2010-2613-Minutes for Meeting April 05,2010 Recorded 5/11/2010DESCHUTES COUNTY
PUBLIC SAFETY COORDINATING COUNCIL
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MINUTES OF MEETING
Monday, April 5, 201.0
Barnes and Sawyer Room, County Administration Building
1300 NW Wall St., Bend, OR
Present were Judge Michael Sullivan; Commissioners Alan Unger and Tammy
Baney; Ken Hales, Community Justice; Scott Johnson, Health Services; Bev
Clarno and Jack Blum, citizen members; County Administrator Dave Kanner;
Sheriff Larry Blanton; Roger Olson, National Alliance on Mental Illness; Eileen
Stein, City of Sisters; Hillary Saraceno, Commission on Children & Families;
Sandi Baxter, City of Bend Police Chief; Shelly Smith, KIDS Center; Donna
McClung, Oregon Youth Authority; Trish Meyers of Saving Grace; Charity
Hobold, Parole & Probation; Ed Boero, Redmond City Council; Captain Tim
Edwards, Sheriff's Office; and Captain Cory Darling, Bend Police Department.
No representatives of the media or other citizens were present.
1. Call to Order & Introductions.
Judge Sullivan called the meeting to order at 3:35 p.m.
2. February Minutes.
The minutes were unanimously approved as written.
3. March Minutes.
The minutes were unanimously approved as written.
4. Public Comment.
None was offered.
Minutes of LPSCC Meeting
DESCH RECOR NNANCYUBLANKENSHIPTES COUNTY CLERKDS v4 2010*613
COMMISSIONERS' JOURNAL 05/1112010 01;10;14 PM
2010-2613
Monday, April 5, 2009
Page 1 of 5 Pages
5. Oregon Violence Against Women Prevention Grant.
Charity Hobold gave an update on the work of the Domestic Violence
Committee, regarding evaluations of programs and community responses.
A grant was requested from the OVW to promote the welfare of women; a
decision was made to apply for funding to help start the lethality assessment
program in Deschutes County. This involves having law enforcement complete
a risk tool on the situation and offender. There are eleven questions, and a
"yes" answer indicates action needs to occur. The idea is to connect the victim
advocacy agencies immediately with the victim; the advocate would be called at
the time of the response. The questionnaire would be attached to the police
report. The grant will fund training for law enforcement, victim advocacy
services and assessments, and for a Parole and Probation person to be able to
handle the caseload for high-risk offenders.
It is important to note that only 4% of domestic violence victims have any kind
of support in place. Typically there are previous complaints. Fatalities have
been as high as 67%, but this was reduced to 45% in one year if the person is
able to get into a shelter. This is without a negative impact to the courts or the
victim. Communities in six states have started this program.
Trish Meyers of Saving Grace stated the quicker someone can get into a
protection program, the better their chance is of getting out of a bad relationship.
This helps them to work more closely with law enforcement as well.
It was noted that a key issue is that 4% of those killed in a domestic violence
incident had tried to get some help, but the most that could be done is leave
information with the victim. This tool will help the victim connect to help
immediately, and it does not involve a lot of extra work. The high-risk
offenders are those more likely to try to kill their spouse or partner.
Jack Blum asked if this is for both female and male victims. Sheriff Blanton
confirmed it is for both.
Commissioner Baney asked if Saving Grace is able to handle additional
capacity. Trish Meyer indicated that they have an idea of how many they might
be helping, and there is an additional % FTE in place for that.
Commissioner Baney stated that she is surprised that strangulation is not
considered a felony in Oregon. Ms. Meyer replied that the Domestic Violence
Council feels the same way. It is a felony if there is a past conviction, but there
is a long way to go. It definitely shows a higher future risk.
Minutes of LPSCC Meeting Monday, April 5, 2009
Page 2 of 5 Pages
Dave Kanner asked why it is differentiated from other types of assaults. Judge
Sullivan said that it is more serious, but is considered harassment, a class B
misdemeanor. It is an evolving situation. It used to be that even if there was a
previous assault, it was still a misdemeanor. Looking at the next biennium,
trying to make a felony out of something in today's budgetary climate will be
difficult.
Mr. Kanner noted that it seems as though the intent is to kill. He asked why this
is not considered attempted homicide. Judge Sullivan stated that there are
usually more charges than just that, and it is filed with the others. Existing
services and programs are hard to fund now, and no one will want to spend
more money or put more people in jail.
Sheriff Blanton observed that domestic violence cases are handled a lot
differently now. In the late 1980's it was not even subject to mandatory arrest.
It is now. And if children are present, or if the action interrupts a 9-1-1 call for
help, it is taken more seriously. Laws are changed and added as a result of
experience. Domestic violence doesn't just affect the victim, but the children
who might be present. Law enforcement takes it very seriously. Judge Sullivan
added that it is a significant problem in today's society.
5. Report on Juveniles Who Sexually Act Out.
Shelly Smith gave an overview of the issue. There are two age groups, under
12 and those 12 years and older. (She referred to a handout, attached for
reference) She will keep LPSCC advised as progress is made.
6. 2009 Trends in Child Abuse.
Ms. Smith provided a handout from the KIDS Center that detailed statistics on
the number of children assisted and the type of help given. (Copy attached for
reference.)
She noted that caseloads have grown by 58% over the previous year. Often the
abuse is both physical and sexual. Some of the caretaker risk factors are prior
law enforcement or DHS action, financial instability, mental health concerns,
domestic violence, alcohol or drug abuse, and often a combination of these
issues. Usually the offender is someone close to the child and not a stranger.
Judge Sullivan said that the children often feel like they are to blame, and don't
say anything out of fear of upsetting the household.
Minutes of LPSCC Meeting Monday, April 5, 2009
Page 3 of 5 Pages
Scott Johnson stated that they are in the early stages of a new grant for child
abuse prevention programs, which will add a nurse position and perhaps be part
of the school-based healthcare facilities.
7. 2011-2013 Deschutes County Behavioral Health Plan.
Mr. Johnson said that the strategic plan, which runs for five years, is a State
requirement. His group is trying to identify what is currently being done and
what should be done in the future. They will need to come before the
Commission on Children & Families and the DHS with this plan.
The future will bring a new Governor and, because of the economy, a big hit to
the State budget. They are trying to maintain what they have that is working
and move forward as much as possible on other things. (He reviewed a handout
at this time, attached for reference.)
The focus is on the wellness of children ages 0 to 8. Often this is related to
intervention. He asked for input especially on the behavioral health portion.
They are also getting into residential related services and employment support.
The State budget is a big worry. There has been an increase in Oregon Health
Plan numbers, but capacity is still limited. There are still a lot of uninsured
people in the State. The bad economy has not made this easy. The lifespan of
clients and how long they need to be treated is 25 to 35 years. They hope to
link primary health care services with behavioral health, as they are often
related.
Oregon Health Authority comes on line soon, and they are 45 to 60 days away
on the electronic records process. Some services have been expanded, and
some have been contracted out, including alcohol and drug treatment services,
including those in the jail.
From a public safety perspective, they are focusing on child safety and
treatment, safe schools assessments and crisis response. These include people
who may be indigent or on the Oregon Health Plan, and those who are
incarcerated.
A recently development is addressing different models. A team will be going to
San Antonio to a national intervention conference, which is getting great
support from agencies and privately.
Minutes of LPSCC Meeting Monday, April 5, 2009
Page 4 of 5 Pages
April is Blue Ribbon Month - child abuse prevention month. There will be a
Proclamation presented at the Wednesday Board of Commissioners' meeting,
along with the symbolic tying of blue ribbons on trees of hope. About 2,300
ribbons have been tied to trees to represent the number of child abuse referrals.
There is also a May 1 I fundraiser at the Riverhouse.
