County infrastructure
• State documentation requirements
resulting in excessive paperwork for
direct service staff
• Health care costs and the impact on
our cost of doing business
• PERS resolution in the Courts; the
ongoing cost of Retirement System
• Uncertainty that the State will make
the necessary changes and provide
sufficient support
• ABHA changes in the near term
• Insufficient transportation system for
clients
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 17
G. 2008-2009 Work Plan
1. Program Priorities
a. Acute Care & Crisis Services-Increase Crisis Team staffing. Analyze data and trends for
commitment investigation and civil commitments. Evaluate performance of new Mobile
Crisis Team. Increase use of Acceptance Commitment Therapy. Increase payment for
Sage View indigent care. Develop crisis respite option(s). Resources needed for respite.
b. Chemical Dependency-Increase addictions treatment services for adults in the justice
system, parents in the child welfare system, indigent adolescents and adults with co-
occurring disorders. Measure utilization and benefit.
c. Children's Services-Develop early psychosis program using team approach (28 young
people ages 12-30). Sustain Children's System of Care for children with significant mental
health needs by offering wrap-around services; maintain low use of psychiatric residential
services; increase intensive community treatment options. Seek resources for school
services. Determine treatment capacity needed for KIDS Center and role in functional
family therapy. Resources needed for school services.
d. Senior Services-Measure current and needed capacity to serve this growing population.
Participate in statewide advocacy to increase geriatric services. Document
performance and benefit. Resources needed.
e. Criminal Justice-Grow alternatives to incarceration; complement County jail expansion.
Assist with in-jail mental health program planning and interface. Participate in jail Reach
In Program. Expand Mental Health Court (25 clients) and Jail Bridge Program (75 clients);
strengthen data collections. With Sheriff's Office, expand addictions treatment during
and after incarceration. Sustain Family Drug Court9. Continue law enforcement training;
support Crisis Intervention Training. Resources needed for Bridge, MH Court and CIT.
f. Developmental Disabilities-Expand case management and respite services for DD
clients and their families. Participate in State discussions of County role(s) in DD services;
promote primary role for County in planning, services and system coordination.
g. Emergency Preparedness-Adopt a County behavioral health plan by December, 2008
including role(s) of DCMH. Include staff readiness, support to vulnerable populations,
help for first responders and public education. Enlist help of others. Resources needed.
h. Employment-Expand DCMH Supported Employment Program based on best practice.
Provide vocational services to 65 clients. Add two employment specialists (1.75 FTE).
Housing-Increase bed capacity in the County. Help Telecare develop a 10-bed secure
program and an 8-bed program. Work with Springbrook to reopen a 5-bed home for
Psychiatric Security Review Board clients. Help Housing Works develop transitional
housing for people with mental illness. Develop a DCMH housing specialist position by
2009. Pending: Expand supported housing and homeless outreach. Resources needed
forsupported housing, homeless outreach, transitional housing and housing vouchers.
8 Use Oregon Treatment Court Management System for program evaluation.
9 Reductions in Federal Byrne Grant funds for the program are expected.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
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j. Cultural Competency and Service-Develop multiple strategies to increase access to
services for people of color; emphasize the Latino community. Resources needed.
2. A Healthy Workforce and Work Place-Recruit, train and support a highly qualified,
motivated and effective staff. Involve staff in strengthening our organization and services.
Fairly and consistently evaluate performance. Maximize productivity, professionalism and
effectiveness. Strive for a healthy work place with mutual respect and support.
a. Staff Survey-Complete biennial survey (at least 80% return rate). Use results for Team
and Department improvements. Report progress to staff by 7/09. Resources needed.
b. Professional Development-Complete training survey (at least 80% return rate).
Set training priorities through December, 2009. Emphasize best practice. Resources
needed.
c. Competitive Salaries-In cooperation with County Personnel and Administration and
within available resources, seek to offer competitive salaries for recruitment and
retention. Resources needed.
d. Workplace Safety-Assess work place safety for staff, volunteers and clients utilizing
results of Bend Police review and other information. Develop and implement protocols
and training as needed.
3. Resiliency and Recovery Based System; Client and Family Involvement-Encourage
people to take control of their lives and participate fully in the community10. Involve clients in
services, program development, evaluation, education and advocacy.
KH: be consistent throughout = resiliency and recovery model
a. Resiliency and Recovery Model-Promote resilience, recovery, and self-sufficiency for our
clients. Include client recovery-oriented goal(s) in treatment plan and progress notes.
b. Participation and Leadership~-Seek participation of clients and family members on
decision making committees11. Promote and support consumer leadership12.
c. Evaluation-Emphasize client involvement in quality improvement13. Review Deschutes
County client satisfaction survey results. Gain feedback from non-OHP clients as well.
d. NAMI-Collaborate with NAMI of Central Oregon on projects of mutual interest including
the Peer to Peer Program and training for law enforcement. Resources needed.
4. Accountability, Access and Public Benefit-Strive for excellence. Emphasize best
practice, compliance, quality improvement, and productivity. Complete Audit Action Plan,
conduct outreach, offer local services; reduce wait lists and no shows where possible.
1OParaphrosed from Partners in Crisis, an advocacy and education group seeking to improve services for people with
mental illness at risk of contact with the justice system.
1For example, the Mental Health Alcohol & Drug Advisory Board, Children's System of Care Advisory Board and Local
Developmental Disabilities Planning Council.
12For example: Clubhouse, thrift store, our managed care organization. Support consumer positions in each setting.
13Primary measures include the ABHA Consumer Satisfaction Survey, the Oregon Change Index, evidence of significant
client involvement in treatment planning, client suggestions and the complaint process.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 19
a. Medicaid compliance-Assure compliance with key Medicaid rules (2007 Fraud & Abuse
Training. Consult with ABHA, the Division of Medical Assistance, and the State Audits
Division. Manage project through a DCMH Medicaid Work Group. Resources needed.
b. Contractina-I m prove DCMH document management and contract monitoring.
Develop a contracts specialist position. Resources needed.
c. MMIS Replacement-Participate in Oregon's upgrade of its Medicaid Management
Information System (claims processing / provider payments). Use new system in 2008.
Assure DCMH systems and processes interface effectively.
d. Community Report-Publish an annual report on our services and performance.
e. Web Site-By June 2009, update Department web site; include service, performance,
and resource information. Consider use of Network of Care system. Resources needed.
f. Performance Review-Review data at least quarterly including productivity, quality
measures, chart improvements, complaints and critical incidents. Review Oregon
Change Index data and Devereux Assessment Tool data.
g. Access-Analyze access to services. Seek equitable access for indigent and OHP clients
in north and South County. Re-examine mobile crisis region in 2009. Participate in plans
for a County Redmond campus. Sustain school services in Redmond and La Pine. Seek
resources to serve a growing seniors community. Resources needed.
h. Electronic Record-Initiate 2008 needs assessment and seek software options that meet
our needs and resources. Complete feasibility study and business plan in 2009. Consider
acquiring a new information system to support treatment, reduce paperwork, document
services and secure revenue. Resources needed for implementation.
i. Licenses-Complete state processes to renewal of service licenses including alcohol and
drug treatment and prevention (expires June 2008), mental health treatment services
(expires June 2008) and children's intensive services (exp. September 2009).
5. Sustainability, Stewardship and Resource Development-Sustain core services, meeting
the needs of a growing community whenever possible. Manage resources wisely and
balance our budget while meeting our legal and contractual obligations.
a. Sound Financial Management-Prepare a 2008-2009 budget that supports the Strategic
Plan. Update the three-year financial plan semi-annually; using operating funds and
reserves to balance the budget and cover essential costs.
b. Encounters-Document services at levels that meet or exceed revenues used. Annually,
calculate service unit costs based on expenses and within Medicaid rules.
c. New Fundincl-Work with the County grant writer to seek new resources for 1) seniors
mental health, 2) school-based mental health, and 3) alternatives to incarceration.
Resources needed.
6. Help for Oregon Health Plan Members-Assure access to services, document encounters
and participate fully in our mental health and chemical dependency organizations. Seek
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 20
ways to increase penetration rate, manage limited resources, and meet State compliance
requirements
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 21
H. LONGER TERM PRIORITIES 2008-2013
1. Consumer and Family Involvement-Actively involve clients and family members, where
appropriate, in the course of treatment, case plans, the design and development of new
services and projects, community planning and advocacy.
a. Individualized Plans of Care-Continue to improve written plans of care for all DCMH
clients. The plans will be written within 45 days of opening.
1) Each plan will reflect and address the expressed needs and preferences of the
individual and that person's family and community support system.
2) Each plan will support the resiliency and recovery of each individual.
3) Each plan will be holistic, integrating the planning and delivery of services and
support available from various agencies, programs and natural supports.
4) The clinician and client will complete the treatment plan collaboratively.
5) Plans will be reviewed and updated as needed, but at least semi-annually.
clinical supervision & charts reviews as measurement
b. Satisfaction-Implement an assessment and satisfaction policy and process through:
1) Outcome analysis (currently through the Oregon Change Index tool);
2) An annual client satisfaction survey conducted by the Oregon Addictions &
Mental Health Division;
3) A feedback form available to clients and caregivers at all program locations;
4) Quarterly review of complaints and grievances; and,
5) Full participation on all advisory boards and committees.
c. Resiliency & Recovery-Explore methods to better orient the local mental health
system toward resiliency and recovery. Dedicate staff time to this effort; encourage
family members and clients to share responsibility.
d. Add family support item
e. Representation-Seek consumer and family involvement on all advisory, planning,
evaluation and policy boards and committees.
Leadership-Continue to support consumer operated and directed efforts. Review
and implement, as feasible, recommendations from the 2008 Consumer Initiative
(Report scheduled for release June 2008). (Add consumer project to 2008-09)
g. NAMI of Central Oregon-Collaborate with the local chapter of NAM] whenever
possible. Meet regularly with NAM] representatives. Make clients and family
members aware of the support offered by NAMI and the benefit of NAMI's Family-To-
Family, Peer-to-Peer and other training and education programs.
h. Consumer and Family Advocates-Create Department position(s) to help assure
consumer and family needs are represented in our system and services. Track the
progress of peer-delivered services in Benton County and elsewhere. Implement
peer-delivered services, at least on a pilot basis, in Deschutes County no later than
2009. Resources needed.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 22
2. Organizational Development (See also Business Services.)
44 Audit Action Plan-Implement recommendations in periodic State, County or
Federal audits of the Department.
a. Resource Development-Sustain and increase funding to support our priorities:
1) Encounters-Continue documentation of all encounters (i.e., services provided),
including to Oregon Health Plan members. Standard: Value of encounters
should meet or exceed revenue invested.
2) Acute Care-Work to limit crises and the need for acute care. Seek State funds
at a level sufficient to assure acute care for indigent and OHP residents of our
County. New resources needed.
3) Equity: Adequate Funding to Meet Needs-Work with the Association of Counties
and the State of Oregon to continue receiving State funds for mental health and
addictions treatment at levels comparable to other counties.
4) Third-Party Revenue-Maximize collection of revenue for services delivered.
5) State and Federal Priorities-Participate in the County process to establish federal
and state legislative priorities. Seek opportunities to educate elected officials.
6) Grants-Secure grants to support program priorities (with County grant writer).
Priorities are set annually based on the Strategic Plan and current needs.
7) Interns and Volunteers-Market opportunities for student interns and volunteers in
the department and its programs when there is a clear service benefit.
c. Cultural Competencx-Increase the public's access to services and the quality of our
services for County residents who face language or cultural barriers.
1) Bilingual staff-Develop a bilingual (Spanish speaking) capacity within all
department programs, including reception staff. Long-term goal, resources may
be required.
2) Translation of Materials-Assure that key print and web information is available in
Spanish.
d. Evidence Based Practices (EBPs)-Continue the Department's commitment to
identify and implement proven, promising practices that are highly likely to benefit
our clients and assure compliance with Oregon law.
1) Resiliency & Recovery Model-Adopt this approach in all treatment services.
Includes adapting the model to children's services and developmental
disabilities, emphasizing resilience or maximum degree of independence.
2) Motivational Interviewing-Incorporate motivational interviewing, counseling and
enhancement in treatment services. The goal is to provide effective help to
unmotivated and mandated populations.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 23
3) Timely Access to Help-Identify and implement the most effective ways to
reduce wait lists and assure prompt service for eligible clients.
4) Support Evidence Based Practices (EBP)-Continue current use of proven
practices (below). Assure ongoing training and supervision as needed. Use
standardized modules or fidelity scales. Monitor outcomes.
• Dialectical Behavioral Therapy
• Supported Employment
• Supported Housing
• Consumer Run Clubhouse
• School based children's services
• Motivational Interviewing
• Dual diagnosis services
• Intensive, strengths based case
management
• Treatment Courts
• Acceptance Commitment
Therapy
5) Improved Training/Development in priority areas as determined by a tracking of
emerging best practice services and consultation with supervisors and front line
staff.
e. Staff Development and A Healthy Work Force-Recruit, train and actively support
highly qualified, motivated and effective staff, thereby strengthening our programs
and our benefit to the community.
1) Work Force Development Priorities:
• Survey staff to identify training needs at least every three years. for 2006.
• Training as needed to support our Evidence Based Practice priorities.
• Continue to identify and promote the best methods to assure paperwork is
current and complete.
• Better use of clinical supervision and team meetings to process difficult
situations with clients.
• competitive salaries
2) Training Priorities: Training priorities will be set annually and will always include
staff development in at least one clinical service or practice.
• Offer at least two training opportunities annually.
• Six-month orientation for new employees.
• Volunteer training(s) (annually for the Advisory Board, key volunteers).
3) Expertise-Increase support to staff by documenting and informing staff of
special skills, expertise and training of all staff members.
4) Library-Offer a library of training/education tapes and videos for use by staff,
volunteers, clients and agency partners.
5) Staff Survey and Improvements-Biennially, solicit staff feedback on our
operations, including opportunities for improvement within staff teams and for the
Department overall. Use the results to strengthen our work place and our
services.
6) Recognition-Develop methods to recognize staff for their work on behalf of
clients and Deschutes County.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 24
7) Team Development-Support team building activities when needed.
f. Measuring Our Performance-Operate a quality improvement system and process to
measure our productivity and effectiveness.
1) Adopt and implement an annual Quality Improvement Plan, including
performance measures for productivity and quality.
2) Convene quarterly public meetings of the Quality Management Committee14 to
review performance data. Prioritize areas for improvement.
3) Publish an annual Community Report Card to inform County residents about our
services and effectiveness including strengths and areas for improvement.
Include comparative data whenever possible.
g._ Oregon Health Plan Member Services-Maintain the administrative structure
necessary to meet our managed care responsibilities. Provide high quality,
accessible behavioral health services for any Oregon Health Plan members residing
in Deschutes County who need covered services.
1) Chemical Dependency Organization-Addiction treatment and support.
