2008-620-Minutes for Meeting April 07,2008 Recorded 6/10/2008DESCHUTES COUNTY OFFICIAL RECORDS CJ 7006.67G
NANCY BLANKENSHIP, COUNTY CLERK
COMMISSIONERS' JOURNAL
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LOCAL PUBLIC SAFETY COORDINATING COUNCIL
DESCHUTES COUNTY
N'T
Gy- E` .~7
G Y' t
MINUTES OF MEETING
MONDAY, APRIL 7, 2008
Allen Room, 2nd Floor County Administration Building
1300 NW Wall, Bend, OR
Present were Judge Michael Sullivan; Tammy (Baney) Melton, Commissioner;
Dave Kanner, County Administrator; Ken Hales, Corrections; Scott Johnson,
Mental Health Department; Erik Kropp, Deputy County Administrator; Jacques
DeKalb, Defense Attorney; Charity Hobold, Parole & Probation, Sandi Baxter,
Bend Police Department; Bob Smit, KIDS Center; Mike Dugan, District Attorney;
Ruth denkin, Sheriff's Office; Carl Rhodes, Oregon State Police; Ernie Mazorol,
Court Administrator; Hillary Saraceno, Commission on Children & Families; Jack
Blum, citizen member; Bob Warsaw, Oregon Youth Authority; Ted Varimonte of
BestCare; Bob and Pam Marble, NAMI; and dessi Watkins of JBar J Youth
Services. No representatives of the media were in attendance.
I Call to Order & Introductions
Judge Sullivan called the meeting to order at 3:35 p.m., at which time the
attendees introduced themselves.
II March Minutes
Bob Smit moved approval, and Jack Blum second. Approval was unanimous.
III Public Comment
None were offered.
IV 911 Proposed Levy
Ken Hales distributed levy rate information and a fact sheet for Becky
McDonald, who was unable to attend today's meeting.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 1 of 8 Pages
V Mental Health Department Strategic Plan
Scott Johnson said his department is required to develop a work plan for
2009-11; a strategic plan was also done. He provided a memo with the
documents to explain the details of the plan. The process allows for a
review and comment period; however, it is not necessarily one that requires
a vote. It will go before the Board of Commissioners on April 23 for
consideration of approval.
Judge Sullivan stated that in the past the County was substantially
underfunded when compared to other counties. Due to a lot of effort from
various individuals and departments to cause change, more parity has been
reached for Deschutes County in this regard.
Bob Warsaw asked if foster care for adolescents is being developed. Mr.
Johnson said that his department is working with Oregon Family Services to
try to make this happen. Maplestar will probably be the new partner. Ken
Hales added that some of this funding may come to the Oregon Youth
Center eventually.
Bob Marble, on behalf of NAMI, stated that there is great concern that
people with mental health issues are living on the streets, not using their
medications, and are a hazard to themselves and others. He said that there
should be outreach to these individuals before significant problems develop.
Pam Marble added that some cities, such as San Francisco, offer outreach in
this manner. Mr. Johnson stated that he would be happy to work with
NAMI on this issue. One option is for LPSCC to comment, but he is willing
to meet with NAMI to discuss this further. Some of these programs are
resource-related but it is wise to be aware of what specifically needs to be
addressed so that efforts can perhaps be made in that direction.
Judge Sullivan stated that he sees cases every day that involve people who
are self-medicating or not taking medication when they should. These
individuals may consider using proper medications if help was made easily
available to them. Jack Blum added that some of these people are homeless,
and without help and guidance can sometimes end up involved in criminal
activities.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 2 of 7 Pages
Hillary Saraceno said that the Commission on Children & Families' Board is
trying to assess and treat homeless youth in this regard. Mr. Warsaw added
that there are a variety of groups in the community that should be involved
in outreach, and perhaps have better resources than government agencies
available to address this issue.
Judge Sullivan stated that the group appreciates the significant headway the
Mental Health Department has made, and if there is a way to get
medications to people on the streets who need it, it is a worthwhile endeavor.
The perception sometimes is that people living on the streets are just not
willing to get a job or live normally, but often they are subject to mental
illness and unable to function in a conventional environment.