8. Other Business.
Judge Sullivan pointed out that this area has some very innovative programs,
all of which deserve recognition. Most other communities have nothing like
them. All it takes is for more people to join in and participate to make them
successful.
Being no further discussion or items addressed, the meeting adjourned at
4: 45 p. m.
Respectfully submitted,
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Bonnie Baker
Recording Secretary
Attachments
Exhibit A: Agenda
Exhibit B: Sign in sheet
Exhibit C: Domestic Violence - Proposal Abstract
Exhibit D: Discussion on Juveniles who Sexually Act Out
Exhibit E: KIDS Center Update for 2009
Exhibit F: Behavioral Health Biennial Implementation Plan for 2011-13
Minutes of LPSCC Meeting Monday, April 5, 2009
Page 5 of 5 Pages
DESCHUTES COUNTY
PUBLIC SAFETY COORDINATING COUNCIL
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April 5, 2010 - 3:30 p.m.
Barnes and Sawyer Room, County Administration Building
1300 NW Wall St., Bend, OR
Agenda
I Call to Order & Introductions
Judge Sullivan
II February Minutes Attachment 1
Judge Sullivan
Action: Approve February minutes
III March Minutes Attachment 2
Judge Sullivan
Action: Approve March minutes
IV Public Comment
Judge Sullivan
IV Oregon Violence Against Women Grant Attachment 3
Charity Hobold, Trish Meyer
Brief Council on proposed program
V Juveniles Who Sexually Act Out Attachment 4
Shelly Smith
Brief Council on MDT event
VI 2009 Trends in Child Abuse Attachment 5
Shelly Smith
Brief Council on 2009 statistics
VII 2011-2013 Deschutes County Behavioral Health Plan Attachment 6
Scott Johnson
Council's opportunity to review & comment on plan
VIII Other Business
Judge Sullivan
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Attachment 3
VY. Proposal Abstract
Deschutes County law enforcement agencies report an upward trend in domestic violence
arrests that indicate injury or lethality. The 2009 numbers of assault, strangulation, attempted
homicide, and homicide arrests are 48% higher than 2004 numbers. To address the increasing
potential for lethality in domestic violence cases, Deschutes County proposes to implement the
Lethality Assessment Program (LAP). LAP is a research-based domestic violence risk
assessment that will be utilized by law enforcement officers to connect high-risk domestic
violence victims with domestic violence program services.
Because strangulation is currently not a felony in Oregon, strangulation offenders do not
receive supervision and monitoring by Parole & Probation in Deschutes County. Strangulation is
strongly correlated with other forms of physical violence and lethality. To address the lack of
supervision of strangulation and other high-risk offenders, Deschutes County proposes to add an
Intensive Supervision Program Parole & Probation Officer to supervise these offenders.
The primary goals for this project are to enhance victim safety and hold batterers
accountable by implementing collaborative use of the LAP and by increasing supervision of
high-risk offenders, with use of the LAP to inform level of supervision. Objectives include: 1)
provide training on lethality and danger assessment for collaborative partners; 2) promote
coordinated community responses that account for victim safety by implementation of LAP and
Danger Assessment; 3) provide immediate access to services for victims at high risk of lethality;
4) provide culturally appropriate services to Latino victims; 6) ensure high-risk offenders are
held accountable; 7) provide a continuum of domestic violence services that address the needs of
victims, and 8) support ongoing initiatives that promote a collaborative response to high-risk
victims.
Page 1 of 1
Attachment 4
Deschutes MDT Discussion on Juveniles who Sexually Act Out
Agenda - February 10, 2010
• Welcomes and Introductions
• Background on Issue
o National Trends and Numbers
o Local Trends and Numbers
o Past community efforts: Juvenile Sex Offender Management Task Force
• What happens to kids that sexually act out in Deschutes County?
o Reports from
■ DA's Office
DHS
■ Law enforcement
• Juvenile Department
■ Treatment
■ Others
• Filling in the Gaps/Solutions
o Washington/Clackamas/Multnomah MDT examples
o Boulder Training Model
o Childcare Provider Training Model
o Brainstorming
• Local Action
o What can the Deschutes MDT do?
Next MDT Quarterly: Wednesday, May 111h, 9- Noon on "Cutting" Behaviors in Kids
National Facts
More than 1/3 of those who commit sexual offenses against minors are under 18 (OJJDP, 12/09)
➢ Half of all adult sex offenders begin their sexually abusive behavior before adulthood (The Prevention
Researcher, 2002)
➢ Adolescent sex offenders are considered to be more responsive to treatment than adult offenders and do
not appear to continue re-offending into adulthood, especially when provided with appropriate treatment
(ATSA, 2000)
➢ Adolescent sex offenders rate for sexual re-offenses (5-14%) are substantially lower than their rates of
recidivism for other delinquent behavior (8-58%) (Journal of Interpersonal Violence, 2000)
Among preteen children with sexual behavior problems, a history of sexual abuse is particularly
prevalent (OJJDP, 12/09)
National Statistics
Key findings from 2009 OJJP "Juveniles Who Commit Sex Offenses Against Minors Report" include:
Juveniles account for 36 % of those known to police to have committed sex offenses against minors.
Juveniles who commit sex offenses against other children are more likely than adult sex offenders to
offend in groups, at schools, and to have more male and younger victims.
❖ 5% of offenders are younger than 9
16% are younger than 12
1
Attachment 4
❖ Rate rises sharply around age 12 and plateaus after age 14
❖ 38% are between 12-14
❖ 46% are between 15-17
❖ Vast majority (93%) are male
Deschutes Juvenile Sex Offender Management Task Force Work Summa
From 2002-2006, funded by a grant from the Bureau of Justice Assistance, a multidisciplinary, interagency,
policy-level team met regularly to address the issue of juvenile sex offenders in Deschutes County.
Original Task Force Goals
Goal One
Lowered juvenile sex offender arrest and criminal re-offense rates
Goal Two
Quality treatment programs and protocols
Goal Three
Effective partnerships and sufficient resources
Goal Four
Increased public awareness and education
Goal Five
Established standards for juvenile sex offender management and treatment
Accomplishments of the Task Force included: establishing that a residential program was not required but
system improvements could move things along; a comprehensive data base related to sexual offending trends up
to that time; establishing partnerships and some financial support for Darkness to Light Child Sexual Abuse
Prevention Initiative from entities that might not have considered themselves stakeholders in the prevention end
of the spectrum; and providing a planning / assessment template that could much more easily be updated / re-
assessed should stakeholders want to review things again in a year or two.
In March, 2006 a research report was completed titled "Central Oregon Comprehensive Juvenile Sex Offender
Management System Project: Assessment and Program Development Recommendations." The specific
Find ings/Recommendations from this report included:
1. Do not develop a secure residential juvenile sex offender treatment program in Central Oregon at this
time.
2. Recruit more outpatient juvenile sex offender treatment providers for Central Oregon.
3. Develop a plan for treatment services for female juvenile sex offenders.
4. Recruit and train more local therapists to conduct psychosexual evaluations for juvenile sex offenders.
5. Develop treatment options and early intervention for young kids.
6. Ensure there is consistency in juvenile sex offender treatment services.
7. Effect any needed change in the organizational culture of those working with
juvenile sex offenders.
8. Adopt an "Integrated Model" comprised of evidence-based principles, organizational development, and
collaboration.
Deschutes MDT Discussion on Juveniles who Sexually Act Out - Minutes from the February, 2010
meeting
What are the gaps and how are we going to address those gaps?
National statistics and data
2
Attachment 4
o There is agreement that Deschutes County is reflective of the national facts related to this
population
o National statistics would suggest that with youth over 12 years old, numbers seem to plateau,
however in Deschutes County; the numbers seem to be increasing up to 16 y.o. and older.