2) Managed Health Organization-Mental health treatment and support, currently
offered through Accountable Behavioral Health Alliance, our five-county MHO.
3) Potential For Future Integration-Explore feasibility of integrating these
organizations and forming a behavioral health managed care organization.
h. Structure and Capacity-Critically evaluate the Department's structure to support
the Strategic Plan and the Department's services in an effective, accountable and
efficient manner. Current challenges:
1) Contract development/monitoring capability (currently insufficient). Audit
finding. Resources needed.
2) Supervisor to direct service ratio (sufficient clinical supervision across the
Department). Note: January 2008 ratio is (supervisors) to clinical staff;
September. 2005. ratio was 9 clinical super pis, rS 5 to 57.1 clinl(-,al slaff. RE'NORK
the way this is written to allow for different ratios for different
teams/services/clients.
3) Support staff: sufficient help for direct service staff to maximize clinical hours.
Direct service to program support ratio (emphasis on direct service with sufficient
support). Note: January 2008 ratio is "clinical staff to = clerical support staff;
September, 2005, ratio was 57.1 clinical staff to 4.5 clerical support staff.
14The CntmtOz Addictions rind M?ntnl Henlth Advicnrv Bnnrd carvat ns th? Qt irility Mnnnn?m?nt Cnmmlttl-
1 Adult Ircatmi,,W has 3.0 supervisors to 24.18 (1!nlcaI staff. Chili x Fc_vi,iIy has 1.6 sup it ors 17.25 clip ua7I ,toff. DD
I~.r_is 0,75 s.iper li ,_-is to 13.05 clinical staff. Seniors has 0.25 super uor f 5 cliI cal ,toff. UPD,sJE TO CURRENT PAT ,J
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 25
4) Medical Director: sufficient psychiatric time for prescribing and administrative
oversight.
5) Prescriber time: sufficient time for prescribing and medication management.
3. Business Services
a. Three-Year Financial Plan-Maintain a financial plan based on current revenue,
expenses, trends, and strategic priorities. See Appendix 1, pages Sustain current
operations (and expand where possible) by using operating revenue and reserves.
New resources, greater cost containment needed in 2008-2013 to respond to gaps in
services and a growing community.
b. County Indirect Charges-Seek methods to assure that County indirect charges do
not increase at a rate greater than operating revenue unless County general funds
are available to offset such increases16. New resources needed if this can't be done.
c. Sustainable Personnel Costs-By 2011 (check), set the number of staff at a level that
can be supported exclusively with operating revenue. Adjust staff levels as needed,
primarily through attrition. Note: On average, about 10-15 (check) positions are
vacant each year.
d. Contractina Process and Support-Improve our contracts management process as
recommended by the County's Internal Auditor. Assure we can effectively develop
and monitor Department's contracts, thereby meeting risk management and legal
requirements while investing wisely and fully in private agencies and their services.
e. Financial Management-Continue to operate our financial billing and fund
management system in compliance with County standards and practices.
1) Sound Management-Assure sufficient resources to maintain a balanced budget
and fund core services. Operate within the annual adopted budget and three-
year financial model. Adjust the three-year budget at least semiannually.
2) Contingency Fund Policy-Invest the majority of our reserves in services over the
next two to four years while operating within this new policy. Assure that the
Department retains sufficient reserves to remain in compliance with this policy.
f. Medical Records-Assure this critical system is operating efficiently within Department
guidelines and requirements. Emphasize efficiency, capacity, benefit, compliance
with State and Federal requirements and adherence to Department policies and
procedures. Note: Includes all programs and remote locations.
g. Electronic Records-In cooperation with Information Technology, form a work group
to study the feasibility of acquiring and using a new electronic system for medical
records. Develop findings and recommendations including a preferred package,
financing and transition plan. Emphasize ease for clinicians and utility for treatment,
161ndirect charges reflect Department payment for the cost of County support services including Legal
Counsel, Personnel, Building Services, Finance, Information Technology and County administration.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 26
planning and billing. Resources secured for needs assessment and feasibility study
but needed for development.
i. Reception Support (Main Bend Clinic and Bend Annex)
1) Centralized Scheduling-Work with Information Technology and clinical staff to
assure use of the centralized electronic scheduling system.
2) Reception-Continue to adapt and enhance reception staff's role in new client
orientations and handling of crisis and screening telephone calls. Bilingual
capability. NOTE this is not in the right place, but in key documents that should
be in Spanish make note that medication instructions can be obtained from
pharmacist in Spanish and our making sure clients are aware of this-also working
around cultural barriers.
j. Fiscal Support
1) Audit Findings-Implement internal auditor recommendations, where practical.
2) Fees-Modify client fee setting process to ensure accurate information is
obtained and appropriate fees are being set.
3) Billing-With help of Information Technology, move to an all electronic billing
system and increase frequency to bi-monthly. Goals are to save staff time and to
improve collections.
k. Capital Acquisition and Minor Equipment-Provide the necessary equipment to
support work of staff and volunteers.
1) Computer Replacement-Acquire and maintain sufficient hardware to support
staff work; acquire less costly WBTs (Windows-based terminal) whenever practical.
Tcjhle- DCMH Comnuter invPntnrv
Year
PCs
Terminals
Laptops
Printers
2008
26
82
17
30
2005
26
70
9
24
2) Vehicles-Budget funds for replacement and acquisition of enough vehicles to
support our services. 2008 fleet: 20 vehicles; 2005 fleet: 22 vehicles.
3) Video Equipment-Assure acquisition and replacement of dependable, high-
quality equipment for groups and training.
4. Program Development (General)-Quality, Access, Services and Productivity
a. Resiliency and Recovery-Department Mission and Values-Emphasize resiliency and
recovery as the foundation for all Department programs. Use the Resiliency and
Recovery Statement principles in program planning and development.
b. Improved Access to Services-Seek methods to provide timely access to services for
eligible County residents.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 27
1) Appointments-Increase access by reducing "no shows," particularly at time of
intake. Reduce waiting list to a maximum of two weeks for non-urgent care.
Increase access through appointment reminders, piloting of a drop-in
appointment process, and reducing the time delay between calling for and
getting an appointment.
2) Scheduling-Use the computer scheduling system consistently and routinely to
schedule appointments, generate service tickets to document services, track
charts, manage cancellations and reschedule appointments when needed.
3) Geographic Proximity-Assure local access to services in La Pine and Redmond
proportionate to projected need. Emphasis on residency of Oregon Health Plan
members and eligible indigent clientele. Work with the community of Sisters to
determine need for local services. Based on this determination, offer local
services to Sisters area residents no later than 2007. Resources may be needed.
4) Orientation for new clients (weekly). NOTE: write in such a way that gives teams
leeway to do the orientation in the way that works best for their 'specific:clier
base.
Insert OHP table here
The table will show penetration rate by community and by 3 age groups
(i.e., children, adults and seniors)
c. Client Chart Review Process-Conduct chart reviews at least quarterly; emphasize
Medicaid regulations and State rules; prompt attention to corrections expected. The
goal remains to have all staff meet regulations and Department standards.
Technical assistance and additional reviews will be focused on staff needing more
help.
d. Client Treatment Charts-Meet information and documentation needs required by
Oregon law and Administrative Rules to document critical client and service data.
1) Critical Review and Change-Reconvene a work group in 2009 to develop
recommendations to expedite paperwork, support productivity (service hours),
increase automation (using technology), assure regulatory and grant compliance
and increasing our efficiency.
2) Training-At least annually, train staff on use of the forms for quality control,
documentation and treatment planning.
e. Group Practice-Continue commitment to offer the group modality for a variety of
treatment and support services (both successful and cost effective for many clients).
1) Continuation of Group Practice-Sustain and expand (where feasible) current
offerings. Offerings January, 2008: 34 Child & Family; Adults and Seniors;
September, 2005: 42 Child & Family; 26 Adult and Seniors.
2) Parent Groups-Offer group treatment services for parents of minor children.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 28
f. Health Care Integration-Seek opportunities to integrate mental health services with
physical health care in our local communities.
1) Care for Low Income Individuals-Collaborate with the Bend Community Clinic
and the Volunteers in Medicine Clinic to assure appropriate referrals and services,
where feasible, for low income individuals and families in the community. Seek to
offer mental health services at BCC NOTE: we do not have the funding to do this
on our own.
2) FQHC in La Pine-Support community efforts to develop a Federally Qualified
Health Clinic to serve the La Pine community; express willingness to offer
behavioral health services.
3) work with Health Dept, as method of Hispanic community access to MH services
g. Web site - Maintain a beneficial and accurate web site for the benefit of the
community, clients and their family members, volunteers and staff.
1) Network of Care-Improve the benefit of the DCMH web site through use of the
"Network of Care" or another comparable service. This internet based system is
multifaceted and offers comprehensive information on mental illness, evidence
based practices and services in the local area. Resources needed.
2) Comprehensive Update-Complete a comprehensive, 2009 update of the site.
5. Child and Family Services
a. School-Based Services-By 2013, expand our current service capacity to assure
mental health and addiction prevention and early intervention services are available
in all public schools in Deschutes County at least one day per week. Resources
needed or services will be reduced over time.
Table: DCMH services in Deschutes County's public schools
2007-2008
2006-2007
2005-2006
2004-2005
Schools served
27
26
26
32
Children served
357 to date
473
693
546
Total public schools
37
37
37
Not available
% of schools served
73%
70%
70%
b. KIDS Center-Sustain and expand mental health services at the KIDS Center as part
of a multidisciplinary assessment and treatment system; provide services to these
children in north and south county. This is a critical community service and program
priority. KIDS Center expansion occurring in 2008 with additional medical services;
additional therapeutic services and physical space will also be needed. Oregon
Health Plan (OHP) funds are essential; community or foundation resources are
needed to offer services to other indigent children and families or therapy services
will be reduced.
Table: DCMH services offered at the KIDS Center (Some services for KIDS Center
clients are provided at the Main Clinic.)
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 29
2007
2004
% change
Children served
219
235
Insert
Hours of service
4,289
2,902
insert
NOTE: Hours of service have gone up while number of children served has gone
down due to an increase in the complexity of the cases being seen. An increase in
treatment hours per client automatically reduces the number of clients seen overall,
as each case must be resolved and closed before opening a new case.
c. Children's System of Care-Continue implementation of Oregon's Children's System
of Care Initiative for the benefit of Deschutes County children (and their families) with
more serious mental health needs. Early emphasis on OHP child members with serious
emotional disturbances. Goals include local options, coordination with other service
systems and active family involvement. OHP funds are essential; there are limits to
our capacity to help high-need children.
Table: DCMH services since proclram began 10/1 /06
Services offered
Oct. '05-Se t 'O6
Oct '06-Sept '07
% change
Wrap around clients
46
67
46% increase
Direct service hours
2,029
2,216
9% increase
Contacts with families
3,799
2,819
26% decrease
Hours with other agencies
1,301
1,116
16% decrease
Note: While services and children served have increased, the reduction in family
contacts is due to internal changes in the way staff time is documented and coded
in the computerized system. Hours with other agencies decreased as the program
developed and it was found that review, operations and management meetings
were no longer needed as frequently.
1) Central Oregon Region-Help develop the Central Oregon Advisory Council,
sustain two regional care coordinator position(s) and expand as referrals
increase; use the approved assessment instrument and manage available
resources.
2) System and Service Development-Develop high-quality, evidence based,
intensive community treatment services to meet the needs of local children and
families. Through our managed care organization, provide or contract for
individualized services through private children-serving agencies based in Central
Oregon. Invest in services through Cascade Child Center, Maple Star and other
providers as needed.
Insert table (showing use of intensive community services)
3) Residential Treatment-With the closure of Trillium Family Services residential care
in Central Oregon (2008) and based on best practice, reduce use of residential
care where other local options exist that are in the best interest of local children.
Insert table (it will show a reduction in use of residential care)
4) School-linked services-Seek opportunities to develop and expand intensive and
day treatment services in school,settings in cooperation with local school districts.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 30
5) Maximize Services; Accurate Recording (Encounters)-Consistently document all
encounters to assure availability of Medicaid resources.
d. Mediation-Sustain (or increase if needed) mediation services to divorcing families
with minor children. Long-standing program will continue to be offered in
collaboration with the Circuit Court. In 2006-2007, 81 couples received mediation
services; 67% of these cases resulted in full or partial agreement on custody and
parenting time. Forty-three additional families received consultation. This is an
increase in mediations from the 75 in 2004-2005. Domestic filing fees are essential.
e. Early Psychosis-Replicate this evidence based program offered in the Willamette
Valley. Provide help for adolescents and young adults experiencing first evidence of
psychoses. Replicate this evidence based program offered in the Willamette Valley.
Develop local team and serve an estimated 28 Central Oregon clients. Extensive
outreach and teamwork required. State funded; continued funding critical.
Youth Suicide Prevention-Work with schools, agencies, and the community to
support suicide prevention strategies and treatment options. Continue development
of the suicide prevention project at the KIDS Center (initiated in 2007). Participate
actively in the Suicide Prevention Coalition, supporting the coalition's priorities. Data:
2005: 3 youth suicides in Deschutes County; 14 in Oregon; no suicides reported in the
County in 2004 or 2003; 24 in Oregon those 2 years17. Resources needed to support
priorities.
g. Early Childhood-Provide staff with supervision, consultation and training to assess,
diagnose and develop appropriate treatment planning and wrap-around services
for young children with mental health needs. Increase staff awareness of services
provided by other community agencies and work with these other agencies to
develop joint treatment planning to meet the needs of young children with mental
health needs. OHP and State funds essential.
h. Home Visits (2005 OMHAS Audit Recommendatio Provide periodic training
opportunities for staff to allow for home visits with families (where needed and within
our capacity) as part of the therapeutic and family support process. Funding
considerations are unknown at this time. One staff member attended a training in
home visit safety in the fall of 2006 and shared the information from this training with
the entire Child 8, Family team.
i. Collaboration With All Children's Systems-Promote a value that our staff work closely
with other children's helping systems including Juvenile Justice, Courts, Child Welfare
and education. Dedicated time of existing staff.
j. Local Access in Outlying Areas-Expansion of services in North and South County in
response to access issues, community population growth and an emphasis on
outreach to Oregon Health Plan members and indigent families. Includes local
services in Sisters at some point in the future. New resources needed to meet growth
in these communities. May require redeploying resources currently located in Bend.
Table: July 1, 2007, Service Levels
170regon Vital Statistics, Department of Human Services, Health Division
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 31
Area
Total
Population
Est. Number of
Children18
Number of Children
Served
1/1/2007-12/31/2007
Bend
77,780
17,500
681
La Pine
1,590
357
157
Redmond
24,805
5,581
348
Sisters
1,825
411
15
Number of Oregon Health Plan members in each area varies; services to OHP
members will remain a priority.
6. Adult Mental Health Treatment and Support Services
(See also Chemical Dependency and Justice System)
a. Community Support Services-Continue to expand case management, treatment
and support services (e.g., jobs, housing) for clients with a serious mental illness.