VI Domestic Violence Diversion Program
Mr. Hales reported that the plan of action is not yet ready, but at this point
he can offer an overview of domestic violence trends. This fiscal year the
numbers are up; about half of the offenders are supervised by Parole &
Probation. Options are needed to handle these numbers. Charity Hobold
stated that there is one full-time Parole Officer for deferred cases; she has 83
cases now but should only have 60. In a month there are ten to fifteen
additional cases, and this is at a crisis level. No other Parole Officers can
take over these cases. The questions are whether they should continue to
supervise this population; and if so, another Officer is needed. It takes about
15 months for treatment and oversight is provided for about 18 months.
There are about 150 cases in the system now. Some were dismissed early,
especially the ones involving female offenders. Some others have gone onto
the regular caseload. It will take a while for some of these numbers to drop
off.
Mr. Hales stated that it is hard to figure out where the plateau is, but he
thinks perhaps the number is 200. Ms. Hobold thought that Judge Sullivan
estimated 200. Judge Sullivan explained there are different kinds of
domestic violence; and mostly assault 4 is supervised. Harassment and other
levels are not supervised. The cost of required treatment is about $2,000,
which is significant for some offenders. He commented that it is one of the
best programs the District Attorney has developed yet. It was thought that
100 people would be involved but the numbers are well over that.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 3 of 7 Pages
This program saves a lot of money; fewer officers have to come to court;
and a guilt plea is required. Victims are supportive if the object is treatment,
not punishment. The family becomes involved and it less confrontational.
The offenders are a lot more motivated to do well with the program than
they would have otherwise. It is an excellent program; if the offender
successfully completes the program, the case is set aside.
Ms. Hobold stated that victims' advocates are in favor of the program as
well because victims don't have to wait for it to go to trial. Mike Dugan said
that the Safe Schools Alliance in his opinion is more important, but this has
been a positive program. Getting the batterer into a treatment program is
very significant, and avoids other problems later that could be much more
dangerous. Many times female victims will not report assaults; typically it is
reported about the seventh time when the situation has become very serious.
This allows a quicker intervention, and it does work in most cases.
Ernie Mazorol said that bench probation is required but no home visits are.
This program needs additional resources so that offenders can be
appropriately monitored. If the offender does not comply, it is important to
get him or her back into compliance. At some point, intake will reach a
level when it is not as effective.
Mr. Hales stated that resources of course are a problem. A commitment has
been made not to diminish the current level of service, but it will be difficult.
Managing this program properly impacts the children and other family
members; he wants children to avoid seeing their parent victimized or
becoming victims themselves. Judge Sullivan stated that usually there are two
officers involved in a domestic dispute case, and handling these situations in a
more effective way reduces the time officers have to spend on these calls.
Mr. Dugan stated that 50% or more of offenses occur in the presence of a
child, and this can have a long-term negative impact.
VII Impact Court
Ernie Mazorol stated that Impact Court resulted in 214 cases in trial within a
six-week period. A pro-tem or visiting judge spend two weeks each during
three months, and this helped reduce the misdemeanor backlog. Some cases
were over two years old. The goal was to dispose of 100 cases within six
months, and a decision was made to bring in the impact judge to address this
problem.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 4 of 7 Pages
Through trials, pleas and dismissals, 149 cases were disposed of, most of the
others were set over. This took care of 53% of the cases.
Judge Sullivan said that this was a substantial effort and inconvenience to all
of the entities involved, but it did take care of a lot of cases. This program
may be continued in the future even though it is very difficult to schedule
due to the number of cases coming in. Over 100 DUIIs are filed each
month; and many cannot be plea bargained or go to diversion.
Mr. Dugan reported that there were 1,383 DUII's last year. It was a very
stressful time for the people in his office.
Mr. Mazorol stated that pleas and compromises should be handled ahead of
time if possible so they don't end up being addressed in impact court. The
focus needs to be getting them out of the system as soon as possible.
Jacques DeKalb stated that perhaps the Judge and District Attorney can meet
with others and report back to LPSCC with some ideas on how to handle the
problem. Judge Sullivan added that every effort will be made to resolve the
cases as quickly as possible.
VIII Other Business
The Circuit Court Judges meeting is scheduled soon, and said to tell him if
there is anything for him to bring to that meeting, which is for Judges only.
There are issues of security as well, which is being handled by the Oregon
State Police; and they don't want a lot of other people there. Pete Burleigh,
the author of "Crazy", will be the guest speaker. He said they will try to
make a video of the speaker for others to view later. His book addressed
how the mentally ill are handled by law enforcement and the courts in this
country.