Local data
0 36% of the Deschutes MDT reviewed cases during the 6 month period from July-Dec, 2009
involved youth who were sexually acting act/offending
o Deschutes' Juvenile Community Justice data was also reviewed for 2002-2009. Juvenile sex
offender numbers remained mostly consistent over this time period
Juvenile Sex Offender Management Task force:
Accomplishments:
o An opportunity to take a snapshot of how our system works.
o Regarding the fact that there is no residential treatment option available east of the Cascades, it
was determined that the population could not support sex offender residential treatment. The
decision was made to focus on improving our systems and looking at what's new to implement.
o An opportunity for different elements of the system to meet together and have a conversation on
the topic.
o Darkness to Light was a result of those conversations. Task force was one of the catalysts for
getting funding and establishing a focus on prevention.
a One of the outcomes was a new set of goals such as addressing the issues of kids under 12 who
fall through the cracks.
o The report dated March, 2006 contains a list of the recommendations. This report is available to
all MDT members.
How referrals move through the system for the under 12 and over 12 populations:
DA:
12-17 Years Old:
• The DA deals with kids 12-17 who are offending. DA gets the police reports, kids go
into detention and get an assessment. 15-17 year olds can be charged as adults. DA
gets the Juvenile Department involved right away to let the family and youth know
what the process is regarding getting an attorney, release options or maintaining the
juvenile in detention. A psycho-sexual assessment is provided to decide how best to
resolve the case. Every effort is used to come up with a creative ways to resolve the
case and determine if it is necessary to list as a sex offender. The crime team meets to
decide the most appropriate disposition.
Under 12 Years Old:
■ The legislature sees 12 years old as the floor because of developmental issues. If there
are community safety issues the DA can see the case at 11 %z years old. Again the DA
contacts the Juvenile Department. Currently there is no tracking to determine if the
young offender's family is accessing resources that are provided for them. The psycho-
sexual assessment is not mandatory, but is in the best interest of the kid. Most do not
go to trial. These cases are mostly resolved in other ways.
DHS: The juvenile comes in through screening. How the case is handled is a case by case decision
depending on family history, parental responsibility, etc. In DHS there is sensitivity around the term `sex
offender'. DHS is not able to use that language unless an expert has done an evaluation. DHS uses the
term `sexually reactive behavior'. A struggle for DHS is the under 10 age group. A therapist works with
them at their developmental level.
o Under 12:
3
Attachment 4
o 12-17:
o Schools:
Sexually acting out may actually be a result of a neglect issue because the parents may
not be acting responsibly to protect the child. DHS
To see a case as a sex offender issue DHS has to look at a lot of different pieces, such
as family dynamics. Are the parents watching out for the welfare of younger sibling in
the home? Concerning behavior is not necessarily a result of child abuse or neglect.
DHS does not have the authority to order a family to take a child to be assessed. DHS
may have to get a court order for an assessment if there is sex abuse. At that point
Juvenile Dept does safety planning with the family. In that case DHS will not stay in
contact with that family. Our foster system is not meant to work with juvenile sex
offenders.
o Kids who are perpetrators at schools are always looked at also as possible victims.
o It is important to report to Law Enforcement Agencies,
o LEA tries to get the child who is sexually acting out to KIDS Center in an attempt get disclosure
right away. This is important because of the possibility of multiple victims.
o Law Enforcement Agencies:
o LEAs work with DA's office, DHS, KIDS Center
o LEAs do the same investigation whether a child is under 12 or over 12.
o LEAs ask that if there is consensual sex between someone over 12 and there is a 3 year age
difference, it should be reported. A report will be made but may not be responded to. Even
consensual sex should be reported because a sex offender may be involved. LEAs can work out
the gray areas.
o Juvenile Department-
o Juvenile Department handles juvenile offender sex crimes and sexually inappropriate behavior.
LEA reports are channeled through the DA to the Juvenile Department. Juvenile Department
and DA work together to determine what is in the best interest of the offender. The Juvenile
Department holds the report while investigation is under way until the petition is filed by DA
office. The Victim's Advocate communicates with Juvenile Department from the beginning.
Most of the cases the Juvenile Department has are adjudicated. At that time the Juvenile
Department calls the family of perpetrator to introduce themselves and to develop rapport with
the family. Contact with the family usually lasts for 3-5 years while the youth is on probation.
Recommendations are made regarding supervision by the Juvenile Department and there is
close coordination with the school and other resources are made available. At the deposition a
report is presented with these recommendations. During probation the psycho-sexual evaluation
is helpful. The Juvenile Department also looks for additional funding the parents might need.
The Juvenile Department coordinates with lots of agencies so that the youth is not able to
triangulate. Information is shared to keep everyone safe. If the youth is in detention, often it is
because of concerns about safety issues for the family.
o Treatment Resources
o Jeff Rex (private therapist) is a main treatment provider for juvenile sex offender referrals from
the Juvenile Department. Currently he is working with 21 youth for sexual offending behaviors
and does not have a waitlist. He will work with youth under 12 who sexually offend, but only
on a case by case basis. If they are very young abuse-reactive offenders, then he is probably not
the right choice to address their needs.
o Susan Kolb (private therapist) works with kids who are not appropriate for group and have
sexual boundary issues. She does work with developmentally delayed juveniles with serious
4
Attachment 4
offending issues. She specializes in females and does not do group. She comes from a trauma
perspective and uses such things as EMDR in her treatment work.
o Jim Saxton (St. Charles Behavioral Health) takes referrals for young kids who have sexually
inappropriate behaviors.
o Deschutes County Health Services has therapists at the main clinic and KIDS Center who will
see young kids who are sexually acting out
A conversation with Multnomah County SIBS (Sexually Inappropriate Behavior) team:
o LEA, DA, DHS, and School representatives meet monthly an hour before MDT case review.
They invite participants as necessary but mainly it is the core MDT group.
o The purpose is to review reports and make recommendation about the kind of follow up the
family and the youth needs.
o Regarding the referral process, as the call comes in a screening process is used to determine the
level of risk. Lower risk cases can be closed at screening, but may still be brought to staffing for
group discussion.
o Because of time restriction, before each meeting the case review list is sent out to the MDT to
gather as much information as possible. On average, 4-6 cases come up per month, but the team
may only have time for 1-2 per meeting.
o Recommendations range from simple phone outreach, to DHS or LEA meeting with family
again to get a child in treatment.
o The Family Support Team at CARES NW helps to staff the case and to get resources to family.
Linda, who work for DHS but is housed at CARES NW, takes the lead in approaching the
family, calls the schools, and makes sure there is a good safety plan if kids acting out at school.
They look at family functioning, adequate supervision and neglect issues. All families are
referred out, so they are able to track who the family is referred to but not whether the family
followed through.
What can the Deschutes MDT do to respond to this issue?
o Create an MDT subgroup
o Trainings to do here or send people to:
■ The Boulder Model: Gail Ryan, Train the Trainer
■ Prevent Child Abuse Vermont, Child Care Provider Training
o MDT case review team draw up list of resources.
o Have an overall plan in place before we begin trainings
o Set up another meeting time to explore a plan and priorities
o Ask schools to get more involved with the subgroup
GAPS:
o Under 12:
o To have more therapists available for the family of children who are acting out sexually.
Training is needed.
o Need to have a tracking system to track the kids under 12.
0 Holes
• DA's office may not be involved.
• LEA makes discretionary decision about the event involving kids 12 and under.
• Juvenile Department cannot force the family to get help.
• DHS can call it neglect only if not providing protection for the younger child.
But often the DHS presence is enough to make a family do what they suggest
regarding protection and therapy.
o There is currently no group for young offenders. More training for therapists needed on young
offenders.