Operate within a framework of Strengths Based Case Management. Provide
outreach and frequent contact with high need clients. Case load has increased
(185 in 2005 to 300 in 2007). Trend suggests case load of - by 2013. Resources
needed.
1) Employment (Supported)-With clients, employers, and the State Vocational
Rehabilitation Dept., offer supported employment to people with mental illness.
Completed 2007 technical assistance with Options of Central Oregon and
successful 2007 fidelity review. Planning 2008 expansion from 1.0 FTE to 2.75;
eventual caseload of _ expected. * Key recovery initiative.
2) Housing (Supportive)-With Housing Works (HW) and others, create short-term
and permanent residential programs and housing units for people with mental
illness throughout the County and Central Oregon region. With HW and Cascade
Healthcare, opened (2005) and continue supporting Horizon House (14 units) in
Bend. Assisted in reopening a 5-bed PSRB home. Continued support to local
foster home options for clients. Resources needed in all areas noted below.
A) Seek County and cities (Bend, Redmond and La Pine) assistance in securing
land for acquisition and grant funds for construction and project
development.
B) Include a housing initiative in the County's planned North County Service
Center.
C) Expand residential programs and foster care options as well as transitional
and permanent housing for clients with mental illness.
D) Secure sustainable funding to expand services in the areas of homeless
outreach, supportive housing and intensive case management. Hire a
housing specialist to assume leadership for the County's housing continuum
and plan.
E) Participate actively in the development of a 10-year Plan to End
Homelessness, assuring access and benefit for special populations.
18Population statistics used are from the Portland State University Population Research Center. Children (ages 0-17)
make up 24.5% of Oregon's total population, and that percentage was used to calculate Deschutes County's child
population.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 32
F) Promote and support residential capacity development throughout Central
Oregon and Jefferson and Crook counties support of any regional housing
projects operated in Deschutes County.
See Deschutes County's Housing Continuum
(for people with mental illness) on next page
b. Acute Care-Work to create and sustain an effective system of acute care and
intensive service options for adults experiencing significant emotional distress.
1) Resources-Effectively invest new State funding. Develop essential acute care,
case management and respite services. Sustain equitable funding achieved in
2007 (comparable to State average for acute care). Sustain access for the
indigent and OHP members to Sage View (15 beds) and the St. Charles Medical
Center Psychiatric Emergency Services (five) beds. Develop crisis respite as an
alternative or a step down from more intensive care. Note: Current, proposed 8-
bed and 10-bed projects will add 5 longer term beds.
2) Regional Council and System-With Central Oregon partners, develop a high-
quality regional system of care. Develop and sustain service options; monitor
services and finances. Continue contracts with Cascade Healthcare Community
for indigent and OHP access to Sage View and St. Charles. Actively manage use
of services; authorize services for indigent, voluntary clients; coordinate continued
stay and discharge planning. Participate in monthly utilization management
meetings.
3) Oregon State Hospital and EOPC-Represent the interests of Central Oregon in
planning for development of the new Oregon State Hospital(s) (2011).
Completed Central Oregon Plan (2007) for regional and local service developed
including priority services and estimated costs. Continue advocacy for this plan.
4) Utilization Management (UM)-Hired UM Manager through ABHA to manage and
monitor use of acute care services. Provides monthly reports on use; works with
crisis staff; convenes monthly regional meeting with counties and hospital to
discuss trends and difficult cases.
Ask Jeff to insert table on use 2006, 2007 and projected future use if possible
c. Outpatient Treatment-Provide mental health, addictions and gambling treatment.
Assure that clients meeting service priorities are seen in a timely fashion. Reorganized
orientation process to assure access within two weeks. Decrease no-show rates.
Continue to expand services in Redmond and La Pine. Redmond services have
been expanded; La Pine clinician in community one day per week. Continue to
support and develop the Dialectic Behavioral Therapy for high-need clients;
sponsored 3-day training for all staff in 2007. Continue to support brief treatment
where appropriate. Caseload management (length and level of care) occurs
through regular clinical supervision. Insert 2007 data and any trend, information.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 33
Deschutes County's
HOUSING CONTINUUM
For people with mental illness
February 2008
(includes both facilities and services)
Key:
New projects or needs in italics
regional (Central Oregon) project
DCMH=Deschutes County Mental Health
PSRB=Psychiatric Security Review Board
HW=Housing Works
INDEPENDENT LIVING
Offer / expand supported
housing, case management
GROUP HOUSING & SUPPORT
Emma's Place 11 units w. voucher 19
Facility 8-12 bed @ County center 20
Facility 6-bed @ HW Redmond site
South County project tbd
Housing First projects annually
RESIDENTIAL PROGRAMS
2 5-bed foster homes (10-beds total) in Bend
Springbrook 5-bed PSRB home, Bend
2008: Telecare 8-bed facility21, Bend?*
2009: Telecare secure 10-bed facility22 Bend*
(Deschutes County development)
South county project(s)
Urgent need: short term respite 3-5 beds
TRANSITIONAL HOUSING
Horizon House 14 units Bend 23
Parole / Probation transitional facility Bend 24
2008-09: New 14-unit transitional facility Bend 25
2011-12: New 14-unit transitional facility Redmond
House of Hope - limited; $400 / month Bend
EMERGENCY SHELTER & ASSISTANCE
DCMH homeless outreach worker(s).
Need: more homeless outreach staff capacity 26
Bridge Corrections Program 2FTE; need 3rd position
Bethlehem Inn (est. 15-20 people mentally ill)
Shepherds House *
Sage View 15-beds Cascade Healthcare Community
Psychiatric Emergency Services 5-bed (St. Charles CHC)
Psychiatric Emergency Service 1-bed St. Charles Redmond
HOMELESSNESS / INSTABILITY / HIGH RISK
DCMH homeless outreach worker(s)
Bridge Corrections Program 2 FTE; need 3rd position
Deschutes County jail est. 8% mentally ill (20-30 of 220)
2008: Alcohol, other drug treatment in jail and after
INFRASTRUCTURE & SUPPORT -DCMH Housing Coordinator needed
19 Emma's Place: 9 of 11 residents have housing vouchers 11.07
m New apartment building on site of the proposed Redmond Deschutes County Service Center
Y1 Residential treatment facility with 5-beds for Extended Care from State Hospital; 3-beds for County placement
22 Secure residential treatment facility with 4 beds Extended Care; 4-beds PSRB; 2-beds County placement
23 Horizon House: 9 of 11 residents have vouchers 11.07
24 Parole & Probation transitional facility: estimated 4 to 8 of the 18 beds are people with a mental illness 11.07
25 Transitional facility: $85,000 grant State of Oregon 2008; Location to be determined; Bethlehem Inn is one possible site.
26 Grant application submitted to State of Oregon Addictions & Mental Health; PENDING
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 34
d. Groups-Continue to support and expand group treatment services. Identify target
populations and diagnoses that are best treated by group services and increase the
use of evidence based practice models. Areas of emphasis include Dialectical
Behavioral Therapy, Dual Diagnosis for the seriously mentally ill, Seeking Safety (for
trauma and addictions), and medication management.
e. Medication Management-Continue to offer critical medical services including
medications to DCMH clients; expanding those services as client load requires.
Increased medication appointments, adding nurse practitioner position (2006) and
increasing prescriber time 25 hours / week. Through DCMH psychiatrist and with
clinicians, offer medication management groups (education, individual
management), improving timely access. Continue to explore the most effective and
efficient use of these limited resources. Assure sufficient capacity for case reviews
required by Medicaid. Increase coordination with primary care providers for ongoing
medication management. Expand use of evidence based practices within
accepted department prescribing practices such as use of medication algorithms
and standardized assessment/documentation formats. New resources may be
needed.
f. Crisis Team-Sustain new (2007) Mobile Crisis Team and evaluate use and early
evidence of benefit by January 2009. Support development of a "crisis bag" for
each member of the Community Assessment Team and on-call workers. Staff
recommendation. Each team member has a resource bag with one shared by the
Mobile Crisis Team.
2004-05 Service Levels for Adult Services UPDATE & break out 65 and older
(maybe)
Area
Est. 2004 Total
Population
Est. Number of
Adults27
Number of Adults
Served
Bend
65,210
49,234
1,449
La Pine
5,799
4,378
181
Redmond
18,100
13,665
455
Sisters
1,490
1,125
45
Number of Oregon Health Plan members in each area varies; services to OHP
members will remain a priority.
7. Seniors' Mental Health Services
Deschutes County Mental Health continues to offer one of the few specialized geriatric
mental health programs serving Oregon Health Plan and indigent clients in Oregon.
Over the next five years, there is a critical need to expand services to meet the need of
the fastest growing segment of Oregon's population. Any inability to respond to growing
needs among our highest risk elderly population will contribute to profound isolation,
diminished health, costly out-of-home placements and even suicide.
According to data compiled by Oregon's Department of Human Services, Oregon's
senior population (age 65+) is projected to rise 33% from 2005 to 2015 compared to a
27Population statistics used are from the Portland State University Population Research Center. Adults (18 and older)
make up 75.5% of Oregon's total population, and that percentage was used to calculate Deschutes County's adult
population.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 35
general population increase of 13%. Deschutes County's senior population is projected
to increase 63% in that 10-year period (compared to 27% for the general population).
Maintaining services, a goal of the County Commissioners, must be viewed as at least
continuing to serve the same percentage of the need, currently 10%. In Deschutes
County that need is growing at three times the rate of the general population. The
staffing to provide the services for 10% of the need must be increased even to keep
pace with growth in the population.
Table no. - Services provided by the Seniors Team
2005-2006
2006-2007
Clients
387
424
Contacts
4,512
4,386
Service hours
3,999
3,680
a. Expand Service Levels-The challenge is to provide even the same level of service to
the rapidly expanding population in need of the services. The range of services must
include case management; crisis evaluations and interventions; mental health
evaluations and assessments; individual, group and family counseling; coordination
with other community services and consultation with medical providers. The team
must also continue to train and educate other elder care providers, offer public
education, play a liaison role with the State Hospital and advocate for quality care
and the other needs of seniors.
b. Geriatric Population at the Oregon State Hospital-The current population of seniors
at Oregon State Hospital is extremely low due to the specialized services to seniors
and to our Enhanced Care Outreach Services program, which keeps people in the
community and returns Deschutes County citizens placed at the State Hospital to
their community. To continue to keep the population at Oregon State Hospital low,
expansion of the Enhanced Care Outreach Services program and community
services is needed.
c. Support passage of Senate Bill 1075 to increase seniors' access to mental health
services.
d. Enhanced Care Outreach Services-The Enhanced Care Outreach Services program
has doubled the number of clients served but is now at the absolute maximum
number of clients for the available staff. Increase staffing to keep pace with the
growing number of people in need of these services.
e. Service Expansion-We attempted to expand services through the use of interns and
volunteers. Without additional staff hours to recruit, train and monitor volunteers and
interns, we are very limited in our ability to use these other resources. Even a part-
time position would allow expansion of the volunteer and intern staff available to
meet at least some of the lower level needs at a very small cost. New resources
needed.
Outreach-Continue the outreach model of service delivery for the seniors
population. Many seniors face significant transportation barriers and by using the
outreach model we are able to have a very low no-show rate and continue to serve
folks despite health, weather and transportation issues.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 36
8. Chemical Dependency
a. Establish Guiding Principles
1) Collaboration-Our community is best served through collaboration, a common
focus and mutual support between Deschutes County Mental Health, other
County departments, and private prevention and treatment agencies and
coalitions. County will continue to host the community Addictions Committee to
help achieve this goal.
2) Investment-Treatment resources available to Deschutes County should be
invested in a manner that assures the maximum amount of high-quality services.
3) Results-Services must be based on evidence based practices and consistently
report measurable outcomes that demonstrate effectiveness. Additional work is
needed in this area.
b. Comprehensive Approach-Work with the community to develop a system with a full
continuum of services to prevent substance abuse and to assure access and
engagement of those in need of addictions treatment. Resources needed.
c. Co-Occurrina Disorders-Retain primary responsibility for the treatment of co-
occurring mental illness and addiction issues by Department clinicians. Assure
qualified, well trained professionals are offering these services. Department staff are
working with state officials to improve financing methods in support of this work.
Services have also been expanded (2008) on the DCMH Community Support Services
team.
d. E uit -Successfully advocated with the State for a fair and equitable investment of
treatment resources for Oregon residents, regardless of their county of residence.
Funding inequities corrected for the 2007-2009 biennium with the passage of HB 3067.
Additional funds invested (2008-2009) in indigent care, help for adolescents, help for
people in the justice system, and help for people with serious mental illness and a co-
occurring disorder. Continue to monitor this issue and advocate so that inequities do
not reemerge in 2009-2013.
e. Family Drug Court-In partnership with the courts, continue administering the
necessary grants to sustain the Family Drug Court and develop an individual Drug
Court if feasible. Coordination occurs through the Circuit Court. Prioritize families
with minor children. Since inception (fall 2006), the court has the capacity to help 25
adults and their minor children (currently 42, January 2008). Note: As of January
2008, Federal funds may be in jeopardy; require changes in the model and resource
development.
County Leadership-Continue to convene treatment and prevention professionals
and other interested individuals at least quarterly to address planning, advocacy,
service coordination and program development priorities and issues. Promote and
bring visibility to chemical dependency issues. Developed the Addictions Committee
as a subcommittee of the County's Addictions & Mental Health Advisory Board to
bring better coordination and emphasis to these issues.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 37
g. Methamphetamine--Coordinated Response-Participate actively in the Meth Action
Coalition, supporting a comprehensive approach focused on prevention, treatment
and public safety. Seek resources to expand treatment. Resources needed.
h. Oregon Health Plan Members-Assure availability of timely, high-quality addiction
treatment services to Oregon Health Plan members through operation of the
County's Chemical Dependency Organization.
1) Continue to assure all eligible members have access to treatment services;
locally whenever possible. Access is not currently a problem, but reductions in
funding (rates) have recently occurred.
2) Continuous evaluation of the Chemical Dependency Organization penetration
rate (percentage of members who receive services). The formula the Chemical
Dependency Organization uses to calculate the penetration rate is the number
of members who received services (numerator) divided by the Chemical
Dependency Organization's adjusted enrollment (denominator). The adjusted
enrollment are members age 13 and older. Oregon's Division of Medical
Assistance Programs, along with the Addictions and Mental Health Division,
recently developed a statewide draft Alcohol and Other Drug Utilization Report
(draft was distributed in October 2007). The formula used by the state to
calculate the penetration rate for plans and fee for service, or open card, uses
the total enrollment, not an adjusted enrollment, as the denominator. So, there
is still much work to be done in getting at a true "comparison" between plans.