Bob Smit pointed out that April is Child Abuse Awareness Month, and blue
ribbons are available to anyone who wants to wear one to recognize these
efforts. He said that there are approximately six counties who participate in
this observance. He hopes that all of the issues surrounding abuse are
remembered and addressed.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 5 of 7 Pages
Jacques DeKalb reported that the Office of Public Defense Attorneys sent
out a survey asking about the quality of indigent defense services. Only
seven District Attorneys out of 36 responded. Overall the score from all of
the responders was between 3 and 4, with 5 being excellent. Almost all of
the responses included comments regarding too many cases, not enough
time, and other similar comments. Obviously the system does not have
enough judges, prosecutors or defense attorneys. They can only handle so
many cases.
Mr. Mazorol asked if Bend will keep the number of police and fire personnel
at an adequate level. Ms. Baxter said 17 positions will be eliminated
eventually. Code enforcement for ordinance violations may end up being a
police department duty instead of through Community Development.
Mr. Hales said that it would be good to meet to figure out the budgetary
impacts to all of the law enforcement agencies, once the budgets are
finalized.
Mr. Dugan stated that the property crimes bills will be on the November
ballot. Mandatory minimum sentences can cost $300 million to $500
million per year. The alternative bill would not carry mandatory minimum
sentences but pushes the second offense into presumptive prison sentences,
but would increase the amount of time to allow for treatment programs to be
completed. The long wait for treatment programs allows further crimes to
be committed. At some point a lot of the property criminals may be in
prison and maybe the crimes will decrease. But someone has to pay for the
jails.
Judge Sullivan said that if mandatory sentences bill passes, there will be a
lot more trials. Mr. Hales stated that this will take away a lot of funding for
other programs. Mr. Dugan assumes that 1145 funding will be impacted and
the State will have to find money to house thousands of more prisoners.
Mental Health and Commission on Children & Families will be negatively
impacted, as will the Courts and other entities where they can find funds to
raid.
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 6 of 7 Pages
Mr. Hales stated that Representative Gene Whisnant will be present at the
next LPSCC meeting to talk about the impacts of the bills.
In regard to the grant to address juvenile gang activity, Mr. Hales will give a
briefing on the requirements of the grant at the next meeting.
Ruth Jenkin stated there is an x-ray machine at the courthouse now, which is
a time saver when examining purses and other objects. There is an extra
metal detector available to Juvenile or any other entity that can use it.
The work center is operational and there are a few extra beds available.
Judge Sullivan stated that the Sheriff's Office has done an excellent job of
security at the Courthouse.
Commissioner Baney complimented Jacques DeKalb on the article on his
work that was recently in the Bulletin.
Being no further items addressed, the meting adjourned at 4:35 p.m.
Respectfully submitted,
JNW~ (f34~
Recording Secretary
Attachments
Exhibit A:
Sign-in sheets
Exhibit B:
Agenda
Exhibit C:
911 Levy Information Sheet
Exhibit D:
Mental Health Strategic Plan
Exhibit E:
Domestic Violence Statistics
Exhibit F:
Impact Court Statistics
Minutes of LPSCC Meeting Monday, April 7, 2008
Page 7 of 7 Pages
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DESCHUTES COUNTY
PUBLIC SAFETY COORDINATING COUNCIL
"971
s a <
April 7, 2008; 3:30 pm, Allen Room, 2nd Floor County Administration Building,
1300 NW Wall, Bend, OR
Agenda
I Call to Order & Introductions
Judge Sullivan
II March Minutes Attachment 1
Judge Sullivan
Action: Approve February minutes
III Public Comment
Judge Sullivan
IV 911 Proposed Levy Attachment 2
Becky McDonald
Action: Update levy rate information and fact sheet
V Mental Health Department Strategic Plan Attachment 3
Scott Johnson
Action: Receive report and comment if desired
VI Domestic Violence Diversion Program Attachment 4
Ken Hales, Ernie Mazorol
Action: Update Council on current trends
VII Impact Court
Judge Sullivan
Action: Update council of Impact Court status
VIII Other Business
Judge Sullivan
Attachment 2
DESCHUTES COUNTY 911
FACTS AND INFORMATION
The 911 emergency number was established in 1965
to serve as a uniform number for anyone in an
emergency that needed police, fire or medical
services. In 1981, Oregon established 911 as the
official emergency number. In 1985, Deschutes
County opened its 911 Operations Center.