5
Attachment 4
o Support group to the parents or a parents education class for this group of parents. Possibly
resurrect the Step-by-Step program.
Parking Lot
Consensual sexual activity
More upstream prevention
NEXT STEPS
Meet to explore plan and define priorities
Create sub-group of the current MDT case review team to possibly review all sexual offenders under 12 yo. and
communicate resources to their families.
Collect all resources for juveniles who sexually act out and their families - post on website for better awareness
and access.
6
int
KIDS
Jar child abuse prevention,
evaluation, and treatment.
Attachment 5
I+ valuakiun T ~w''
2008
KIDS Center Statistics for 2009
Full Evaluation
309
342
Ages of children served:.
Exam Only
81
59
20009
2008
SPI - Med Only
76
45
0-5 171
137
DEC - Med Only
4
4
5-12 206
198
Interview Only
3
2
12-19 111
114
Consults
15
10
Rechecks or SPI Interview
13
16
Total services
5011
478
Total children served
488
Seen more than once in 09
8
9
Seen prior to 09 65 1 40
Observations:
• We saw more children aged 5 and under in 2009 than in 2008. This accounts for the difference between full evals and
exam only evals in 2009.
• Our improved availability to see children more acutely accounts for seeing more SPI (suspicious physical injury) in 2009.
• Overall, almost 10% more children were served with evaluations in 2009 than in 2008.
llet0~'rr/t1Q 82%
VS X,
Suspicious Physical Injury (SPI) Cases 2009 2008
Referrals seen 76 51
Evals w/in 48° 63 (83%) unavailable
Observations: We did not keep statistics for "seen within 48 hours" for 2008, but 2009 represents an 83% compliance with Karly's
law. There was a 50% increase between 2008 and 2009 in the number of Karly's Law cases evaluated at KIDS Center.
Likelihood of Abuse
Sexual Abuse
Physical Abuse
Neglect
Emotional Abuse
DEC
Totals
3
5
Total
(probable)
(likely/diagnosed)
138
106
244
72
83
155
38
18
56
79
39
118
27
20
47
354
265
619
iZclsun fu1efe`1 ;i Sexual Physical Emotional Neglect DEC Secondary Witness
332 140 2 3 10 1
Observations:
Children are often referred for one type of abuse but during the evaluation disclose another type; this accounts for the fact that we
have more findings of abuse than we do referrals for that type of abuse. This is more likely to be true for sexual abuse referrals
1
Attachment 5
(that they disclose physical abuse or emotional abuse) but an estimate of our "findings of abuse" rate for sexual abuse would be
74% (244/332) for 3 and 5; and 32% for diagnosed which fits the national statistics for child welfare "indicating" a report of abuse
(sexual abuse).
CUITcnt
"
20()9 Risk liactoty C retalte '
or past
Lit '
risk
factor
Sexual abuse
101
Mental Health Concerns
266
Exposure to DV
244
Financial Strains/ Unemployment
264
Prior DHS/ LEA Involvement
360
Alcohol
272
Meth
158
Current
w}C , t { 1° or past
'Ob9ltis'b'altc~xs+ithopr6) risk
fhctpr
Physical 71
Sexual 59
Mental Health Concerns 158
Exposure to DV 228
Financial Strains/ Unemployment 116
Prior DHS/ LEA Involvement 298
Alleged Offender a; Adult Juvenile 13-17 Juvenile 13<
2009 310 29 24*
2008 224 41 28 *Under reported due to how juveniles
2009 Gender Male Female (who sexually act out) are classified in
292 71 our system. Could be as high as 150.
2008 Gender 259 37
200 Alleged C)ff nd, 1R_
total Physical Emotional DEC 2008
Relation Sexual Neglect totals
Father
100
43
46
3
5
2
61
Other Known (can identify offender
92
88
4
0
0
0
100
but not biologically related)
Mother's Partner
55
24
26
1
2
2
34
Mother
51
9
28
2
4
8
24
Other Relative
31
29
2
0
0
0
56
Step-father
22
30
Totals
438
277
127
6
11
12
348
y Y
Cthn,crty of [ lac
200-8-T
,
~ . .
„
.xO(19 ~ ^ . ' ~
Caucasian
375
317
Native American/Alaskan
13
22
Hispanic/Latino
62
51
Hawaiian/Pacific Asian
1
0
African American
7
7
Asian/Indian
0
9
Other
21
15
Unknown
9
23
Change in numbers of children evaluated in tri county area 2003-2009:
2
DESCHUTES
CROOK
JEFFERSON
WARM SPRINGS
2003
106
23
41
18
2004
123
41
25
17
% CHANGE 03-04
16.03%
78.26%
-39.04%
-5.50%
2005
174
36
29
18
%CHANGE 04-05
41.46%
-12.19%
16%
5.88%
2006
205
33
18
13
%CHANGE 05-06
17.81%
-8.33%
-37.93%
-27.77%
2007
222
44
23
10
% CHANGE 06-07
8.29%
33.33%
27.77%
-23.07%
2008
309
58
54
12
% CHANGE 07-08
39.19%
31.81%
134.78%
20.00%
2009
345
66
41
8
% CHANGE 08-09
10.36%
13.79%
-24.07%
-33.33%
Change from 2003 vs Present
224.52%
186.96%
O%
-55.56%
Attachment 5
unservatlons:
Medical Director will check in with the Jefferson County MDCAT Chair and Dr. Locker in Warm Springs to investigate why
numbers are declining for those areas.
FAMILY SUPPORT PROGRAM:
Families served with family support services: 123
Number of hours volunteered in family support program: 415
Number of staff, interns and volunteers who provided formalized family support services: 8
THERAPY SERVICES:
Deschutes County Health Services (serving OHP clients only)
Information Total Number
Number of Clients Served 185
Number of Visits 2,317
Total Hours 2,285
Number of Referrals 213
KIDS Center employed therapist (serving low-income families):
• 23 children served with therapy from KIDS Center therapist
• Number of therapy visits (combined from DCHS and KIDS Center therapist): 2,675
Observations:
• Combining DCHS and KIDS Center therapist numbers, I 1 less children were provided therapy in 2009 than in 2008 (208
as compared to 219); however there were 512 more visits for those 208 children.
+ Referrals to therapy increased even though numbers of children decreased slightly; this may mean that families are not
being able to follow through on actually getting their children to therapy.
PREVENTION/EDUCATION:
Darkness to Light:
• Total adults trained in D2L: 711
• Total number of trainings: 68
3
Attachment 5
o Trainings were held in various settings including KC's community training, parent groups, businesses, schools
(both public and COCC), churches and childcare facilities. These trainings cover the tri-county area and Warm
Springs.
• There were 3 D2L Facilitator trainings held and a total of 24 new D2L Facilitators.
Publications/Media:
• -"KIDS Center It's My Body" workbook developed and published
• -SafeTOUCH curriculum for elementary schools in editing process.
• -7 child sexual abuse media ads created and run on 3 TV stations, 6 newspapers and 7 radio stations
Regional trainings:
• 7 on Oregon Interviewing Guidelines
• 5 on medical assessment of child abuse
VOLUNTEERS:
• 150 volunteers donated over 3,500 hours providing vital services to KIDS Center and clients.
• KC provided extended volunteer training three times in 2009 with a total number 57 hours extended to incoming
volunteers.
INTERESTING FACT: Since we opened in 1994, we have served 6, 543 children with evaluations and therapy. While this is not
an unduplicated number, it still speaks to the enormity of impact that KIDS Center has had on the community.
Deschutes County MDT - 2009
OVERVIEW
The mission of the Deschutes County MDT is to bring together agencies to work collaboratively on the issue of child
abuse in an effort to protect and best serve the needs of child victims and their families.