The Chemical Dependency Organization will take an active role with the
Addictions and Mental Health Division and Division of Medical Assistance
Programs to assist in making improvements to the statewide Alcohol and Other
Drug Utilization Report, which will provide a mechanism by which the Chemical
Dependency Organization can extrapolate a "comparative" measure of
penetration in an effort to evaluate performance in this area and target future
improvement initiatives. The current penetration rate based on the adjusted
enrollment as the denominator from July 2004 through June 2007 is 1.5%.
3) Develop mechanisms which facilitate and strengthen the coordination and
integration of physical health and mental health care services for members who
present for primary addiction treatment services. This will be accomplished
through the Performance Improvement Project (PIP) with Central Oregon
Individual Health Solutions (COINS), the fully capitated health plan and
Accountable Behavioral Health Alliance (ABHA), the Mental Health
Organization. Both COIHS and ABHA serve Chemical Dependency Organization
members.
4) Devise strategies and initiatives to enhance outpatient addiction treatment and
prevention services for Chemical Dependency Organization members. These
strategies will be developed in collaboration with sub-contracted treatment
providers, DCMH and other community stakeholders. Collaboration will occur
through the use of the Addictions Subcommittee.
Prevention- Section lu be udpated by Robin Mars'nali, Cun-)mission on Children &
Fair ili Support the substance abuse prevention work of the Deschutes County
Commission on Children & Families (CCF). Invest public funds through projects
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 38
sponsored by CCF. Support evidence based projects that reduce at-risk youth
behavior and support healthy family functioning.
1) Increase partnerships with treatment providers.
2) Reduce adolescent alcohol use in Deschutes County.
3) Conduct analysis of beer and wine tax money distributed in Deschutes County.
4) As able, reinvest funds from the Chemical Dependency Organization in projects
that prevent substance abuse.
Priority Populations-For the foreseeable future, the Department will focus its limited
treatment resources by prioritizing service to specific groups in our community.
1) Youth-In an effort to stem the spread of substance abuse in our community, we
will focus on the prevention and treatment of adolescent alcohol use.
2) Adults-Focus on five populations: a) pregnant women, b) intravenous drug
users, c) families with minor children (child welfare concerns), d) people with a
methamphetamine addiction and/or e) individuals in the justice system (effective
alternatives to incarceration and opportunities to prevent recidivism).
3) As restricted resources become available, other populations in our community will
receive assistance within those grant guidelines.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 39
9. Justice System Services
Mental health and substance abuse treatment services and prevention strategies are
essential to an effective public safety and justice system. It is the collective goal of
mental health professionals, the courts, corrections and law enforcement in Deschutes
County to ensure access to quality treatment, prevention and support services for youth
and adults with mental illness who impact the criminal justice system.
"People with mental illness or 'co-occurring disorders' exact a high toll on the justice
system. Revenue spent on their care while incarcerated pulls scarce resources away
from the justice system's primary function-prosecution of criminals. Besides:
• Individuals with mental illness stay in jail longer;
• They are more expensive to maintain;
• Without proper treatment, they pose a high risk of re-offending; and
• They are at high risk for suicide while incarcerated." 28
The Deschutes County Local Public Safety Coordinating Council and its members
endorse a long-term community effort to develop and implement a system of effective
programs and projects that range from prevention, early intervention, diversion from jail,
in jail services, transition planning and post release services. We intend to provide for
public safety; reduce recidivism; offer viable alternatives to incarceration when that is
deemed appropriate29; and better serve, treat and hold accountable individuals with
mental illnesses and/or addiction issues. We support a comprehensive approach to this
effort that includes the following:
a. Primary target population(s) - Each program or project offered through Deschutes
County will have a target population clearly identified. Likely examples include
people with a significant mental illness, people with both a mental illness and another
co-occurring disorder or people with a primary presenting addiction illness.
b. Alternatives to Incarceration Report (2006)-Seek opportunities to acquire resources
to develop and expand alternatives to incarceration at levels that correspond to our
population increase and the bed expansion planned for the Deschutes County Jail.
Develop a treatment and public safety system that is balanced and that provides
sufficient jail capacity and in-jail health services (both current and planned) as well
as the best possible behavioral health services 30 pre and post adjudication. The
Report's priorities will be advanced, where possible, along with the current jail
expansion effort. Resources needed.
c. Collaboration-Develop a lasting and formal partnership through the Local Public
Safety Coordinating Council to address the criminalization of the mentally ill and to
plan and carry out core strategies and programs.
28 Oregon Partners in Crisis.
29 Alternatives to Incarceration are defined as those services and strategies offered prior to incarceration, strategies that
are implemented within a jail stay as part of a more comprehensive case plan as well as services offered through
Deschutes County for people released from jail and intended to prevent further incarceration.
30 Behavioral health services are defined as a combination of mental health and addiction screening, assessment,
treatment, case management and other support services offered by and through the resources of Deschutes County.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 40
d. System Development-Emphasize a systems approach to improvements in programs,
services and practices used to address the issues associated with mental illness and
addictions.
e. Diversion
1) Crisis and Intensive Outreach-Reduce unnecessary hospitalizations and
incarceration through prevention and early intervention. Sustain the County's
Community Assessment (Crisis) Team and Mobile Crisis Team for assessment and
crisis intervention; expand the Community Support Services Team for intensive
wrap-around services to high-need clients (includes treatment and connection to
programs and supports).
2) Coordination and Referral to Medical Center-Work closely with Cascade
Healthcare Community and other hospital systems. Assure appropriate referrals
and coordination of services. Increase the justice system's awareness of hospital
and County roles, services and capacities.
3) Sage View-Support successful operation and availability of this secure (short-
term) crisis stabilization, treatment inpatient psychiatric center for eligible
individuals including Oregon Health Plan members and indigent County residents.
Resources needed.
4) Psychiatric Emergency Services at St. Charles Medical Center-Assure sufficient
access to short-term stays at the hospital for assessment and stabilization. New
hold room unit (5 beds) opened in January 2006. DCMH Crisis Team continues to
provide daily coordination.
Crisis Intervention Training (CITI-In cooperation with local law enforcement,
Cascade Healthcare Community and NAMI of Central Oregon, offer CIT as an
evidence based practice; increasing the ability of first responders to work with
people with mental health or addiction issues. If that is not feasible given limited
resources; offer an abbreviated introduction to mental illness and local services.
Assisted Deschutes County Sheriff in offering an 8-hour training (2007) for field officers
and jail staff. Trained Bend Reserve Police Academy. 2008 trainings will include
Redmond Police, Crook County Sheriff and Oregon State Police. Long term, offer
periodic trainings for officers from all Central Oregon agencies. Coordinate project
with Sheriff and Police Chiefs:. Note: The 2007 legislature pass a new law requiring
DPSST (Oregon Police Academy) to offer a training for new officers.
g. Family Drug Court and Drug Court-In partnership with the courts and treatment
providers, assure administration (through the County or other entity) of the necessary
grants to sustain the Family Drug Court and develop an adult Drug Court if feasible.
Coordination occurs through the Circuit Court.
1) Family Drug Court-Prioritize families with minor children. Since inception (fall
2006), the court has the capacity to help 25 adults and their minor children
(currently 42, January 2008). Note: As of January 2008, Federal funds may be in
jeopardy; require changes in the model and resource development. Resources
needed.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 41
2) Evaluation-Completed two initial evaluations of the Family Drug Court to
determine benefit and opportunities for improvement and/or expansion. Ensure
an annual reevaluation process through the most appropriate group.
3) Expansion Long-Term-Expand the Drug Court to serve adults in need of
addiction treatment. Resources needed.
Mental Health Court-With courts and program partners, sustain and expand this
treatment court as an effective treatment alternative for County residents with a
mental illness who commit (primarily) non-person misdemeanors and some felonies.
Note: Participation requires the concurrence of the District Attorney, the individual
and the Court. Deschutes County Mental Health services: assessment, treatment,
case consultation. Expand the court in 2008-2009 from 12 members (2007) to (up to)
25 members. Continue to expand the court in conjunction with jail expansion, as
resources allow. Resources needed.
i. County Parole & Probation Specialization-Continue availability of specialized
personnel with expertise and a mental health case load. Note: FTE increased to 1.5
in 2007. Beneficial to increase FTE as caseload expands. Expand this capacity further
in conjunction with jail expansion. Resources needed.
j. Multi-Disciplinary Case Coordination-Convene a regular meeting of jail, parole and
probation, mental health, hospital staff to coordinate services for people who
frequently use the services of multiple systems. Initiated in 2007
k. Jail Services
1) Perform services through jail staff including assessment, medication and
stabilization, particularly of seriously and persistently mentally ill population.
Challenges that must be addressed include:
a) The cost of psychotropic medications as part of an inmates health care;
b) longer term jail stays for this population than any other jail population; and
c) The lack of mental health treatment in the jail facility itself.
2) Assure County Mental Health Department staff are available for crisis assistance.
Needed hospitalizations are accomplished cooperatively between jail and
mental health staff.
3) Expect DCMH to continue to convene a regular meeting with representatives of
the Courts, hospital, Parole & Probation and the jail to develop a shared plan for
managing the care and custody of alleged mentally ill persons (AMIP) who are in
custody of law enforcement agencies. The parties have reviewed policies for
intervention with inmates with mentally illness.
4) Within HIPAA and other confidentiality requirements or limitations, determine
proper methods of sharing client information between DCMH, Deschutes County
Jail health care staff and similar juvenile Community Justice staff solely for the
purpose of ensuring continuity of health care and reinstatement of benefits. Seek
assistance of County legal counsel in establishing a process; including review of
SB 913 (2005 Oregon legislative session).
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 42
5) Offer support for the efforts of the Sheriff's Office to develop a specialized unit as
part of the 2011 jail expansion. Offer to assist in the related design and program
development to assure effective services, and case consultation and referral post
release.
Jail Bridge Program-Expand and sustain community reentry services to adults with
co-occurring disorders in the jail and the community corrections system in Deschutes
County. Participate actively, where appropriate, with the Sheriff's Office and the
Parole & Probation in the Reach In Program. Acquire dedicated resources to
develop a team of (at least) three professionals to offer case management,
treatment and support services. Adding second position in 2008 including capability
to treat. Reduce recidivism and improve functioning in the community through
housing and job assistance, treatment, medication management and other help.
Note: Significant expansion needed at time of jail expansion. One of two current
positions is not sustainable long term. Resources needed.
m. Juvenile Services-(This section was provided by Juvenile Community Justice).
Deschutes County Juvenile Community Justice operates a secure detention facility
for juveniles under the supervision of the Juvenile Court, or juveniles with detainable
law enforcement who are awaiting a Court disposition. The decision to detain a
youth is a serious one and must comply with Oregon Revised Statute guidelines.
While not participating in a formal study or technical assistance project regarding
detention decision practices and developing alternatives to detention, the
department constantly seeks to monitor and improve its use of detention to ensure
the safest and most cost efficient ways to protect the public and reduce recidivism.
As of this writing, a needs analysis is being done to ascertain the need for emergency
shelter resources, as an alternative to detention for eligible youth awaiting court
arraignment and disposition.
Other challenges and needs being addressed in relation to effective use of
detention include:
1) Ensuring sustainable funding for Functional Family Therapy, a family-based
treatment model with the specific aims of reducing recidivism and preventing out
of home placement, as well as sibling delinquency prevention.
2) Youth offenders with treatment-specific needs who await placement for long
periods of time in detention due to lack of immediate treatment availability and /
or a safe placement option in the home. These include offenders with serious
mental health disorders and sexual offenders awaiting residential treatment.
n. Supervised Housing-As recommended by Adult Parole & Probation, seek resources
to develop and offer transitional, supervised housing for people with mental illness
who are diverted from the justice system or are seeking to re-enter the community.
The goal is to offer safe, stable housing for clients and to prevent recidivism. This
need became more apparent with the 2004 closure of Park Place. Parole &
Probation has developed a transitional housing option (2007) to replace lost space at
the reopened Work Release Center. Services (monitoring, supervision, case
management and treatment) are needed for residents in this housing.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 43
o. Psychiatric Security Review Board (PSRB)
1) Greater Awareness-Expand this program locally with additional staff, services
and housing options. Four additional PSRB secure beds are expected in
Deschutes County in 2009. Seek State assistance in training jail staff and others on
the PSRB process and guidelines, clarify process to differentiate mental illness
issues from criminal acts, and the County's role in revocations. Establish a method
to better inform the jail of PSRB individuals residing in Deschutes County. County
hosted fall 2006 meeting for educational purposes. Continue to seek
opportunities to better clarify the PSRB program and process as well as the
responsibility of varies parties to this process. Increase coordination with public
defenders. Continue offering (County PSRB Coordinator) testimony to the courts
when appropriate on PSRB cases. Continue work with law enforcement on roles
and responsibilities during the revocation process. Note: Deschutes County has
continued to have 10-12 under PSRB supervision (2008 figures are comparable to
2005).
After identification of need for further information regarding the Psychiatric
Security Review Board (PSRB), the State Director met locally with medical center,
jail, county and court personnel; as well as Circuit Court Judges.
2) Aid and Assist-Expedite the aid and assist process for PSRB clients to reduce
unnecessary jail days awaiting processing. Arrange training for assistant district
attorneys and defense attorneys on PSRB and the aid and assist process.
Education and coordination with public defenders has provided some decrease
in the delays in this process; continued improvement is needed.
p. Addictions Treatment-In 2008 and in cooperation with the Deschutes County
Sheriff's Office, expand addictions treatment for people involved in the justice
system. Expanded Bridge Program will also increase access to service for people with
a serious mental illness needing dual diagnosis treatment. The development of the
Family Drug Court has also expanded access to addiction treatment for qualified
families.
10. Developmental Disabilities Services
a. eXPRS Payment System-This system now provides for direct payment for
subcontracted services. It will expand to include case management service
payments this spring. This will be the first change in the new direction that the State
will be taking in terms of payments to counties for services provided.
b. Case Management and Crisis Resolution-Continue to advocate for the expansion
of the regional program to add new local resources to allow individuals to remain in
the community and have their needs met. Continue the increase in funds for case
management services to meet the need of the growing population. The program is
required to serve all eligible county residents, and that population has increased by
I* .
c. Family support-Continue offering goods and services to high need children and
their families; expand whenever possible. Families served have increased 22% in the
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 44
past two years through a one-time use of funds to help wait list families. 2006-2007 56
families served; 2005-2006 46 families. Wait list has increased from 35 to 47 families in
two years. Resources needed.
d. Residential Options and Community Resources-Increase options for people with
disabilities to remain in their homes and community with their needs met. Recruit,
train and monitor more foster home options for adults and children. In the past two
years, developed five new foster homes in the region for medically fragile children
and adults, and adults with behavioral challenges. Develop two new residential
resources in the community over the next four years to meet an increasing need. The
biggest challenge is to help providers recruit, train and maintain the staffing needed.
e. Brokerage Services-The state has increased the funding for clients to enter
Brokerage services for the next 18 months. Even at the increased rate we will still
have at least 40 people waiting for services as of July 2009, when the Staley lawsuit
mandates that all eligible clients have access to Brokerage services. We will
continue to make the State aware of this shortfall. State resources needed.