The 911 Center is the only emergency
communication center for 19 public safety agencies
in Deschutes County including police, fire and
medical emergency response personnel.
Deschutes County 911 is funded partially through a
statewide emergency communication tax. This tax is
set at $.75 per phone line, including cell phones. The
state returns $0.435 to counties and cities for
operations at 50 PSAPs (Public Safety Answering
Points), such as Deschutes County 911.
The balance of Deschutes County 911 operating
budget comes primarily from property taxes. There
are two categories of property taxes which account
for most of the annual 911 operating revenue: a
"permanent tax rate" of $.16 per $1,000 of assessed
value and voter approved local option levy.
Currently, Deschutes County 911 is operating
without a local option levy.
Calls for Service
POPULATION: Deschutes County is
expected to increase from
130,500 residents in 2003 to more than
160,810 in 2007*.
CURRENT CALLS: Today 911 operators
average over 745 non-emergency calls and
193 emergency calls per day. These 938
total daily calls equal a call to 911 every
minute and one-half, 24 hours a day.
PROJECTED CALLS: By 2012 total calls are
projected to increase to approximately 979
calls per day.
May 20, 2008 Election Information
PROPOSED MAY 2008 LEVY INFORMATION
Voters will be asked to vote on a proposed five-year
local option levy that would provide funding for the
Deschutes County 911 Service District.
The proposed five-year levy rate of $.23 per $1,000
of assessed value would replace the expired levy. On
a home with an assessed value of $170,000, the
homeowner would pay $39.10 annually for 911
services.
In the May 2007 election, a similar levy
received a yes vote**, but because passage also
required a 50% voter turnout and that was not
received, the levy did not pass.
• The four-year levy rate of $.09 per $1,000 of
assessed value expired on June 30, 2007.
• New levy rate would increase operational
capacity to accommodate the increased demand
for services due to county population growth.
• In addition to answering non-emergency calls for
service and dispatching emergency services, 911
personnel are trained and certified to give
lifesaving emergency medical instructions to
callers until emergency personnel arrive.
• Deschutes 911 Service District covers an area in
excess of 3,000 sq. miles.
*Portland State University Population Center, July 1, 2007.
**Nancy Blankenship, Deschutes County Clerk
Deschutes County Mental Health (DCMH)
2008 Initiatives benefiting public safety, client care
Report to Local Public Safety Coordinating Council January 7, 2008
1. Mental health court expansion from 12 adults to (up to) 25 DIVERSION / TREATMENT
Additional referrals will be accepted early in 2008. Requires use
of reserves; not sustainable without additional revenue.
2. Drug court sustained at 25 families. DIVERSION / TREATMENT
DCMH grant administrator. Currently 25 adults, 42 children.
First graduations Feb. 2008. Sustainability of Byrne $ in question.
3. New AOD treatment in jail and post release (with DCSO) TREATMENT IN FACILITY
AND OUTPATIENT
Criminal Offender Tx. & Recovery Program. Seamless screening,
assessment and treatment. RFP Jan. 2008; to be contracted.
Services in facility (DCSO post release (DCMH AOD equity
4. New Treatment & Recovery Program: Addicted Families INTENSIVE OUTPATIENT
Intensive alcohol/drug abuse outpatient treatment for adults
referred by child welfare. RFP Jan. 2008. Expected to serve 79
families in 18 months. Complements drug court services.
5. Bridge Program expansion -doubling staffing to 2 fte REENTRY, CASE MANAGEMENT
AND TREATMENT
Expanding community reentry from jail services. Case management,
treatment, referral to other services. Adds treatment capability.
Need to sustain and expand: sustain fte funded with reserves; add 3rd.
6. Training law enforcement officers -Crisis Intervention Training CRISIS MANAGEMENT
AND REFERRAL
Training of Redmond PD officers re. services, protocols, Mobile Crisis
Team. Joint effort with LEAs to offer CIT periodically is recommended.