The purpose of ORS 418.747 to 418.796 is to establish and maintain a county multidisciplinary team and protocols for
timely investigations of allegations of child abuse and provide comprehensive services to victims of child abuse
through collaboration and a coordinated response.
In Deschutes County the District Attorney has designated KIDS Center as the Chair and Coordinator of the MDT. The
KIDS Center Executive Director doubles as the MDT Chair and the KIDS Center Prevention and Education
Coordinator doubles as the MDT Coordinator.
OBJECTIVES OF THE MULTI-DISCIPLINARY TEAM
1. Protection of the child
2. Comprehensive fact-gathering
3. Consistent interventions utilizing this protocol
4. Coordination between agencies
5: Effective legal intervention to protect the child and community
6. Comprehensive services to children
MULTI-DISCIPLINARY MEETINGS
In order to better serve Deschutes County and to comply with statutory requirements, the MDT adopted two types of
meetings, (1) a twice a month case review meeting and, (2) a quarterly training meeting.
CASE REVIEW TEAM: Team members review a designated list of cases to ensure protocols are followed,
to track cases and to share information.
Who attends: Law Enforcement Agencies (LEAs), District Attorney (DA), Department of Human
Services (DHS), Deschutes County Mental Health (DCMH), KIDS Center (KC), Juvenile Department,
and any other individuals deemed necessary.
4
Attachment 5
Data for 2009: This team met 24 times and reviewed 304 children. In comparison, in 2008 only 24
children were reviewed.
QUARTERLY MDT: Provide training opportunities for MDT members regarding child abuse issues; allow
time for networking; provide policy and legal updates from the various agencies and to address any global
issues regarding child abuse that are identified in the Case Review Team meetings.
Who attends: All members of the Case Review Team, Adult Parole and Probation, School
Representative, and any other representatives deemed necessary.
Hosted 4 trainings for the Deschutes County MDT partners, topics included "Understanding Karly's
Law," "Medical Indicators of High Risk for Future Fatality in Child Maltreatment," Recognizing
Child Neglect," a cultural diversity and sensitive training, and "Juveniles Who Sexually Act Out - a
community discussion."
Additional accomplishments:
✓ Participated in a MDT training hosted by the Department of Justice and the Western Region Child Advocacy
Center.
✓ Re-wrote the MDT protocol
✓ MDT participated in KIDS Center's re-accreditation process with the National Children's Alliance (occurs
every 5 years).
✓ Hosted the Child Fatality Review in December, 2008 and June, 2009.
5
Deschutes County Health Services (DCHS)
2011-2013 Behavioral Health Biennial Implementation Plan
Draft March 17, 2010
OVERVIEW
Department Description
Deschutes County Health Services (DCHS) was formed in 2009, as a consolidation of the
County Health and Mental Health Departments. Health Services offers services at more than
40 community locations including 26 public schools, health clinics in downtown Bend,
Redmond and La Pine, five school clinics, agencies such as the KIDS Center and State
Department of Human Services, area hospitals, care facilities and homes. Services are also
provided through mobile outreach.
Behavioral Health
Our projected Behavioral Health Division budget totals $15.5 million with 106 fte. The
Division helps County residents who face serious mental health and addictions issues. Staff
and contracted agencies also help people with developmental disabilities and their families.
Priority populations include Oregon Health Plan members, uninsured County residents with
nowhere else to turn and people in crisis, who are often in unstable situations or are a
danger to themselves or others. The department also coordinates services for County
residents in care at the State Hospital or served through other agencies or facilities. These
services alleviate community problems, assist people in need, promote client health and
prevent more costly care and intervention. Behavioral Health will help more than 4,000
County residents in FY 2011. Behavioral Health consists of five program areas: Child and
Family, Adult Treatment, Seniors Mental Health, Developmental Disabilities and Business
Services.
Public Health
Deschutes County Health Services also has a primary responsibility to address issues
related to the basic health and wellness of Deschutes County and its residents. The Public
Health Division budget totals $8.7 million with 69 fte. The Division assesses, preserves,
promotes, and protects the public's health. A number of direct services are provided,
including immunizations, family planning, prenatal care and school based health centers as
well as nutrition to young children and their mothers. Other services include disease control,
disaster preparedness, tobacco prevention, health education and monitoring of community
health. Patient visits are projected to total more than 35,000 in FY 2011. Public Health
consists of six program areas: Community Health, Reproductive Health, Maternal Child
Health, Women, Infants & Children (WIC), Environmental Health (a July 2010 transfer from
the County Community Development Department) and Business Services.
2011-13 Preliminary Priorities in Behavioral Health
Deschutes County Health Services will place a continuing emphasis on departmental
efficiencies, service integration and better access to care. Recognized as a behavioral
health integration project by the State of Oregon through 2015, the Department will
continue to work actively to improve the overall health of our client populations by focusing
on general community (public) health as well as coordinated care between primary care and
behavioral health. Examples: better coordination of care with Mosaic Medical, LaPine
Page 1 of 16
Community Clinic, VIM, Cascade Healthcare Community Behavioral Health, CHC acute care
and area Emergency Departments. The Department will integrate primary and behavioral
healthcare in five school-based health centers (including two new centers in Sisters and
Redmond). 2011-12 plans also include expanding behavioral health service capacity in
Sisters, Redmond and LaPine as well as medical capacity in the Bend area.
In 2011-13, with sufficient resources, maintenance of effort will include (examples):
• Helping OHP members and the highest need uninsured residents;
• servicing two treatment courts and our Bridge Program (post incarceration);
• funding acute care and operating mobile and day crisis services;
• offering clinic, case management and outreach services throughout the County;
• signficantly expanding supported housing and residential treatment options;
• continuing supported employment and homeless outreach services;
• offering help to children/families at clinics, public schools and the KIDS Center;
• offering mediation services at the Rosie Bareis Campus (Bend)
• expanding the benefit of our Early Assessment & Support Alliance;
• expanding the benefit of the Launch program (abuse prevention; wellness);
• continuing to offer geriatric services through a small specialized team;
• partnering with the Cascade Peer & Self Help Center
• developing peer support positions at multiple locations and
• contracting with numerous community providers.
Essential partnerships include work with all contracted providers, Health Matters, COIHS
(the fully capitated health plan) and Pacific Source, Accountable Behavioral Health Alliance,
and the Community Mental Health Programs in Crook (Lutheran Community Services NW)
and Jefferson (BestCare Treatment Services) counties. Other partnerships include the three
area School Districts and the High Desert Education Service District, the Commission on
Children & Families, local law enforcement agencies, the Circuit Court (11th Judicial District),
the Department of Human Services (state and local), the new Oregon Health Authority and
the Deschutes County Local Public Safety Coordinating Council.
The Department is most grateful for the support and assistance of the Deschutes County
Board of Commissioners and the County Administrator as the local mental health authority
for the County and to the citizens serving on the 19-member Deschutes County Addictions &
Mental Health Advisory Board. Financial support from the County General Fund increases
our range and level of services, particularly to uninsured residents of Deschutes County.
2010-11 Departmental Priorities
In addition to ongoing operation of a wide range of public health, behavioral health and
support services, we are in the process of identifying a number of critical projects that require
special effort in CY 2010. Our preliminary list is geared to developing and strengthening our
new department. It includes the following:
1. Public Health Accreditation - Selected as one of 19 counties nationwide, DCHS is
using Public Health Accreditation to assess our operation and strengthen our agency.
Deliverables: assessment; improvement priorities, quality improvement project.
2. Budget FY 11 - Prepare the 2011-12 budget based on operating costs and emerging
priorities, adjusting for potential funding reductions. Deliverable: adopted budget.
3. Electronic Record Project - Begin a multi-year project to convert most DCHS
operations to an electronic system. Deliverable: 2010 selection and implementation.