Lifespan Respite Services (Regional Programl-Successfully advocated for
improvements in state system (more accountable, better organized) and more state
funding to improve the quality of life for clients and families and delay or prevents
costly out-of-home placements. Expanding coordinator to full time. In addition to
coordinating the program in Crook, Deschutes and Jefferson counties, coordinator
also provides consultation services to Harney County to improve their program.
g. Client and Family Self-Advocacy-Continue to offer training opportunities as a way
to support people in acting as advocates, working to make the community more
accessible to people with disabilities. Aid clients in attending community forums and
planning groups (e.g., transportation planning).
Regional Services Program-Recently added five new non-crisis placements in
Central Oregon. Plan for five additional placements by 2009. Hire a regional
development specialist (funds secured). Work with providers and advocates to
identify barriers to expansion; work with the specialist to create solutions.
31 The Staley lawsuit settlement requires that all eligible individuals must be enrolled into brokerage services
by age 18 as of July 1, 2009.
Deschutes County Mental Health Strategic Plan 2008-2013 April, 2008
Page 45
APPENDIX 1: Financial Plan 2007-2010
Budget FY Projected Projected Projected Projected
Account Description 2007/08 FY 2007/08 FY 2008/09 FY 2009/10 FY 2010/11
91.46 95.46 101.28 95.28 95.28
BUDGETED AND ACTUAL REVENUES
Beginning Net Working Capital 2,900,000 2,876,903 2,750,000 1,924,857 1,245,729
State Grant"
3,794,861
4,662,823
5,179,808
5,283,405
5,389,073
ABHA
2,326,940
2,326,940
2,771,800
2,827,236
2,883,781
Other State, Grant & Patient Revenue
1,709,078
1,750,146
1,441,014
1,438,960
1,452,831
General FundB
1,462,516
1,462,516
1,525,899
1,571,676
1,618,826
Other Transfers Inc, 0
428,193
428,193
453,825
488,289
524,165
FUND RESOURCES TOTAL
12,621,588
13,507,521
14,122,346
13,534,423
13,114,405
BUDGETED AND ACTUAL EXPENDITURES
Personnel ServiceE, F, G
Community Contracts
County Indirects
Materials and Services
Capital Outlay
Transfers Out-Project Development
Contingency
FUND REQUIREMENTS TOTAL
Beginning Working Capital
Carryforward
Historical Under Spending vs. Budget
on Personnel and Materials
Projected (Loss) for Period
Ending Net Working Capital
Restricted Working Capital
Unrestricted Working Capital"
7,226,067
7,488,426
8,350,821
8,427,980
8,933,659
1,750,700
1,925,700
1,942,754
1,949,608
1,988,600
819,265
819,265
917,128
935,471
954,180
1,243,043
1,284,020
1,436,686
1,425,535
1,454,046
100
-
100
100
100
150,000
150,000
150,000
150,000
150,000
1,432,413
-
-
-
-
12,621,588 11,667,411 12,797,489 12,888,694 13,480,585
2,900,000 2,876,903 2,750,000 1,924,857 1,245,729
700,000 909,890 600,000 600,000 600,000
( 767,587) ( 126,903) ( 825,143) ( 679,128) ( 1,011,909)
2,132,413 2,750,000 1,924,857 1,245,729 233,830
- 150,000 150,000 150,000 150,000
2,132,413 2,600,000 1,774,857 1,095,729 83,820
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 46
Notes and Assumptions:
A. Additional permanent DHS State Grant funds of approximately $783,000 per year will begin being
received mid way through the 2007/08 fiscal year. An additional 4.00 FTE was added around 1/1 /08 to
provide services with these funds and an additional 5.32 FTE will be added during the fiscal year
2008/09 budget process.
B. Assumes County General Fund contribution increases of 0.6 for fiscal year 2008/09, and a 3% increase
for fiscal years 2009/10 and 2010/11.
C. "Other Transfers In" represents funds transferred from Mental Health's other two County budgeted funds
(Funds 270 and 280). This account has traditionally been used for the transfer of dollars from Fund 270
and 280. Fund 270 is the depository fund for all our OHP dollars received through ABHA (recommended
government budgeting practices from the GFOA), and Fund 280 is where we budget and administer
our CDO. When developing our annual budgets we use a conservative estimate of how much income
will be available to fund operations in Fund 275, and as a result excess dollars can build up in these two
funds.
D. State Grant and Administrative Fee are increased 2% each year, except where specifically otherwise
noted.
E. Annual salary increases are calculated using a 6.5% annual increase: 3% is the anticipated COLA
increase, and the other 3.5% is Mental Health's average annual step increase. Salary and benefit
increase appears less due to a reduction of FTE in projected years and current staff who have reached
the highest step in their classification.
F. With the intent of remaining conservative in forecasting, PERS contributions are maintained at the
current rate of 19% for years beginning with 2008/09.
G. No additional expenditures have been included in projections for any impact resulting from the salary
study the County is planning.
H. It is our intent to keep the unrestricted fund balance equal to or greater than the amount needed to
pay for one month of operations, although fiscal year 2010/11 presents a problem and must be
addressed.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 47
4. Appendix 2: LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 48
Appendix 3: Deschutes County 2008-09 Goals and Objectives
County Mission: Enhancing the Lives of Citizens
by Delivering Quality Services in a Cost-Effective Manner
Items that may relate to this Strategic Plan Mental Health are bold and italicized
Integrate Deschutes County public safety and prevention functions into a continuum of
services that meet the needs of citizens
1.1. Continue to explore and determine funding levels for public safety functions (including
expanded jail, alternatives to incarceration, 911, DA, Courts, etc.)
1.2. Lead and coordinate efforts in community disaster and pandemic planning and work
with the business community and non-profit community on business recovery
planning.
1.3. Facilitate implementation of allowed alternatives for addressing groundwater
problems in South County.
1.4. Explore alternative funding and service delivery options for prevention and treatment
services while maintaining access to those services.
1.5. Determine which County Health and Human Services are being duplicated by non-
governmental organizations in order to improve service delivery.
2. Deschutes County staff has the knowledge, skills, resources and tools necessary to deliver
top-quality public services.
2.1. Identify priority training needs and sourcing programs to meet those needs.
2.2. Provide internal leadership development opportunities
2.3. Review and as necessary, revise administrative policies
2.4. Ensure that the work environment is safe, conducive to productivity and free of
harassment.
2.5. Create recognition program for employees.
Ensure the effective and efficient stewardship of the County's natural and built resources.
3.1. Develop a North County Campus possibly in conjunction with other non-profit and
public entities.
3.2. Evaluate space needs and plan for projected growth for 911, Sheriff, Parole, and
Probation and other Departments as necessary.
3.3. Employ best natural resources practices in the management of County lands
3.4. Update the County's comprehensive plan, addressing and integrating rural
development, preservation and transportation planning.
3.5. Develop long-term maintenance plans for County facilities.
Provide services that meet the needs of the citizens within budgetary constraints.
4.1. Establish goals and objectives that are consistent with the public's needs, as we
understand them.
4.2. Develop and implement action and communication plan of the results of the
employee survey.
4.3. Use customer / employee satisfaction data to inform and impact the next budget
process.
4.4. Continue to foster a positive environment of customer service within the County.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 49
5. Foster strong, accessible partnership and accountability with employees, customers,
community partners and all citizens.
5.1 Enhance two-way communication mechanisms between County Commissioners,
Administration, and employees, so staff continues to feel free to communicate honestly
with leadership in order to improve accountability and involvement.
5.2 Enhance two-way communication between County leadership and public and
community partnership.
5.3 Define and communicate cultural values and attributes essential to the County.
6. Ensure fiscal responsibility in all aspects of County operations.
6.1 Continue to explore and implement alternative funding sources for road maintenance
and construction.
6.2 Remain competitive in salary and benefits.
6.3 Create cost-effective county-wide procurement standards that encourage sustainable
practices.
6.4 Review reserves strategy and develop contingency policies.
6.5 Explore opportunities for combined service delivery with other governmental agencies to
save money for the public. _
6.6. Prior to launching a new program or service, demonstrate that the County is the best
provider as a matter of course.
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 50
For more information, please contact:
Scott Johnson, Director
Deschutes County Mental Health Department
2577 NE Courtney Drive, Bend, Oregon 97701
541-322-7502 or scott Johnson@co.deschutes.or.us
Deschutes County Mental Health Strategic Plan 2008-2013
April, 2008
Page 51
,
Deschutes County Mental Health Department
2008 Staff Survey
To: All Staff, Deschutes County Mental Health
From: DCMH Staff Survey Committee members:
Greg Bland, Camille Brandt, Amber Clegg, Fred Doolin, Loretta Gertsch, Kathe
Hirschman, Scott Johnson, Jean Mendenhall, Breanna Montoya
Date: March 17,2008
Subj: Deschutes County Mental Health Staff Survey Results
An effort to strengthen our Work Place and our Services
Our thanks to everyone who participated in the Department's 2008 Staff Survey. 79 staff
responded, which should give us a representative sample of our strengths and challenges.
Much like the 2005 survey, what we like most about our jobs relates to our clients and co-workers.
The general response seems to indicate that we're making progress and things are viewed
favorably. At the same time, there's always room for improvement. Identifying these needed
improvements will be a healthy exercise for us all.
Survey results are attached. They are also available on the shared drive:
LINK to quantitative results: All MH Staff\Staff Survey\2008\2008 Staff Survey Results doc
LINK to comments: All MH Staff\Staff Survey\2008\2008 Staff Survey Comments doc
This packet also includes our mission and values, County-wide employee values (a draft) and a
comparison of results from 2005 and 2008.
HERE'S HOW YOU CAN HELP
Each team is asked to review your results and come up with at least one improvement for your
team and at least one improvement for the Department as a whole to work on.
Please make your recommendations for improvement as specific and tangible as possible,
keeping our mission and values in mind. We'd appreciate any suggestions by May lst. We'll
finalize a set of improvements based on suggestions from all the teams. We'll share this
Improvement Plan at the All-Staff meeting on June 2nd.
Thanks again!
S:\Mental-Health\AII_MH_Staff\Staff Survey\2008\Scott's Letter to Staff 2007.doc
Deschutes County Mental Health
Mission and Values
Our Mission
To provide high-quality and integrated client-centered services that will enable
those we serve to strengthen their lives and roles in the community.
Our Values
Our clients
We believe those we serve should be involved in directing the course of the services
we provide as a component of a holistic approach to the betterment of their lives.
We believe our clients should have access, voice and ownership.
Our staff
We believe our staff is a valuable resource, and we promote the personal well-being
and professional development of each individual. Through continuing education,
peer review, and teamwork, we support each other in our efforts to deliver
compassionate, accountable services of the highest caliber. We value trust,
professionalism, integrity and mutual respect in all we do.
Our services
We believe mental health services are an integral part of a healthy community and
that comprehensive care is best provided through service integration, interagency
collaboration, and partnerships with other service agencies.
Our community
We believe mental health services should be visible and available to those in need
and that public awareness and education are key elements in community wellness.
We strive to make our services visible to the community and to deliver them in an
effective and efficient manner. We encourage feedback and use a strategic
planning process proactively to address the needs of our community.
Our Values as Employees of Deschutes County
(Draft February, 2008)
DCMH employee,
With the recent County and DCMH staff surveys, an active effort is underway to promote and
discuss our shared values as people who work for Deschutes County. The following five values
have been developed to bring clarity to what matters to us as employees and to promote
dialogue. Are these the kinds of things you would subscribe to and ask of your peers? Can we
envision how we will conduct ourselves as we live these values? I'd welcome any thoughts as
we work on any improvements in our work place.
-Scott Johnson February 15, 2008
As Deschutes County employees, we value:
Integrity, Accountability and Respect
We demand honest, ethical and respectful dealings with each other and with the public.
We keep our promises, admit mistakes, and are courageous in doing what's right. Our
conduct ensures that Deschutes County government earns the trust of the community it
serves.
Professionalism
We are committed to the highest level of competence and professional conduct. We also
recognize that humor, employed in a timely and appropriate manner, is vital to the well-
being of our organization.
Effective and Efficient Use of Resources
We strive to provide cost-effective services according to the community's priorities. We are
committed to finding solutions to problems that use common sense, good judgment and
compassion, keeping in mind what is the best outcome for the community.
Safe and Enjoyable Workplace
We value a safe work place, and one in which we are honored and recognized for our
talents and accomplishments. We value the free expression of ideas, honest and open
communication, and positive attitudes.
Innovation and Collaboration
We encourage fresh ideas and teamwork among employees and between county
government and the community it serves.