7. Other behavioral health initiatives CRISIS SERVICES, HOUSING,
JOBS, ACUTE CARE
a. Sustain new Mobile Crisis Team for Deschutes & Crook.
b. New acute care funds to improve Sage View rate; assure indigent
access to Sage View and Psychiatric Emergency Services at SCMC.
c. New early psychosis program to work with 20-30 teens and young adults.
d. Expanded supported employment program benefiting 70 more clients.
e. Proposed - 10-bed secure residential treatment program;
8-bed residential treatment program. Includes 4 PSRBoard beds,
9 State Hospital Extended Care Beds and 5 county-managed.
f. Proposed - expand homeless outreach; add a new
transitional housing program (Bethlehem Inn & Housing Works)
Criminal Justice / LPSCC rpt new $ 1.7.8 1/4/2008
To: Members of the Deschutes County Local Public Safety Coordinating Council
From: Scott Johnson, Director, Deschutes County Mental Health (DCMH)
Date: March 24, 2008
Subj: Opportunity for LPSCC Review and Comment of Mental Health 2009-11 Biennial Plan
Every two years, we complete a state-required "Biennial Plan". Submitting the plan requires an
opportunity for several groups to review and make comment on our submittal. The groups
include the Commission on Children and Families, the Local Public Safety Coordinating Council
and the State Department of Human Services. The plan is lengthy and also includes our longer
term, more comprehensive Strategic Plan.
What follows here is a paraphrased summary of our major mental health efforts related to the
Justice System in Deschutes County. All of this material should be familiar to LPSCC. It should be
noted that items identified as "resources needed" would require further investment for us to be
able to proceed. Also, items like the Bridge Program and our Mental Health Court rely at least in
part on the use of DCMH reserves. This is not sustainable long term.
The full DRAFT plan is available via email. We will be asking for any formal comment at the
Council meeting April 7. Contact me if you have questions before the meeting. Scott
scott iohnson@co.deschutes.or.us or 322-7502
Strategic Plan priorities related to public safety
a. Primary target population(s) - (1) people with a significant mental illness, (2) people with co-
occurring disorders or (3) people with a primary presenting addiction illness.
b. Alternatives to Incarceration Report (2006)-develop alternatives at levels that correspond
to our population increase and the bed expansion planned for the County Jail. Develop a
treatment and public safety system that is balanced (in jail health services) and treatment
alternatives. Advance Report priorities where possible. Resources needed.
c. Collaboration-Develop a formal partnership through the LPSCC to carry out core strategies.
d. System Development-Emphasize a systems approach to improvements to address the
issues associated with mental illness and addictions.
e. Diversion-(1) Sustain County's Crisis Team and Mobile Team; (2) expand intensive wrap-
around services to high-need clients; (3) coordinate referrals to the Medical Center; (4)
Support access to Sage View; (5) assure access to Psychiatric Emergency Services at the
hospital (for assessment and stabilization). Resources needed.
f. Crisis Intervention Training (CIT).-In cooperation with others, offer training to local law
enforcement; increasing the ability of first responders to work with people with mental health
or addiction issues.
g. Family Drug Court and Drug Court-Administer the necessary grants to sustain the Family
Drug Court; consider adding an Adult Drug Court in the future (if feasible). Resources
needed.
h. Mental Health Court-Expand this treatment court in conjunction with jail expansion, as
resources allow. Resources needed.
Parole & Probation Specialization-Continue specialized personnel with expertise and a
mental health case load. Expand this capacity with jail expansion. Resources needed.
Case Coordination-With jail, parole and probation, mental health, and hospital staff,
coordinate services for people who frequently use the services of multiple systems.
k. Jail Services-Perform services through jail staff including assessment, medication and
stabilization, particularly of seriously and persistently mentally ill population; assure County
Mental Health Department staff are available for crisis assistance; needed hospitalizations
are accomplished cooperatively between jail and mental health staff; with confidentiality
rules, share client information to ensure health care and reinstatement of benefits.
Bridge Corrections Program-Expand community reentry services to adults with co-occurring
disorders in the jail and the community corrections system in Deschutes County. Participate
actively in the Reach In Program. Resources needed.
m. Juvenile Services- Continued operation of 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. Current challenges: need for emergency shelter, sustaining
Functional Family Therapy, service / placement options for youth with serious mental health
disorders and sex offenders needing residential treatment. Resources needed.
n. Su►aervised Housing-As recommended by Adult Parole & Probation, transitional, supervised
housing for people with mental illness who are diverted from the justice system or are seeking
to re-enter the community. Services are needed for residents. Resources needed.
o. Psychiatric Security Review Board (PSRB)-Expansion of this program in Deschutes County;
four additional secure beds are planned; informing the DA and local law enforcement of
new PSRB individuals in our County.
p. Addictions Treatment-With the Sheriff's Office, expanding addictions treatment for people
involved in jail / work center and post releaser. Also increasing treatment for parents with
children in the child welfare system (complements Family Drug Court).