Page 2 of 16
4. Environmental Health transfer - Integrate the Environmental Health Unit in the
Community Development Dept. into DOHS. Deliverable: transfer of budget and staff July
2010. Note: also requires relocation of DCHS services to another Bend site.
5. Health Report - Publish the new 2010 Report. Deliverables: with the Advisory Boards,
review and select 1-3 projects for attention; disseminate the report; educate the public.
6. Integration - A major collaborative regional project through 2015, develop a model to
integrate primary care and behavioral health services throughout Central Oregon.
Deliverables: single point of accountability; infrastructure development; improve health
outcomes, client satisfaction and cost containment.
7. Launch Development - As a major project through 2015, kick off our new child abuse
prevention and child wellness initiative (5-year Federal grant). Deliverable: expand
integrated services at at-least three school-based health centers.
8. New Manager - Hire a new manager for Program Support Services with an emphasis
on strengthening our quality improvement, initiating our new service integration project,
and supporting our planning and evaluation activities. Deliverable: hire in first quarter.
9. Plan: County Goals & Objectives - The County asks each Department to develop
these measures as part of the budget process. Deliverables: Post quarterly updates of
our progress in achieving 2009-10 objectives; propose 2011-12 goals and objectives.
10. Plan: Behavioral Health Biennial Plan - The State requires this plan every two years.
Deliverable: develop and submit the adopted 2011-2013 plan to the State.
11. Plan: Public Health Annual Plan - The State requires this plan every three years.
Deliverable: develop and submit the adopted 2010-2011 plan to the State.
12. Policy Manual DCHS Review prior behavioral health and public health policies guiding
our operation; update as needed. Deliverable: policy manual.
13. Residential Development - Consistent with our housing continuum, increase
affordable housing for people with mental illness by 32 slots / units. Deliverable: 4
projects completed by December 2010 including three in Bend and one in Redmond.
14. Redmond 2011 - With the County, explore the feasibility of creating a Redmond
Service Center including a range of community based DCHS programs and services.
Deliverable: a plan of services to be offered in Redmond in 2011 or later.
15. School-based health centers - Continue County efforts to expand school based
centers throughout the County. Deliverable: open a second center in Redmond and the
first center in Sisters in the fall of 2010.
16. Strategic Plan - The Department currently has two adopted strategic plans.
Deliverable: integrate and streamline the material into a single plan early in 2011.
17. Web site Update - Recreate the current web sites into a single informative site that is
easy to navigate and serves the public well. Deliverable: launch of new site in 2011
Page 3 of 16
STATE REQUIRED FORMAT AND INFORMATION
1. County/Community Mental Health Program (CMHP) Area Name: Deschutes
2. County/CMHP Physical Address: 2577 NE Courtney Drive, Bend, OR 97701
3a. Addiction Treatment Services Contacts
1) Lori Hill, Adult Treatment Program Manager; 2) Scott Johnson, Director
2577 NE Courtney Drive, Bend, OR 97701
Email: 1) LoriH@deschutes.org; 2) Scott]@deschutes.org
Phone: 1) 541-322-7535; 2) 541-322-7502 Fax: 1 & 2) 541-322-7565
4a. Prevention Services Contacts
1) Jessica Kelly, Substance Abuse Prevention Coordinator
2) Hillary Saraceno, CCF Director
3) Scott Johnson, DCHS Director
1 & 2) 1130 NW Harriman, Suite A; 3) 2577 NE Courtney Drive
1,2,3 Bend, OR 97701
Email: 1) JessicaK@deschutes.org; 2) HilS@deschutes.org; 3) Scott)@deschutes.org
Phone: 1) 541-330-4632; 2) 541-317-3178; 3) 541-322-7502
Fax: 1 & 2) 541-385-1742; 3) 541-322-7565
5a. Mental Health Services Contacts
1) Lori Hill, Adult Treatment Program Manager; 2) Barrett Flesh, Child & Family
Program Manager; 3) Kathy Drew, Senior Services Program Manager
1, 2 & 3) 2577 NE Courtney Drive; 1, 2 & 3) Bend, OR 97701
Email: 1) Lori H@deschutes-org; 2) BarrettF@deschutes.org; 3) KathyD@deschutes.org
Phone: 1) 541-322-7535; 2) 541-322-7591; 3) 541-322-7557
Fax: 1 & 3) 541-322-7565; 2) 541-322-7566
6a. State Hospital/Community Co-Management Plan Contacts
1) Tara Gross, Housing Specialist: 2) Lori Hill, Adult Treatment Program Manager
1) 1128 NW Harriman; 2) 2577 NE Courtney Drive; 1 & 2) Bend, OR 97701
Email: 1) TaraG@deschutes.org; 2) LoriH@deschutes.org
Phone: 1) 541-317-3116; 2) 541-322-7535
Fax: 1) 541-330-4642 & 2) 541-322-7565
Page 4 of 16
7. Subcontractors: Note: All funding amounts are preliminary estimates oniX, reflecting
2009-2010 contractors, Deschutes County and Deschutes County Health Services
reserve the right to modify this list of contractors and contracted amounts.
#1 Subcontractor Name: BestCare Treatment Services
Approval/ License 93-1269087
Amount of Funds: $135,000
Program Area: Alcohol & Drug Treatment--Adult
#2 Subcontractor Name: Commission on Children and Families
Approval/ License 93-6002292
Amount of Funds: $360,000
Program Area: Alcohol & Drug Prevention--Youth
#3 Subcontractor Name: Pfeifer & Associates
Approval/ License 93-1254885
Amount of Funds: $542,000
Program Area: Alcohol & Drug Treatment--Adult & Youth
#4 Subcontractor Name: Rimrock Trails Adolescent Treatment Center
Approval/ License 93-1019081
Amount of Funds: $80,000
Program Area: Alcohol & Drug Treatment--Youth
#5 Subcontractor Name: Cascade Healthcare Community, Inc.
Approval/ License 93-0602940
Amount of Funds: $2,211,000
Program Area: $Mental Health--Adult
#6 Subcontractor Name: Oregon Treatment Network
Approval/ License 93-1187763
Amount of Funds: $74,000
Program Area: Alcohol & Drug Treatment--Adult
#7 Subcontractor Name: Maple Star Oregon, Inc.
Approval/ License 93-1263318
Amount of Funds: $120,000
Program Area: Mental Health--Youth
#8 Subcontractor Name: Dr. Joseph Barrett
Approval/ License MD24477, expires 12/31/2011
Amount of Funds: $40,000
Program Area. Mental Health--Adult
#9 Subcontractor Name: Dr. Marc Williams
Approval/ License MD22829, expires 12/31/2011
Amount of Funds: $490,000
Program Area: Mental Health--Adult & Youth
#10 Subcontractor Name. Gayle Woosley
Approval/ License 200050099NP, expires 1/9/2012
Amount of Funds: $146,000
Program Area: Mental Health--Youth
#11 Subcontractor Name. Dr. Angelina Montoya
Approval/ License MD26047, expires 12/31/2011
Amount of Funds: $16,000
Program Area: Mental Health--Youth
#12 Subcontractor Name. Sarah Cota, QMHA
Approval/ License not available at this time
Amount of Funds: $16,000
Program Area: Mental Health--Youth
Page 5 of 16
8. Signature pages for all who review and sign-off on this plan. This section will include
the reviews and comments by the Deschutes County Commission on Children &
Families (March 18, 2010 review), the Deschutes County Local Public Safety
Coordinating Council (April 5, 2010), approval of the Deschutes County Addictions &
Mental Health Board (April 7, 2010), Pat Carey, Regional DHS representative (tbd) and
adoption by the Deschutes County Board of Commissioners (April 14, 2010).
9. County Planning Process
Place X for
Priorities Identified
(in SB 555
New Strategy Proposed
Community Plan
Increase use of subcontracted services to
Access to Care
X
manage demand. Utilization management
process to better manage caseloads.