DESCHUTES COUNTY MENTAL HEALTH
2008 STAFF SURVEY RESULTS
1. EMPLOYMENT TERM: Your length of employment with DCMH:
2008 REPONSES
2005 RESPONSES
Percent
Total
Percent
Total
Less than 2 ears
26.6%
21
25.3%
24
2-5 ears
31.6%
25
74.7%
71
More than 5 ears
41.8%
33
Answered
79
95
Skipped
0
4
Potential re ponders
119
99
ivu c: /-uuo answers to tnis question were "Less than 2 years" or "More
than 2 years"
2. PROGRAM: Your primary program team:
2008 RESPONSES
2005 RESPONSES
Team
Total
Team
Responses
Team
Total
Team
Responses
BT
Business Team
12
9
12
10
CF
Child & Family Team
27
18
23
23
CA
Communit Assessment Team
8
3
4
9
CS
Community Support Services
19
11
16
11
CT
Communit Treatment Services
22
15
18
DD
Developmental Disabilities Team
14
11
15
14
S
Seniors Team
6
3
5
1
E
A
istration
11
9
8
Answered
79
Ski ed
3. IMPROVING? Has DCMH moved in a positive direction over the past
two years? (Scale: 1 = Worsening; 2 = Same; 3 = Improving)
2008
Worsening
The Same
Improving
Don't Know
Average
Service to clients
6.8%
31.5%
49.3%
12.30%
2.18
5
23
36
9
Communication
1.4%
24.7%
68.5%
5.5%
2.56
within department
1
18
50
4
Communication
0.0%
37.0%
37.0%
26.0%
1.85
with the public
0
27
27
19
Supervision
0.0%
45.2%
47.9%
6.8%
2.34
0
33
35
5
Management of
1.4%
38.4%
49.3%
11.0%
2.26
department
1
28
36
8
Managing change
1.4%
39.7%
46.6 ,0
12.3%
2.21
1
29
34
9
Managing conflict
1.4%
34.2%
43.80/b
20.5%
2.01
1
25
32
15
Answered 73
Skipped 6
Page 1 of 5
2005
Worsening
The Same
Improving
Don't Know
Average
Service to clients
27%
25%
34%
14%
2.08
23
21
29
12
Communication
13%
36%
42%
8%
2.32
11
31
36
7
Supervision
13%
41%
31%
15%
2.21
11
35
26
13
Management of
11%
44%
32%
14%
2.25
department
9
37
27
12
Managing change
11%
46%
33%
110/0
2.25
9
39
28
9
Managing conflict
14%
40%
22%
24%
2.11
12
34
19
20
Answered 85
Skipped 9
2008 Team Averages:
Service
to
clients
Communication
within
department
Communication
with the public
Supervision
Management
of
department
Managing
change
Managing
conflict
BT
1.67
2.29
2.33
2.17
2.17
2.20
2.20
CF
2.53
2.88
2.60
2.59
2.40
2.38
2.64
CA
2.50
2.50
2.50
2.50
2.50
3.00
3.00
CS
2.70
2.82
2.50
2.90
2.80
2.90
2.75
CT
2.23
2.54
2.30
2.46
2.50
2.50
2.40
DD
2.60
2.80
2.44
2.30
2.60
2.50
2.40
S
2.67
2.67
2.67
2.33
2.67
2.67
2.67
A
2.67
2.86
2.83
2.57
2.71
2.43
2.57
4. Optional Comments relative to IMPROVING. (See "2008 Staff Survey
Comments" document in shared AII_MH Staff/Staff Survey/2008 folder. Link:
SAMental Health\All MH Staff\Staff Survey\2008\2008 Staff Survey
Comments.doc)
5. ARE YOU VALUED? Do you feel valued and/or supported by: (Scale:
1 = Never; 2 = Sometimes; 3 = Often; 4 = Always)
2008
Never
Sometimes
Often
Always
Average
2.8%
28.2%
59.2%
9.9%
2.76
Clients
2
20
42
7
0.0%
18.3%
60.6%
21.1%
3.03
Co-Workers
0
13
43
15
0.0%
23.9%
47.9%
28.2%
3.04
Your Supervisor
0
17
34
. 20
5.6%
31.0%
40.8%
22.5%
2.80
Your Program Manager
4
22
29
16
7.0%
32.4%
42.3%
18.3%
2.72
[dept Director
3
23
30
13
36.6%
49.3%
11.3%
2.8%
1.80
Commissioners
26
35
8
2
15.5%
59.2%
23.9%
1.4%
2.11
Public
11
42
17
1
Answered 71
Skipped 8
Page 2 of 5
2005
Never
Sometimes
Often
Always
Average
2%
24%
550/0
19%
2.90
Clients
2
20
46
16
1%
19%
51%
29%
3.07
Co-Workers
1
16
43
24
7%
20%
48%
25%
2.90
Supervisors
6
17
40
21
7%
25%
43%
25%
2.86
Program Managers
6
21
36
21
6%
40%
35%
19%
2.67
Dept Director
5
34
29
16
42%
48%
11%
0%
1.69
Commissioners
35
40
9
0
17%
57%
25%
1%
2.11
Public
14
48
21
1
Answered 84
Skipped 10
2008 Team Averages:
Clients
Co-Workers
Your
supervisor
Your
Program
Mana er
Dept
Director
Commissioners
Public
BT
2.71
3.00
2.57
2.29
2.71
1.43
2.29
CF
2.83
3.06
2.89
2.67
2.61
1.83
2.11
CA
2.50
2.50
3.50
3.00
3.00
1.50
2.50
CS
3.10
3.20
3.40
3.00
2.60
2.00
2.20
CT
2.85
3.08
3.00
2.62
2.38
1.62
1.92
DD
2.90
2.90
2.90
2.80
2.70
1.80
2.20
S
3.00
3.33
3.67
3.67
3.67
2.33
2.67
A
1.88
2.88
3.25
3.25
3.25
2.00
1.75
6. Optional Comments relative to ARE YOU VALUED. (See "2008 Staff
Survey Comments" document in shared AII_MH Staff/Staff Survey/2008
folder. Link: SAMental Health\All MH Staff\Staff Survey\2008\2008 Staff
Survey Comments.doc)
7. STRATEGIC PLAN. Please rank how you think we are doing now on
each of the following: (Scale: 1 = Very Weak; 2 = Somewhat Weak;
3 = Somewhat Strong; 4 = Very Strong)
2008
Very Weak
Somewhat
Weak
Somewhat
Strong
Ver Stron
Average
Ease of access to
0.0%
14.3%
70.0%
15.7%
3.01
services
0
10
49
11
Client involved in
0.0%
10.0%
70.0%
20.0%
3.10
treatment,
tannin services
0
7
49
14
Staff development
11.4%
34.3%
42.9%
11.4%
2.54
opportunities
8
24
30
8
Commitment to
4.3%
8.6%
64.3%
22.9%
3.06
evidence based
practices
3
6
45
16
Quality
2.9%
27.1%
58.6%
11.4%
2.79
Page 3 of 5
2008
Very Weak
Somewhat
Weak
Somewhat
Strong
Ve Stron
Avera e
improvement;
measuring results
2
19
41
8
Use of recovery
4.3%
20.0%
61.4%
14.3%
2.86
and resilience
concepts
3
14
43
10
Significant,
1.4%
11.4%
70.0%
17.1%
3.03
meaningful client
involvement
1
8
49
12
A clear sense of
2.9%
25.7%
50.00/0
21.4%
2.90
our priorities
2
18
35
15
Informing the
0.0%
37.1%
51.4%
11.4%
2.74
public about our
services and
results
0
26
36
8
Managing and
4.3%
22.9%
60.0%
12.9%
2.81
preparing for
change
3
16
42
9
Answered 70
Skipped 9
2005
Very Weak
Somewhat
Weak
Somewhat
Strong
Ve Stron
Avera e
Ease of access to
9%
30%
47%
13%
2.64
services
7
23
36
10
Client involved in
1%
20%
61%
18%
2.96
treatment
1
15
46
14
Client involved in
12%
45%
41%
3%
2.34
improving services
9
34
31
2
Staff development
21%
36%
37%
7%
2.29
opportunities -
16
27
28
5
Commitment to
4%
14%
71%
11%
2.88
evidence based
practices
3
11
54
8
Quality
13%
22%
54%
11%
2.62
improvement;
measuring results
10
17
41
8
Use of recovery
8%
37%
500/0
5%
2.53
and resilience
concepts
6
28
38
4
A clear sense of
12%
30%
53%
5%
2.51
our priorities
9
23
40
4
Informing the
11%
53%
33%
4%
2.30
public about our
services and
results
8
40
25
3
managing and
110/0
30%
57%
3%
2.51
preparing for
Chan e
8
23
43
2
Answered 76
Skipped 18
Page 4of5
2008 Team Averanes-
BT
CF
CA
CS
CT
DD
S
A
Ease of access to services
3.14
2.89
2.50
3.10
3.23
3.10
3.00
2.75
Client involved in treatment,
3.00
3.17
3.00
3.10
3.31
3.30
3.00
2.50
tannin services
Staff development
2.57
2.56
2.00
2.40
2.46
2.50
3.00
2.88
opportunities
Commitment to evidence
3.00
3.17
3.00
2.80
3.00
3.10
3.00
3.25
based practices
Quality improvement;
2.71
2.83
2.50
2.40
2.69
3.20
3.00
2.88
measuring results
Use of recovery and
3.14
2.83
2.50
2.90
2.77
2.80
3.00
2.88
resilience concepts
Significant, meaningful
3.00
3.11
2.50
2.90
3.15
3.20
2.50
2.88
client involvement
A clear sense of our
3.00
2.67
3.00
2.80
2.77
2.90
4.00
3.38
priorities
Informing the public about
2.86
2.83
2.00
2.60
2.46
2.80
3.00
3.13
our services and results
Managing and preparing for
2.57
2.72
3.00
2.90
2.69
2.70
3.00
3.38
Chan e
S:\Mental_Health\AII_MH_Staff\Staff Survey\2008\2008 Staff Survey Results.doc
Page 5of5
Deschutes County Mental Health Staff Survey Results
Comparison of Surveys December 2005 and January 2008
Question #3 Has DCMH moved in a positive direction over the past 2 years? 1 to 3 SCALE
Jan 2008
73 responses
Dec 2005
89 responses
%
change
Service to clients
2.48
v 2.08
~
19%
Communication within the department
271,,
n/a
nice' '
Communication with the public
5E~
n/q
n/a .
Communication
2.61
2.32
12%
Supervision
2.51
2.21
14%
Management of department
2.54
2.23
14%
Managing change
2.52
2.25
12%
Managing conflict
2.53
2.11
20%
General analysis: staff who responded (OTHER THAN don't know) rates our
performance in all areas highly; lowest score was 2.48 on a 1 to 3 scale
Note: for the purpose of comparison, the responses to the 2008
survey for the two questions relating to communciation were combined
and compared against the general communication questions in 2005
Question #5 Do you feel valued and / or supported by:
1 point =worsening
2 points = same
3 points = improving
1 to 4 SCALE
Jan 2008
71 responses
Dec 2005
89 responses
change
Notes
Clients
2.76
2.90
-5%
declined
Co-Workers
3.03
3.07
-1%
a strength
Supervisors
3.04
2.90
5%
a strength
Program Managers
2.80
2.86
-2%
similar
Department Director
2.72
2.67
2%
similar
Commissioners
1.80
1.69
7%
lowest; a little better
Public
2.11
2.11
0%
low score
1 point = never
2 points = sometimes
Question #7 Our Strategic Plan includes a number of important initiatives
3 points = often
4 points = always
1 to 4 SCALE
Jan 2008
70 responses "
Dec 2005
89 responses
%
change
Notes
Ease of access to services
3.01
2.64
14%
improved
Client involvement in treatment
3.10
2.96
5%
improved
Staff development opportunities
2.54
2.34
9%
improved but lowest
Focus on evidence based practice
3.06
2.29
34%
improved
Quality improvement; measuring results
2.79
2.88
-3%
declined; 3rd lowest
Use of recovery & resilience concepts
2.86
2.62
9%
improved
Significant client involvement
3.03
2.53
20%
improved
A ciEsClr sense of our priorities
2.90
2.51
6%
improved
Informing the public about our services
2.74
2.30
19%
improved; 2nd lowest
Managing and preparing for change
2.81
2.51
12%
improved
1 point =very weak 3 points = somewhat strong
2 points = somewhat weak 4 points = very strong
S:\Mental-Health\AII_MH_Staff\Staff Survey\2008\Analysis comparision 05 08.x1s 3/17/2008
DESCHUTES COUNTY MENTAL HEALTH
2008 STAFF SURVEY COMMENTS
4. IMPROVING? Has DCMH moved in a positive direction over the past two
years? Comments:
BT
We have high hopes for Supervision and management with our new Manager on
board.
CF
My experience was that Barrett was a great improvement in supervision as well as
communication when he was in the supervisory role.
CF
We need more therapists to handle case load and serve clients coming thru the
door, in the schools, at the KIDS Center and be able to serve them well without
cutting therapy time.
CF
In the Child and Family department we have gone from having autonomy over our
schedule and time to being over) micromana ed regarding our time.
CS
it started good and has proceeded to real) good!
CS
Current supervisor has made great improvement.
CS
Continual evaluation of where things are at and how they can be better is a great
trait of the leadership.
CT
The lack of health coverage for clients has been the biggest barrier to our ability to
serve clients better. Screening out clients that do not have insurance means that
they end up getting worse and ultimately use the ER or crisis services, which seems
inefficient and more costly. I realize this is a systemic problem throughout the state
and believe DCMH is doing everything they can to serve this population given the
financial constraints. The supervision I have received at DCMH has continued to be
excellent.
CT
Because of my short employment time here, I can't answer to what it used to be
like, but what I see is a fairly well oiled machine. When there is an issue, it seems
to be dealt with in an efficient way. I have not seen conflict o unresolved.
DD
I appreciate the improved publicity about our department as well as the director
reports and the all staff meetings.
DD
Accepting change, which is inevitable
S
My answers here reflect my already good opinion of these topics. With the exception
of our inability to provide the QUANTITY of services to Seniors that we'd like, the
above topics need very little improvement.
A
With the new resources and ongoing planning we are making strides. At the same
time, needs are increasing and there are more pressures on staff to provide more
help and accept more referrals.
A
DCMH staff is consistent in efforts to improve in all areas.
Answered 14
Skipped 65
6. ARE YOU VALUED? Comments:
BT
I feel that sometimes there is a slight rift between the support staff and clinical
staff, as though our contribution to the MH team is construed as somehow less
important because we don't provide services directly to the clients. That said, the
majority of the clinical staff are very kind and appreciative, if occasionally
condescending.
BT
A ain room for improvement with new manager
CF
Prior Program Manager.
CF
I truly feel valued by co-workers. Their support is key and the Child & Family
program current) has a strop well-balanced team.
Page 1 of 13
6. ARE YOU VALUED? Comments (continued):
CS
what about other agencies that we work with? that would be a sometimes to an
often.
CS
Seems public understanding of services offered is limited.
CT
To be honest I really don't care what the commissioners think. What matters to me
is the people I work with here at the clinic. I'm grateful that managment deals with
them so I don't have to.
CT
Karen and Lori are very good at making clinicians feel valued.
CT
I do not feel the BOCC is very involved in our program. I have not seen one of them
visit our site since I started working here. The token plaque and letter they give out
at the 5, 10, 20 year mark seems patronizing and belittling considering that in this
day and age staying with an agency more than 5 ears is a HUGE accomplishment.
CT
Karen Tamminga takes a great deal of time in recognizing accomplishments of team
members. Often there are team appreciations held during our team meetings.
CT
Organization is top down driven, quasi military structure. "Higher ranking" people
have little or no interaction with line staff.
DD
The switch from Mike Maier to Dave Kanner has seen a significant drop in feeling
valued. Especially when trying to hire new and experienced people, he has no
interest in even discussing increasing a scale for experience.
DD
Positive feedback where warranted should be art of an management style.
A
I think there is great respect for the work that the Department does. I also think
this County generally support social services and the key role of County government
in helping low income people needing health care and support services. At the same
time, we will need greater support in the next several years if we are going to serve
a growing community and prevent more costly, damaging situations in the
community.
A
It's all relative to the context and the individuals.
Answered 15
Skipped 64
8. STRATEGIC PLAN: Comments:
BT
N/A
BT
Therer should be an N/A button. None of this pertained to our department, and one
of the buttons had to be selected before moving on. This will make results
inaccurate
BT
Client treatment is essential, however, to be able to maintain/improve services
provided, correct a erwork/bi[ling is essential too.
CF
lately the priority has been on productivity and paperwork. Decrease in priority on
how we help clients change effectively.
CF
Sometimes things get implemented without the proper explanation or training on
the "why" are we doing these things. Hard to have the buy in if you don't have the
explanation to back it up.
CF
Limited training opportunities, though cost effective, limit clinicians ability to learn
new skill sets. Particularly when several of the training hours are already obligated
to mandatory trainin s.