The Biennial Plan, with any final changes will be forwarded to the County Commissioners in April
for adoption. The full Strategic Plan will likely be forwarded to the County Commissioners in May.
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:
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
scott_j ohnson@co.deschutes. or.us
DESCHUTES COUNTY MENTAL HEALTH (DCMH)
2009-2011 IMPLEMENTATION PLAN
Table of Contents
Page
Letter to Bob Nikkel, DSH Addictions & Mental Health Division 1
General Guidelines
Licensure/Approval 5
Services to Diverse Populations 5
Standard Plan Requirements
County Contact Information Form 6
County Planning Process 8
Current Linkages with State Hospital System and Mental Health Acute Care Inpatient Providers 10
Residential/Detoxification Services Coordination 11
Coordination of Addictions Treatment with the Criminal Justice System 12
High Priority Needs 12
Allocation and Use of Resources Provided by AMH 14
Attachment 1: List of Subcontracted Services for Deschutes County 15
Attachment 2: Board of County Commissioners Review and Approval 16
Attachment 3: Local Alcohol and Drug Planning Committee Review and Comments
Attachment 4: Local Mental Health Advisory Committee Review and Comments 17
Attachment 5: Commission on Children and Families Review and Comments 19
Attachment 6: County Funds Maintenance of Effort Assurance 20
Attachment 7: Planned Expenditures of Matching Funds (ORS 430.380) and Carryover Funds 21
Attachment 8: Review and Comments by the Local Children, Adults and Families District Manager 22
for the Department of Human Services
Attachment 9: Review and Comments by the Local Public Safety Coordinating Council 23
Prevention Plan 24
Attachment 10: Prevention Strategy Sheet 27
Problem Gambling Services Plan 28
Children's Mental Health Services Plan 29
Older Adult Mental Health Services 31
Deschutes County Mental Health Strategic Plan 2008-2013 32
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
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.
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.
Target 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.
Pursue an initiative to increase productivity in community mental health through a
streamlined set of Administrative Rules and reater 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.
6. 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 Johnson, 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
11. 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
Name Scott Johnson
Title County Administrator
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 Information
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: 2.577 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
Information
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 Community 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 Strate is 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.
Sae 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 Oregon 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 o 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 makes
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. 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 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. Housins-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 Leadership--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. Contractinp,-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
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 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 I
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: Deschu
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, Oreizon 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`" 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
Signature
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, (541) 322-7509
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
cares stem
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:
Effective:
Promising:
Communities Mobilizing for Change on Alcohol
Big Brothers/Big
Friendly PEERsuasion
Guiding Good Choices
Sisters
Nurturing Parenting Programs
Incredible Years
Preschool and Toddler
Life Skills Training
School-Aged Children
Project Towards No Drug Abuse
Families in Recovery
Second Step
Spanish Families
Strengthening Families
Making Parenting A Pleasure
Functional Family Therapy
Healthy Families America
Preparing for the Drug Free Years
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 $39,500
Community coalitions 16,500 See details below.
Evidence cased curricula for MS/HS and/or families 10,000
Gender specific curricula 10,000
Youth Conference and youth team 8,500
Retailer training/Reward Reminder Program 2,000
Professional development 1,000
Total $87,500
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.
Accessibilitv 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.
5. 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
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
DRAFT
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.
Page 32 of 81
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.
Page 33 of 81
TABLE OF CONTENTS
Page
Common Acronyms Used In This Plan
4
A.
Executive Summary Will be updated
5
B.
Overview Will be updated
7
C.
Our Vision, Mission, Core Values
8
D.
Policies
9
E.
Environmental Trends and Challenges
12
F.
SWOT Analysis
15
G.
2008-2009 Work Plan
17
H.
Longer Term Priorities 2008-2013
1. Consumer and Family Involvement
19
2. Organizational Development
21
3. Business Services
25
4. Program Development (General)-Quality, Access, Services and Productivity
27
5. Child and Family Services
29
6. Adult Mental Health Treatment and Support Services
32
7. Seniors' Mental Health Services
34
8. Chemical Dependency
36
9. Justice System Services and Alternatives to Incarceration
38
10. Developmental Disabilities Services
44
1.