Increase peer supports and peer delivered
Adult Mental Health
X
services. Improve integration with primary
care.
Affordable Housing
X
Work with local housing authority to increase
supported/affordable housing options.
Increase parent involvement and behavioral-
public health integration through use of
Parent-Child Interaction Therapy. Increase
Children's Mental Health
X
suicide prevention activities in conjunction
with Commission on Children &
Families. Continue to develop Early
Assessment Support Alliance (EASA) program
for first break psychosis.
Decrease Juvenile Arrests
Domestic Violence
Health Insurance
Resource to help with Health Kids and OHP
X
enrollment information and referral
Expand co-occurring disorder treatment
Reduce Adult
X
capacity. Maintain jail partnerships for alcohol
Substance Abuse
and drug treatment services to corrections
population.
Reduce Child Mistreatment
X
Maintain therapeutic services @ the KIDS Center
Reduce High Schl Drop Out
X
Therapeutic services to homeless youth at Cascade
Youth & Family Services
Continue provision of PATH services. Work
with local housing authority to increase
Reduce Homelessness
X
supported/affordable housing
options. Contract with Cascade Youth &
Family Services providing therapeutic services
to homeless young adults in transition.
Maintain Mental Health and Family Drug
Reduce Adult Crime &
Courts and ]ail Bridge Program; expand as
Recidivism
X
resources allow. Maintain jail partnerships for
alcohol and drug treatment services to
corrections population.
Reduce Juvenile
X
Offer safe school risk assessments as part of the
Delinquency & Recidivism
Safe School Alliance
Reduce Teen Pregnancy
X
Offer family planning services; special focus on
Page 6 of 16
Place X for
Priorities Identified
New Strategy Proposed
(in 56 555
Community Plan
adolescents at our Downtown Health Center;
support services for Public Health My Future My
Choice Program for middle school youth
Runaway & Homeless Youth
X
See Cascade Y&F reference above
10. Does your county have a written Cultural Competency Plan? No, but we undertake
a number of activities to address cultural competency.
11. 12. If no, list strategies the CMHP will implement to ensure culturally competent services
will be provided, including developing a Cultural Competency Plan.
We emphasize the strengths inherent in all cultures and examine how our system can
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. A percentage of staff attends
cultural competency classes on an ongoing basis and shares this training within the
department. We have adjunct staff available who are fluent in a variety of foreign
languages, and interpreters are provided at no charge. We contract with Latino
Community Association to provide oral and written translation services, and cultural
competency trainings.
Each subcontractor is encouraged to attend cultural competency training each
year. All local programs are notified of cultural competency trainings as they become
available. We maintain alcohol and drug treatment for minority populations through
our own services and investment in local providers. BestCare Treatment Services is a
valuable community resource in these efforts. BestCare provides Spanish language,
culturally specific, evidence-based alcohol and drug treatment services in Bend and
Redmond. These services are an essential part of our Deschutes County system. We
have initiated an internal work group to critically review our operations and make
recommendations for improving our cultural competency. 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.
13. Check the data sources consulted that will demonstrate to us data driven planning
responsive to the needs of Oregonians.
County Demographics
O Prevalence Data
AMH Reports
Minimum Data Sheets
Problem Gambling Data
Mental Health Data
County Profiles
Other: Youth behavior surveys, law enforcement record data, school district data,
environmental scans, community readiness assessments, internal data system.
Page 7 of 16
14. List steps that link detox, outpatient and residential treatment services ensuring a
continuum of care in addiction treatment and recovery.
Deschutes County Health Services (DCHS) uses available resources to help fund local
detox and residential treatment, in addition to outpatient services, to help ensure
access to a continuum of care in Central Oregon. Clinicians primarily use local
resources when clients are in need of detox and/or residential services, which helps to
facilitate service coordination. DCHS therapists, case managers and crisis staff
regularly make referrals when needed. Detox/residential facilities also coordinate
discharge planning when referral is back to DCHS. Also provide staff support to the
Addictions Committee, a committee of the County Addictions & Mental Health Board
and a networking vehicle for provider coordination.
15. In reference to ORS 430.420 and 430.630 (10) (J): check all populations that will
continue to be addressed through coordination and integration of care supported by this
plan.
Juvenile Drug Courts
Adult Drug Court
Mental Health Court
Mental Health Jail Diversion
Local Juvenile Detention
Adult Jail
Youth Offender Re-entry (local)
Youth Offender Re-entry (OYA)
Adult Offender Re-entry (local)
Adult Offender Re-entry (DOC)
16. List the current functional linkages with the state hospital system including child and
adolescent program (SCIP and SAIP) and mental health acute care inpatient providers.
Acute Care: Weekly meetings of local acute care staff, community mental health
program (CMHP) staff, and the Extended Care Management Unit (ECMU) liaison to
discuss hospitalized clients with longer term needs. Treatment options are reviewed
and discharge planning discussed including state hospital transfers and diversions to
community resources when possible.
Adult Mental Health: CMHP crisis staff maintain regular coordination with the state
hospital when newly committed clients are transferred for long-term care. If a
hospitalization extends beyond several months, this role is transferred to the CMHP's
residential specialist. The residential specialist has regular meetings with state
hospital and ECMU liaison to facilitate discharge planning and community
placements. The residential specialist also maintains contact with other facilities if a
county resident is placed in a facility outside the county.
Child Mental Health: Children's System of Care Initiative is being
implemented. When child is unable to maintain placement in community, we engage
Accountable Behavioral Health Alliance (ABHA) children's care coordinator. Regular
meetings with ABHA and Greater Oregon Behavioral Health regarding continuity of
care, placement concerns and future planning to reduce residential, sub-acute and
acute placements and to identify and develop more local resources to support youth
in their community. Use of ECSII and CASII to assess acuity and levels of care
Page 8 of 16
necessary. We work closely from the time of placement with residential, sub-acute
and acute facilities, including SCIP and SAIP, to coordinate care and assure a
supportive and seamless transition back into community. We use local natural
supports such as parents, teachers, relatives, friends and families to support
placements and empower youth in successful transitions.
17. List steps to collaborate with other child-serving providers that ensure services and
supports are comprehensive and well coordinated:
Foster Care: Coordinate and implement a recertification process of Maple Star, a
local foster care agency, to assure quality services. Contract with Maple Star for
respite and therapeutic foster care services. Coordinate with Central Oregon
regional CMHPs (Crook, Jefferson and Deschutes). Work closely with local DHS
regarding placement, treatment and transition. Monthly meeting with MHOS, DHS,
Maple Star and State regional placement coordinator.
Early Intervention: Coordinated efforts with KIDS Center for children who have been
physically and/or sexually abused; therapy provided on-site by Deschutes County
Behavioral Health therapists. Monthly meetings with DHS to staff common cases
and interventions. Behavioral health services at School Based Health Clinics for
youth 0-6 and their families, in conjunction with Public Health. Linking Actions to
Unmet Needs in Children (LAUNCH) federal grant serving children 0-8 in Deschutes
County who are at risk for neglect and abuse, in conjunction with Public
Health. Referral to Family Resource Center for parenting classes.
Other: County DD child service coordinators meet with Child & Family behavioral
health providers to plan together for the best services for the child and family.
18. List steps to involve young adults in transition (age 14-25) in making decisions that
impact addictions and mental health services in your community.
Annual focus group brings transitional age youth consumers together with Addictions
& Mental Health Advisory Board members to discuss insights gained into delivery of
behavioral health services to this population. EASA (Early Assessment and Support
Alliance) consumer involvement in treatment planning and service delivery.
19. List steps to coordinate continuity of care over time and through episodes of care that
ensure children/youth remain at home, in school, out of trouble, and with friends.