CT
RE: very strong score for "quality of measurment of results", is not meant in a
positive way. The county has gotten tot he point where it feels like what is more
important is numbers of clients and production of hours and the cost of being able
to do good TX vs watered down therapy. Plus having a stressed out staff. RE:
managing and peparing for stage I really don't know, but there was no way to
answer this.
CT
Use of recovery and resilience concepts??? I don't know what those are... Therefore
the answer I gave is only because one was required to move on in the survey.
Page 2of13
S. STRATEGIC PLAN: Comments (continued):
DD
Don't really know much about it. It seemed to be developed by management and I
do not know man staff who know much about it at all.
S
M narrow perspective from the small world of Seniors Program.
A
The plan is very ambitious and is often tied to resource needs. I think it helps us
focus on what people regard as our core responsibilities. I think the plan has helped
us advocate for and receive more support.
A
The weaknesses in the area of measuring results are 1) we sometimes flounder in
determining just what is meaningful to measure and how to measure it, and 2) the
reluctance of some staff to see the value of a quantifiable measurement of our
success vs. "bean counting."
Answered 12
Skipped 67
9. WHAT I LIKE MOST ABOUT MY JOB AND WHY THIS IS IMPORTANT TO ME:
BT
I actually just like the job itself. I get to interact with a variety of people and that
keeps things interesting .
BT
I like all the other employees I work with and that makes my job easier and more
enjoyable.
BT
What I like most about my job is that I work with people that are very peronable,
approachable, and are more than willing to answer any and all questions that I may
have. I feel as though I am very educated about my job and what is expected of
me. This is important to me because I need to work with a team that can
communicate effective) and therefore I love m job and do m best at all times.
BT
N/A
BT
The ability to effect changes that improves my ability to provide ever better service,
however indirectly, to the community. This is important to me becasue I personally
need some connection to a purpose other than simply a paycheck in my
employment.
BT
N/A
BT
the fact that in the middle of chaos in between managers, we still got the job done
and held together, that is important because it shows what we are made of.
CA
Our supervisor is excellent. I enjoy team work. The department has many highly
skilled compassionate clinicians.
CA
I love my job, it is challening, at times overwhelming, but always interesting. I
believe we all provide a valuable and necessary service to vulnerable community
members. Sometimes the complexities of providing this service is lost on the
primary stakeholders. But I have never seen this to be different in other settings as
well. My support from my co-workers and supervisors is generally excellent and
there is a high degree of accountability among the staff I work with making conflict
resolution much easier to manage. I gain a great deal of satisfaction from the work
I do.
CF
Effecting change in clients, being able to do my job without too many bureaucratic
roadblocks & enjoying/respecting m co-workers.
CF
Watching clients make healthy changes in their lives--it's the reason I'm doing this
work--to facilitate a health healing change process.
CF
Helping people, it uses m skills.
CF
co-workers impacting the community working with a team levels of services and
support available count benefits
CF
I appreciate the people with whom I work, it make all the difference in the world
when providing the services that we do. It is important to have good colleagues
who are supportive because if you don't the therapist's experience mirrors that of
the client in feeling isolated trapped, unsu orted and unvalued.
Page 3 of 13
9. WHAT I LIKE MOST ABOUT MY JOB AND WHY THIS IS IMPORTANT TO ME
(continued):
CF
Team is great! Love working with children.
CF
The resilient in the clients we support.
CF
What I like most about my job is the trust my supervisor has in me to perform my
job and do what it takes to get it completed on a daily basis. Management treats
me as an individual and has been flexible and supportive.
CF
I enjoy working with children and families. Fellow co-workers and a strong sense of
team is extremely important as the work we do is often difficult and emotionally
challenging.
CF
Diversity and fexiblit . Supervisors openness to new ideas.
CF
WORKING WITH MY CLIENTS
CF
The staff I work with and the knowledge that what we do here is crucial.
CF
Helping people. Because it is what I was made to be doing.
CF
The fact that clinical judgement can outweigh 'the bottom line'. It is very hard to
provide the services that we do if we feel that the client does not come first. If we
only look at the 'bottom line' our clients just become numbers.
CF
I like being part of a team that is committed to helping people have better lives; it's
important to me because I care about people, especially children.
CF
I like the people that I work with because they are very supportive and
knowledgeable. I enjoy working children and their families and seeing positive
change take lace.
CF
The mental health services I provide is both rewarding to me and my clients and is
well supported b m fellow team.
CS
It offers a variety. I can help make a difference. I work with a great team.
CS
...having the opportunity to introduce positive change into the lives of individuals
that have often not understood change as an option. Knowledge is empowerment
and and can enable thos in the hardest of situations with a way out.
CS
I have an amazing upervisor, wonderful colleagues and staff; I work for a
department that shows a commitment to its mission, and its mission is very
important. I'm doing the work that I feel called to do. What's not to like in all of
this? Jim
CS
I enjoy the teams and the clts i work with
CS
I like working with clients and coworkers.
CS
Strong team concept. Alot of autonomy once I know my role and respect for my
knowledge. Direct contact with clients
CS
supportive supervisor and co-workers, b/c team support is crucial to keep doing
difficult work day in and day out.
CS
Diversity in job duties Appreciation Makin a difference
CS
I take pride in offering support and services (even limited services) to SPMI
individuals who may not be able to gain access on their own. I appreciate following
them through the process and seeing how lives can be changed.
CS
The support of co workers and ease of rapport with staff. It is important to know
you have loyal partners to support/encourage you when you need it to make sure
both staff and clients are receiving the best care possible.
CT
I feel "independent" in my work. Although I am supported I feel trusted to do what
I am hired to do with a minimal amount of supervision.
CT
that i have the opportunity to help people who need help, i like the team that I work
with, and the support I get from my supervisor to do the best job I can for my
clients.
CT
Page 4 of 13
9. WHAT I LIKE MOST ABOUT MY JOB AND WHY THIS IS IMPORTANT TO ME
(continued):
CT My co-workers, plus I have a good supervisor and program manager. They both
know thier stuff and have a great sence of humor. This is what helps me get
through the rediculous amount of paperwork and forms and the huge case loads we
have.
CT The ability to be creative to assist the population we serve to become more
confident and hopefully. more self-sufficPnt
CT
What I like most about my job is working with the clients, I feel my job is helping
them through a hard time in their life. This is important as it is a deliberate choice I
am making as to how I want to live my life. This job gives me not only the
opportunity but the support, encouragement and training/supervision to do it well.
CT
The most important thing to me is that I enjoy what I am doing. I enjoy my job
because I have such great co-workers and supervisors. I feel very valued and
appreciated by my team. I also feel that I get the support I need when I am feeling
burnt out, which helps to keep me going. I also enjoy seeing client's make changes
and improve their lives.
CT
My fellow work mates. I have done what I do for many years and have never
worked in a place where I feel more appreciated. The support and encouragement
from team members has been amazin !
CT
Being able to help facilitate healing and mental health for individuals who are in the
most need in our county, working with caring and professional co-workers in a
beautiful art of the northwest
CT
I feel valued and supported in my work. I appreciate the ability to offer evidenced
based practice. I appreciate the expertise and variety of clinicians we have. Good
supervision. Good trainings that help provide the best practice in our work. I think
we have improved relationships with management. I feel appreciated in the
community form work.
CT
I enjoy working with clients, seeing the progress and watching them grow and
succeed. I also value m team supervisor and program manager.
CT
I honestly feel like I/we make a difference to the health and happiness of our
community. The monitary compensation is LOW, so the only reason I'm still here is
because of the satisfaction I get from seeing the change/improvment in the
individual clients who "do the work." A sincere "thanks" from a client or family
member means everything to me. That, combined with the priveledge of working
with the great people on our team is what keeps me here.
CT
supportive program team members.
DD
Providing avenues for staff to do quality work.
DD
I like m job because I am able to do it m own way.
DD
Benefits and working atmosphere. quality of co-workers.
DD
I like being able to have some independence but with support and structure. I like
the client based plans but the paperwork involved with these plans is overwhelming.
DD
I am confident that I am effective in supporting the agencies that provide
residential services to our clients. I enjoy my relationships with my clients. I enjoy
my relationships with the providers and staff of the residential programs. I feel
confident in my knowledge of the needs of my clients and systems that are in place
to ensure quality service delivery. I feel effective in meeting the requirements of my
job. I feel that what I do makes a difference for the lives of the clients and the
services delivered b providers.
DD
Working with children and families who face struggles every day and do it with a
race that amazes me.
DD
Having a positive impact on clients' lives.
DD
I like being involved in improving the services provided to individuals in rural areas.
DD
The interaction with families and clients. Our team members.
Page 5 of 13
9. WHAT I LIKE MOST ABOUT MY JOB AND WHY THIS IS IMPORTANT TO ME
(continued):
DD
Feeling like I am making a positive contribution to the overall system of client care.
Trying to help myself and others feel good about something every day. Even if it is
a chance encounter with another person, we need to feel a sense of helping the
overall process or picture.
S
What I like most about my job is the opportunity to help someone make his or her
life better. Also supporting those who are in most need. This is important to me
because our society, by supporting these programs, shows understanding of the
importance of the needs of mental) ill people.
S
I like helping people and feeling like I've made a difference in their lives. I
appreciate the opportunity afforded by DCMH to be at the leading edge of how to
provide geriatric mental health. Working with committed professionals is very
important to me. The Seniors Team, as well as most employees at DCMH that I
have frequent contact with are committed professionals. (no, committed does not
mean to OSH
A
I like the challenge. I do better when I feel that my work is valued. I struggle when
other departments do not have supervision or management as this directly impacts
my role due to accuracy, quality and efficiency concerns, it also increases my work
load.
A
The variety of work done throughout the department. Opportunity to use previous
experiences for ongoing jobs. This is important to me because there is always a
chance to improve the efficient of how things are done.
A
I like that we provide much needed services to the community, have a positive &
supportive work environment and strong community partnerships. These things are
all important to help balance the stress and challenges of the work that we do.
A
The fact that every day this Department helps people who have nowhere else to
turn for assistance. I also like the support of my peers and the incredible diversity
in the work. It is very challenging.
A
I like being of service to others, the challenges and problems solving opportunities
that go with it. I enjoy empowering others to work towards self-actualization or
simply to help minimize their suffering. I enjoy trying to effect change in individuals
and in the larger systems of both families and communities. It's important to me
because it's focus is on relationaships, familes, communities and growth in a
positive manner.
A
The quality of the staff. We provide service to those least able to pay for these
services et the recieve this service from qualified, caring and well trained staff.
A
What I like most is the people I work with and the opportunity to help by "ironing
out the wrinkles" that may b in the way and/or b just making someone smile.
A
I enjoy the challenge this position offers.
Answered 69
Skipped 10
10. BENEFIT TO OUR COMMUNITY & CLIENTS-Suggestions for improvement:
BT
I would like to see our crisis services announced more to the general public.
BT
We have added more interns and clinicians creating more work for our department
which means we need to add more staff to efficiently keep up wish the extra vvork
created.
BT
N/A
BT
I would like additional training/understanding of how the other departments/teams
within MH work so that I can provide better tailored service to the other teams
which would in turn support them in their goal of helping the community.
BT
We need better communication between the different departments
Page 6 of 13
10. BENEFIT TO OUR COMMUNITY & CLIENTS-Suggestions for improvement
(continued):
BT
I think making sure that paperwork is filled out correctly is huge. If we can't bill for
some services due to incomplete paperwork then we loose money. We loose too
much money then budget cuts cause loss of services, therefore not benefiting the
community.
CA
More services available. CCB,VIM and DCMH are maxed and people are falling
through cracks or waiting long time for treatment. Maybe a push for more MH/SW
volunteers at VIM???? Budget increases that would enable more clinicians.
CA
As a community and service delivery system we are in a constant state of growth
and change. This creates pressure to constantly adjust to these increased demands
with very limited resources for many who have very little. One of my primary
suggestions is that we enhance our ability to treat families, not just the identified
client. Also, we as a system need to be able to move to an electronic record to more
efficiently handle the increased volume of information that is being shared and
generated. This should in m opinion be a high priority.
CF
Cultural competencies ...I do not feel our agency is easily accessible by those of
different cultures & languages. I don't think I've had a cultural competency training
since I've been here. I think this is important for all staff, not only clinicians (since
we et a lot of training in this area in graduate school).
CF
Simplify/streamline paperwork and scheduling systems so that more time can be
devoted to client services.
CF
Secure email for client info. Automate more.
CF
family involvement. Need flex funds again. Talk therapy is not all that effective.
CF
FUNDING. Having access to services.
CF
Paperwork and accessibility to parents is a barrier to providing services, especially
treatment within the schools. Specific guidelines for working with children in schools
when parents are not making themselves available for formulating treatment plans,
updates, signatures etc. would be helpful.
CF
Mental Health services to individuals who do not qualify for OHP, but who have
minimal financial support.
CF
Continued strategies on building relationship with community partners and being
creative with developing programs that matter to our consumers and community. I
would be curious to know what our community prioritizes in regard to mental health
intervention and prevention within the community.
CF
More resources to access community programs (recreational activities / respite)
that allow clincians to take non-traditional approaches to meeting client's individual
needs.
CF
unsure
CF
clarity of DCMH public services available to schools
CF
Cutting back on the paperwork, still. (or production % expectations) We are loosing
good therapists who are unable to keep up with the paperwork because they have
high level/hi h number case loads and helping their clients is more of a priority.
CF
Making it easier to access services as far as having a less complicated intake form
.
The amount of pages and info in a intake package is ridiculas.
CF
It would be wise for us to have a back up plan for EVERY position within our
department. While all of us are important, we are all at risk of something going
wrong (i.e. illness, death). I feel that it is important for us to have an advanced plan
in place just in case so that we do not hire the position just for the sake of filling the
space. When we end up hiring a not so wonderful fit, it impacts the entire
department in a negative way.
CF
It would be helpful to have more opportunities for evidence based practice trainings
to rovide a greater service to our clients.
Page 7 of 13
10. BENEFIT TO OUR COMMUNITY & CLIENTS-Suggestions for improvement
(continued):
CS
Not overloading clinicians so they cannot service their clients as they should be
serviced.
CS
Accessibility even to those without OHP. Is there a grant out there we can go after
to help fund this very large "falling through the cracks" population? Those without a
crisis SPMI or OHP are real) struggling.
CS
Educating families as to how we do our work, and why, so that they will better
understand "the system," and have realistic expectations of treatment.
CS
I think easier access to our clients in outlying areas- Redmond, Lapine. Increase
time for medical and nursing services in these towns.
CS
We need a well put together Flyer defining the various services ofered through
DCMH. We need less paperwork and more direct contact time. Doubt this will
happen though. Continue to support the consumer movement and bring their face
into the public as a way of letting the community see that our clients are
contributing members of society - ABHA Art Show, Thrift store, need for contact
with other agencies, schools, clubs. We also need better options for housing our
clients, including finding a way to get those clients with felony charges, who have
made big life Cahn es and are safe and in recover a chance to have quality of life.