Appendices
1. Financial Plan 2008-2011
46
2. Local Mental Health Authority Responsibilities
3. Deschutes County Goals & Objectives
Page 34 of 81
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
Page 35 of 81
Deschutes County Mental Health
2008-2013 Strategic Plan OLD / TO BE UPDATED
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
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 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
critical underpinning of the Oregon Health Plan (OHP), including mental health and
addictions treatment for OHP members in Deschutes County.
i Page 7. A Blueprint for Action, Governor's Mental Health Task Force, September, 2004.
as many as 7,350
Deschutes County adults
and 3,150 children may
need mental health services
in 2006."
Page 36 of 81
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
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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.
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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).
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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:
Intearity, 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 Eniovable 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.
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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:
1. 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. Strengths 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.
s AMHAB refers to the Deschutes County Addictions & Mental Health
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2. County role as the Local Mental Health Authority
By statute, 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
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
a 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.
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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.
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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
1. 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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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.
HEALTH CARE REFORM
16. 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.
17. 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.
18. 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).
19. 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.
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RESOURCES
20. 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.
21. 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.
22. 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.
23. County & 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.
24. 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
25. 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
26. 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.
27. 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.
6The 17% reflects the actual increase for Deschutes County Mental Health.
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ACCESS
28. 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
29. 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.
30. 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.
' Pre-commitment investigations: 191 in 2005-2005; 239 in 2005-2006; 307 in 2006-2007.
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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
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G. 2008-2009 Work Plan
1. Program Priorities
1. 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.
2. 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.
3. 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.
4. 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.
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 collection8. 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.
6. 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.
7. 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.
8. 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
for supported 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.
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10. 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 7109. Resources needed.
b. Professional Development-Complete training survey (at least 80% return rate). Set
training priorities through December, 2009. Emphasize best practice. Resources 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 committees1l. Promote and support consumer leadership' 2.
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.
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. Contra ctina-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 / 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.
10Paraphrased 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.
"For example, the Mental Health Alcohol & Drug Advisory Board, Children's System of Care Advisory Board and Local Developmental
Disabilities Planning Council.
12 For example: Clubhouse, thrift store, our managed care organization. Support consumer positions in each setting.
"Primary 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.
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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.
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 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.
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 ways to increase penetration rate, manage limited resources, and meet
State compliance requirements
Page 51 of 81
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.
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. Representation-Seek consumer and family involvement on all advisory, planning,
evaluation and policy boards and committees.
e. 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).
f. NAMI of Central Oregon-Collaborate with the local chapter of NAMI whenever
possible. Meet regularly with NAMI 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.
g. 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.
2. Organizational Development (See also Business Services.)
44 Audit Action Plan-Implement recommendations in periodic State, County or
Federal audits of the Department.
Page 52 of 81
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.
d. Cultural Competency-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.
e. Evidence Based Practices (EBPsi-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.
3) Timely Access to Help-Identify and implement the most effective ways to
reduce wait lists and assure prompt service for eligible clients.
Page 53 of 81
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.
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.
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.
7) Team Development-Support team building activities when needed.
g. Measuring Our Performance-Operate a quality improvement system and process to
measure our productivity and effectiveness.
Page 54 of 81
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.
h. Oreaon 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.
i. 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 supervisors15 to 57.1 clinical staff.
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.
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.
14The County's Addictions and Mental Health Advisory Board serves as the Quality Management Committee.
15Adult Treatment has 3.0 supervisors to 24.18 clinical staff. Child & Family has 1.6 supervisors to 17.25 clinical staff. DD has 0.75 supervisors
to 13.05 clinical staff. Seniors has 0.25 supervisor to 4.55 clinical staff. UPDATE TO CURRENT RATIOS
Page 55 of 81
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, 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 positions are vacant each year.
d. Contracting 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,
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.
j. Fiscal Support
1) Audit Findings-Implement internal auditor recommendations, where practical.
16Indirect charges reflect Department payment for the cost of County support services including Legal Counsel, Personnel,
Building Services, Finance, Information Technology and County administration.
Page 56 of 81
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.
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
Page 58 of 81
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.
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 Droaram beaan 10/1 /06
Services offered
Oct. '05-Sept '06
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
Page 59 of 81
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.
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.
f. 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
Page 60 of 81
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 Recommendations-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 & 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: Jul 1, 2007, Service Levels
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.
"Oregon Vital Statistics, Department of Human Services, Health Division
1 8Population 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.