CS
A better balance between meeting the state's charting requirements, and having
those efforts reduce direct service time as minimal) as possible.
CS
More support around training staff regarding EBP's
CS
Continuation of making Rainbow Clubhouse more consumer friendly is critical. It
seems it may help to move it to a new, nearby location so that more services can
be offered there more often. Adding specific support to meet the younger clients to
help them normalize their situations and get peer support will also be helpful. It
sounds like a task force is being created to review this and plan accordingly so I
suggest that continues.
CT
I am not sure.
CT
More tangible resources for clients to get their basic needs met, housing, food,
transportation, especially transportation to their appointments
CT
Make sure other agencies and professionals are aware of what services we do and
do not provide, so we obtain appropriate referrals and we can also refer out.
CT
Assess community needs related to Mental Health services. Make a plan that is
realistic to serve our clients with-out the need for so many on-going changes. It
feels like we are often on a Roller Coaster and do not get off! Match staff
expertise/strengths with their assigned 'ob.
CT
1.) Increase outpatient staff so more clients can be seen on an outpatient basis
rather than using the costly ER system. Z) Implement electronic medical records to
streamlinen our work giving us more time to spend with clients.
CT
Don't know.
CT
Continue to provide access to crisis services and employ enough therapists to see
clients regulary,so that their therapy is useful and clients can move on with their
lives
CT
More clinicians if possible to releave some of the stress of those working here with
very heavy caseloads and complicated clients.
CT
The volume of clients seems the greateset it has ever been, caseloads are very
large which means treatment seems watered down.
CT
We need to be able to attract and hire more than just interns.
Page 8 of 13
10, BENEFIT TO OUR COMMUNITY & CLIENTS-Suggestions for improvement
(continued):
CT
Dump ABHA. Replace this mangled care model with a really good clinician or two,
perhaps with an academic background as well as deep clnical experience.
Administration is made up of good adminsetrators rather than top clinicians, so
clinical knowledge is rarely used in designing the programs. For instance, the
quality control person has no clinical experience, but spends endless time designing
forms that have NOTHING to do with effective treatment and create paperwork
burdens for counselors. This puts the whole organizaetion several years behind the
curve in providing great care. The current "evidence based " statements and OCI
surveys are simply eyewash in the view of most clinicians.
DD
More supervision when starting the 'ob.
DD
less federal requirements that provide no value whatsoever to tx.
DD
I wish we had more time for resource development for our clients.
DD
more time to work with community organizations that can provide tangible services
to our families. An example that already is in place is making a connection with the
High Desert Museum so that families can et free asses.
DD
Support more trainin s for parents / providers.
DD
Control the changes/paperwork required by the State that eats away at direct
services.
DD
Keep acknowledgment of good work, positive contributions and successes out of
any political arena, and give praise where it is due. This gives the caregiver
personality fuel for greater efforts.
S
I have only one area of improvement that would greatly benefit our community and
current/future clients, and you've heard it many times: double, better triple, the
size of the Seniors Team. Given the growth in this population and the continued
decline of our medical system, MH issues are growing faster than the population. I
have no idea how to achieve this given fiscal realities. A black hole of impossibility,
eh?
A
I feel client no show rates and client involvement in the treatment planning process
are interconnected. By training and expecting clinicians to learn, employ with clients
and demonstrate the recovery model in their documentation, we could address
several issues at once. If the client owns their treatment then they are more likely
to participate and be involved.
A
Anything that we do internally to clearify descriptions to our staff will ultimately
transfer to our clients. Ease of finding information, such as inventory needs, printing
logs, costs forspecial projects, etc.
A
Better community options for the uninsured clients that we are unable to serve and
must turn away. There are other communities that have private non-profit
counseling agencies that serve low income clients on a sliding scale basis. It might
be helpful to have information on how these agencies developed in these
communities and how the are funded.
A
A ability to increase our services IN Redmond, LaPine and possibly Sisters.
Improvement in our capacity to help people of color, particularly the Latino
community. We also need to expand our services to seniors and we need to expand
our alternatives as the Count jail increases in size.
A
Strengthening family relationships and seeing the systemic value in this for our
clients and community. Engage more familes as a whole in the counseling process.
Create a dedicated family Thera program.
A
Availability of services in Spanish not through translators. Outreach to the hispanic
community who are reluctant to seek services. I would also like to see more
expansion of services outside the M-F 8 to 5 box.
Page 9 of 13
10. BENEFIT TO OUR COMMUNITY & CLIENTS-Suggestions for improvement
(continued):
A
The biggest challenge is to help all the people who need our help. I don't think there
is one magic solution to this problem, but I feel we are moving in the right direction
by being creative in how we provide services and use our resources, and by trying
to streamline our organization to eliminate inefficiencies.
A
Unsure
Answered 58
Skipped 21
11. HEALTHY & PRODUCTIVE WORKPLACE-Suggestions for improvement:
BT
Communication and follow through.
BT
We need to add more staff to our department to keep up with the added work load
created b the new interns and clinicians recent) hired.
BT
I have only been with the county for 2 months. Not long enough to suggest any
changes that need to be made.
BT
I would like to see a complete cessation of gossip and other similar negative
behaviors that hurt others personally and professionally. I would like to see a
committment to working for and with beneficial changes rather than against them. I
would really like to see the BT quit relying on "temporary" staff that have in reality
been employed longer than many "permanent" staff. Temporary staff are an
excellent short-term resource, however, in terms of personal committment to
employment and accountability, I think they are not the best long-term solution for
staffing needs.
BT
More communication can not be stressed enough. Especially when there are
changes coming just down the way.
CA
not sure
CA
Again, an improved electronic medical record and enhanced family services with an
ability to provide intensive outpatient services on a short term basis would be my
suggestions for improvement.
CF
Regarding productivity: Getting to my paperwork is still a problem. Especially since
we are out in the field so often.
CF
It's unclear what clinicians need to prioritize: productivity or paperwork
(documentation)? Many clincians experience the conflicting mandates as though
they are continually failing on one front or the other. If their client hours are up,
their paperwork suffers and vice versa. We need support if we're going to be able to
do both well.
CF
overwork not being able to complete work in normal work hours
CF
More office space. When there is "scarcity" of space that adds an extra challenge to
the already challenging work that we do.
CF
More trainin s offered to staff free of charge.
CF
More interdepartment recognition and interaction of positives. Examples of co-
workers going out of their way to be creative, innovative,etc. to work with
consumers we serve. I think we should have a "catch them in the act" type of
recognition program that highlights employees providing good customer service,
actions that highlight our missions and values etc.
C
Minimize micro-management of staff schedules and equal time exchange.
Productivity should be used to measure workload and clinicians should have the
flexibility to manage their schedules with limited management pressure.
CF
too much paperwork. We met requirements for so many overseers, paperwork
becomes for them not for clinic or client needs.
CF
clarity of billing procedures and use of appropriate forms
CF
I believe that we have a health and productive workplace.
Page 10 of 13
11. HEALTHY & PRODUCTIVE WORKPLACE-Suggestions for improvement
(continued):
CF 2 retreats a year.
CF I think that all programs should actively be searching for grant opportunities. This
may help reduce the dependency on OHP funding and will also provide monies for
more positions. Thus helping to reduce the workload that we all experience.
CF It would be helpful to have less micromanagement of our hours and let us as
professionals uphold our schedules and professional integrity.
CS Making the envirnment of (offices, waiting room) at the Annex more updated, not
sterile-paint, etc
CS
I enjoy a healthy and productive workplace thanks to a Supervisor that really
prioritizes self care (for others that is...he could get a little better about it for
himself
CS
Improve the heating system- cold in the winter
CS
We need upgraded equipment, vehicles, computers, copiers. We need more space
for groups and expanding staff at the annex.
CS
Improvements to the annex building. Currently, temperatures in the offices range
from 59 -75 degrees, which is uncomfortable for staff and clients. Additionally,
better sound proofing with offices would improve confidentiality and privacy issues.
CS
More effective) dealing with staff who are difficult and who are manipulative
CS
Truly some compact air purifiers in the offices would be good for physical health,
especially with the number of clients we see daily. Full spectrum lights in every
office in the way of small lamps would also help, especially in the offices that do not
have windows/skylights. This can affect mood and thus productivity. White noise
sound machines for the offices and/or hallways where therapy/treatment is going
on will be helpful in keeping sessions confidential.
CT
oppportunities for training increased without having to take vacation time to get the
quality and uanit of training necessary to do this work.
CT
Having a realistic case load. Right now we are all carrying huge caseloads and it's
almost impossible to get everthing done. In fact I've just used up about 45 minutes
of time I could have used to do progress notes filling out this survery plus the
county one. Less emphasis on production hours, we are all aware we need to
produce billable hours but it really is stressful when all you begin to think about is
your hours vs providing good therapy to your clients. Also the GOBHI training for
billable hours was an absolute waste of time, plus poorly conducted, demeaning and
the worst training I have ever attending in my life (no exaggeration) The most
valuable thing that resulted from the training was the cheat sheet Lori Hill
developed, which helped explain what and how to bill for hours. The training
seemed to focus more on having us pass a test verses teaching us the information
we need, giving us a simple format to use, and encouraging people to ask
questions. If we have to keep doing it, please have the training focused to being
functional and helpful not unative.
CT
Communication Everything seems hurried. A calm work place where staff,
management and supervisiors work together to better provide services with quality
out-comes.
CT
1.) Complete the study on Mental Health Specialist 2 position salaries and hopefull
y
increase the overall pay so we don't lose more people to other agencies. 2.) Provide
opportunities for moral boosting - hosting a free pizza day, giving out gift cards,
possibly nominating staff for individual honors etc.
CT
Don't know.
CT
Trim down documentation so individual and group therapy will be more of the
priority than endless paperwork
Page 11 of 13
11. HEALTHY & PRODUCTIVE WORKPLACE-Suggestions for improvement
(continued):
CT
The trainings that are offered are good quality and variety, want to make sure that
clinical trainings are a priority for the agency. With multi-day trainings we get depth
in one area but not much variety in a year.
CT
I think instead of looking at how we can fund a new "position," we'd be better
served in the long term by better compensating our current staff. I don't think we're
competitive and therefore we have difficulty attracting--and often keeping--quality
staff. We hire interns. Look how many of our current staff have a private practice in
order to augment their income. When staff realize that they don't make what most
of their colegues make... I think it diminishes our staff's real sense of value. Pats on
the back are nice, but they are not all of what promotes high morale, loyalty and
ultimate) the highest quality of work.
CT
Create a "Master therapist" or Psychologist position who can advise less experienced
counselors provide testing support, help with program design.
DD
None
DD
No issues
DD
I'd like to be able to flex m schedule more.
DD
More retreats or trainin s that are of interest and relate to our work
DD
Fix the HVAC system. Mike has worked a lot on it but the temperature is still
inconsistant (the heat is on in the morning in the summer time and then the AC has
to kick in extra hard to cool the building off in the afternoon, making it feel freezing
cold--this is a waste of money, energy and not environmentally sound / "green")
and when the heat is on the air quality is terrible smells feels "dusty").
DD
Continue to make it a priority to hold all-staff meetings periodically throughout the
year. I believe this improves communication between management and staff.
DD
Invite communication with employees. Keep morale up letting people know they are
doing well in a quickly changing world
DD
Encourage folks to talk with one another, and be nice whenever the can.
S
None. In m narrow world all is well.
A
Looking at expectations and productivity in ALL departments.
A
Continue to organize areas that staff have access to. Notify staff of the changes that
are completed. Make sure standard office supplies are present in all work stations.
Assign someone to monitor those areas and keep u with the demands.
A
Less paperwork for clinicians and move to an electronic based medical records
system. Implement a "Therascribe" type software program for clinician "paperwork"
that streamlines and expidites required forms and verbage and also has a built in
reminder system for updating tx. plans,annual reviews, etc. deadlines. Managable
caseloads. Incentive based programs for superior performance. Reduce the ticky
tack reports and oversight that kill staff morale. Create a simple and accesible
wellness program that promotes physical exercise, diet and relaxation and stress
reduction as art of the program.
A
I really appreciate the efforts of the support staff and others to coordinate some
fun, social activities. Those who participate really seem to enjoy the opportunity and
people are able to meet and connect with co-workers--this is really important
because of all the new faces. I hope these can continue. Its beginning to feel like
space is a growing issue as we continue to grow.
A
Increased communication between and across teams within the department. At
times it seems that our protectiveness with information has led to a somewhat
secretive, "need to know" atmosphere. The problem with this is that one person
may not realize that another person really DOES need to have the information in
order to perform his or her function in the department.
A
Unsure
Answered 51
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Page 12 of 13
12. OTHER SUGGESTIONS/OPTIONAL COMMENTS:
BT
No
CA
Thanks for the privilege of working with a great department!
CF
Cultural training with all staff, developing a plan for making our agency more
accessible/inviting, ongoing confidentiality trainin s all staff).
CF
I think that the direction of our organization overall as well as within the specific
program that I work within has become a place and environment that I enjoy and
look forward to coming to work. Most people I interact with are positive and want to
make the efforts to continually make this a good place to work despite the difficult
clients we serve.
CF
Clinical supervision and availability of managment is limited and should be
increased in order to support the clinical development of employees. The majority of
management/clinician time is used to promote administrative needs and does not
focus on clinical skill development.
CF
I think that there is a need to add more support staff.Possibly a roving capacity, or
a person to do all dictation and PCP letters
CF
We are headed in the right direction.
CS
Kee u the good work. I continue to see things moving forward.
CS
Thank you to Supervisors, Program Managers and our Director. You are really all so
accessible and approachable! I don't think man counties et to experience that.
CS
Thanks for the serve and for its format. Nicely done!
CS
I feel the many financial challenges that have come up for Mental Health services,
have been met with creative solutions and job security has been much better this
year. Morale also is up. I'm impressed with the changes in Clubhouse and the
expanding Consumer movement. I am also pleased with the extensive use of DBT,
as well as some new groups to deal with Dual Diagnosis and Trauma.
CS
Incentives for car-pooling, using public transport,etc., would alleviate parking issues
and promote health for individuals and the environment.
CS
Better clearing of snow and ice in the parking lots in the winter so as to limit
-
possibilities of injury.
CT
no.
CT
I can't think of anything right now but I probably will tomorrow or the next day.
CT
There does not appear to have been signifiant follow-through/floow-up after
surveys are completed and opportunities are identified.
CT
Hire more therapists
CT
There seems to be more stability in the colossal amounts of change occuring.
Overall team morale and a positive atmosphere seems to be occurin most days.
CT
I feel like all I've really done here is complain about low pay. I'm sorry for that. I
think that even if there is TRULY nothing that can be done about the compensation,
that we should be having conversations about the issues and be clear on what the
thinking is and plans are. Thanks for the opportunity to share thoughts.
CT
We appreciate our willingness to listen....
DD
Nothing at this time.
DD
O enin windows for "fresh air".
Answered 22
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