Page 61 of 81
1) Employment (Supportedj-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.
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.
Page 62 of 81
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.
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.
Page 63 of 81
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 8t 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
's Emma's Place: 9 of 11 residents have housing vouchers 11.07
Z0 New apartment building on site of the proposed Redmond Deschutes County Service Center
ai Residential treatment facility with 5-beds for Extended Care from State Hospital; 3-beds for County placement
zl Secure residential treatment facility with 4 beds Extended Care; 4-beds PSRB; 2-beds County placement
v Horizon House: 9 of I 1 residents have vouchers 11.07
V Parole & Probation transitional facility: estimated 4 to 8 of the 18 beds are people with a mental illness 11.07
35 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
Page 64 of 81
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
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
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
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.
Page 65 of 81
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.
f. 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.
Page 66 of 81
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-Occurring 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.
Page 67 of 81
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-Support the substance abuse prevention work of the Deschutes County
Commission on Children & Families (CCF). Invest public funds through projects
sponsored by CCF. Support evidence based projects that reduce at-risk youth
behavior and support healthy family functioning.
Page 68 of 81
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.
j. 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.
Page 69 of 81
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.
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.
28 Oregon Partners in Crisis.
z' 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.
Page 70 of 81
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 (CITE-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.
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.
Page 71 of 81
3) Expansion Long-Term-Expand the Drug Court to serve adults in need of
addiction treatment. Resources needed.
h. 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 (prima(ly) 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.
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).
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.
Page 72 of 81
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.
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
Page 73 of 81
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
13%.
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
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
Page 74 of 81
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.
f. Lifespan Respite Services (Regional Program-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).
h. 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.
Page 75 of 81
A. APPENDIX 1:
To be updated by DCMH Operations Manager
Account Description
Budget
FY
2007/08
Projected
FY
2007/08
Projected
FY
2008/09
Projected
FY
2009/10
Projected
FY
2010/11
BUDGETED AND ACTUAL REVENUES
State Grant
ABHA
Marriage Licenses
Divorce Filing Fees
Federal Grant-Byrne
State Grant-CJC
Local Grant-COCIB/Pharm
State Miscellaneous
Title 19
Li uor Revenue
School Districts
Mental Health Jail Comp
Miscellaneous
Contract Payments
Patient Insurance Fees
Patient Fees
Seizure/Forfeiture
Interest on Investments
Rentals
Donations
Interfund Contract
Juvenile 230
CDO 280
General Fund
OHP-CDO 280
Other Acute Care 276
General Fund Other 001
General Fund-Alt. to Incarceration
General Fund Other 105
FUND RESOURCES TOTAL
BUDGETED AND ACTUAL EXPENDITURES
Personnel Service
Community Contracts
Count Indirects
Materials and Services
Capital Outla
Transfers Out-Project Development
Contingency
FUND REQUIREMENTS TOTAL
Beginning Working Capital Car forward
Page 76 of 81
Historical Under Spending vs. Budget on
Personnel and Materials
Projected Loss for Period
Ending Net Working Capital
Restricted Working Capital
Unrestricted Working Capital
Notes and Assumptions
Page 77 of 81
4. Appendix 2: LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES
Page 78 of 81
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.
4. 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.
Page 79 of 81
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.
Page 80 of 81
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 iohnson@co.deschutes.or.us
Page 81 of 81
Attachment 4
Domestic Violence Deferred
Sentencing
Number entering each month
15
10
5
0
June'01 July'01 Aug'01 Sept'01 Oct'01 Nov'01 Dec'01 Jan'08 Feb'08 Mar'08
All monhary figures rounded to the nearest $100 23
Domestic Violence Deferred
Sentencing
Ave number DVDS cases under daily supervision
90
80
70
60
50
40
30
20
10
0
All monllary figures rounded to the nearest $100 24
1
Statistics for Impact Court
January - March 2008
Total Trial Set: 214
• Trials/Pleas/Dismissals:149
- Trials that took place: 35
- Pleas: 91
- Dismissals: 18
- Civil Compromise: 5
• Set Overs: 51
- Stipulated:5
- Defense Counsel: 28
- Court:6
- State:2
- New Counsel appointed: 3
- Motions to Dismiss - Speedy Trial Issues Pending: 3
- Review for Mental Health Court: 1
- Review for DVDS Court: 1
- Motion to Suppress: 2
0 Failure to Appear Warrants: 14