In the Children's System of Care Initiative (CSCI), we offer wrap-around services in
community settings. Regular continuity of care wrap-around meetings include all
parties involved with each child: the child, parents, teacher, relatives, foster parent,
DHS caseworker, Deschutes County Behavioral Health Staff, Juvenile Justice, Family
Court Coordinator, coach, friends, etc. We use the services of Cascade Child Center
for Day Treatment Services as well as Maple Star for local foster and respite
placements. With local office of the State Department of Human Services, we
coordinate therapeutic foster care services provided by Maple Star.
Use of Qualified Mental Health Associate (QMHA) and Qualified Mental Health
Professional (QMHP) skills trainers and therapists (both in-house and contracted), to
provide services in home and community settings. Also work closely with local
Family Court coordinator. Regular monthly meetings with ABHA and GOBHI
regarding continuity of care, placement concerns and future planning to reduce
Page 9 of 16
residential, sub-acute and acute placements and identify and develop more local
resources to support youth in their community. We use flexible funding to enhance
positive experiences for children in the community through involvement in sequential
esteem building activities such as Healing Reins equine therapy, Juniper Swim &
Fitness, dance classes, etc. We work closely from the time of placement with
residential, sub-acute and acute care facilities to coordinate care and assure a
supportive and seamless transition back into our community. We use local natural
supports such as parents, teachers, relatives, friends and families to support
placements and empower youth in successful transitions.
20. List steps the Mental Health Authority takes to ensure access to services, and
interagency coordination with the local Seniors and People with Disabilities.
Case managers work to develop good knowledge of State Seniors & People with
Disabilities (SPD) services as well as to maintain good relationships with individual
SPD workers. This enables us to facilitate clients' access to benefits, including
medical benefits and food stamps. Clinicians and the supervisor in the Enhanced
Care Outreach Services (ECOS) program meet monthly with SPD staff to ensure
coordinated services for shared clients. There are increasing instances of adult
mental health clients having significant medical needs, and at times this can cause
issues in terms of service eligibility between agencies. Currently these situations are
managed on a case-by-case basis. A regular meeting with SPD and our behavioral
health would be helpful to better facilitate interagency communication regarding
these situations, at both the system and the individual levels. A plan to establish
this is in process.
21. List support services the Community Mental Health Program (CMHP) intends to purchase
with these funds during 2011-2013 for any of the populations included in this plan.
Housing: On-site case management at all supported housing sites. Help clients
obtain housing vouchers, work with landlords to secure stable housing. PATH
services & work with homeless shelters. Work with residential treatment providers
and maintain capacity.
Education Assistance: none.
Employment Assistance: Supported Employment program will continue to operate
with a high fidelity score.
Transportation: limited vouchers.
22. List planned strategies to integrate mental health, physical health (including dental) and
addiction services for all populations, birth through older adult.
Deschutes County Health Services is a core partner in the Central Oregon Link 4
Health (L4H) Health Integration Project, a state demonstration site for integration.
It is recommended that you contact lane-Ellen Weidanz at AMH for more
information. This pilot project will remain in place with State technical assistance
and support through at least 2015 and will focus on Triple-Aim outcomes (i.e. health
improvement, client experience and cost of care).
In addition, the federally funded Linking Actions to Unmet Needs in Children
(LAUNCH) Project will integrate behavioral health Parent Child-Interaction Therapy in
School Based Health Centers. Public health screening identifies women with
pregnant-post-partum depression and refers to behavioral health for counseling
services. Intention is to also maintain proficiency in treating co-occurring
Page 10 of 16
disorders. Provide information and referral of behavioral health clients to Living Well
with Chronic Conditions program. Participate in grant-funded program to place
dental hygienists in WIC clinics. Visits by the Dental Van are announced to
behavioral health clients.
23. List steps taken to prioritize drug court participants.
Assessment within 24 hours of referral. Intensive addiction treatment, with 5-phase
system of advancement toward graduation. Parenting skills training is
required. Flexible funds help with housing, transportation, dental services and child
care. Deschutes County Health Services provides grant administration with the
program support and coordination through the 11th Judicial District and the core
treatment team.
24. What is the amount of funding that the Community Mental Health Program (CMHP)
contributes to treatment court programs including both adolescent and adult drug
courts, mental health courts, etc.?
$490,767 annually
Page 11 of 16
25. Complete the table for funding allocation for each service element: Subject to change.
AMH Funding
Amount
Programs/Projects
Funded
Amount of
County MOE
Matching
Funds
Planned Expenditure of
MOE Funds
SE 60
SE 61
SE 61A
SE 62
SE 66
[ 1,182,452 ]
[ 51,844 ]
[ Outpatient addictions
treatment
SE 67
SE 67A
SE 70
282,000
0
SE 71
SE 80
89,051
0
SE 81
70 000
0
SE 1
222 372
0
SE 20
2,078,202
0
SE 22
618,428
0
SE 24
1,731,3421
0
SE 25
744,198
0
SE 28
885,440
0
SE 30
84,704
0
SE 31
436,992
0
SE 34
842,376
0
SE 35
18 734
0
SE 36
20,072
0
SE 38
298,584
0
SE 39
SE 201
43,526
0
The following are new service elements; include in table if we are requesting to use them
A&D 72
A&D 73
MHS 26
MHS 27
Peer-led
26. Describe rationale for any changes in funding allocations from the 2009-2011
biennium. Not applicable. These decisions will be assessed and finalized in the spring
of 2011, based on need, local investment decisions and the outcome of the 2011
Legislative Session.
27. How much Beer and Wine tax funding does your CMHP area receive annually?
Approximately $125,500
Page 12 of 16
28. List how beer and wine tax money is allocated:
$16,000 allocated to Adolescent residential
$ 42,000 allocated to Adult detox
$ 67,500 allocated to Adult outpatient services
29. Check whether the Community Mental Health Program (CMHP) has alcohol & drug,
gambling prevention and/or treatment services and/or supports in place to reach the
following populations of interest. If yes, list strategies for each:
Children (0-6): Yes 1) Evidence based parenting curriculum (Incredible Years);
2) Development and distribution of a parent resource guide; 3) Support for
Family Resource Center
Youth: Yes 1) Drug and alcohol assessment; 2) Counseling and referral
services; 3) Toward No Drug Abuse and gambling prevention program 4)
Evidence based school based curricula; 5) Training and support for prevention
coalitions; 6) Community mobilization of stakeholders, community partners
and members; 7) Retailer training for proper sale of alcohol; 8) Reward-
Reminder and minor compliance checks of alcohol; 9) Social norming and
media awareness campaigns; 10) Advocacy for evidence based strategies as
a standard; 11) Support for the Community Schools Initiative and Family
Resource Center
Young Adults in Transition (14-25 y/o): Yes 1) Drug and alcohol assessment;
2) Counseling and referral services; 3) Toward No Drug Abuse and gambling
prevention program.
Cultural Groups: Yes We maintain alcohol and drug treatment for minority
populations through our own services and investment in local
providers. BestCare Treatment Services is a valuable community resource in
these efforts. BestCare provides Spanish language, culturally specific,
evidence-based alcohol and drug treatment services in Bend and
Redmond. These services are an essential part of our Deschutes County
system.
Co-occurring Disorders: Yes Deschutes County Health Services provides mental
health, alcohol and drug, and gambling treatment services in house. Many
staff are dually credentialed so that services are integrated within the agency
and often with a single provider.
Veterans: No specialized program. Some veteran's served.
Older Adults: Yes Addiction issues are usually addressed by the geriatric
specialist working with the individual. The therapist would have access to
consult with other therapists in the agency who have expertise in treating
substance abuse or gambling.
30. Check whether CMHP has mental health treatment services and/or supports in place to
reach the following populations of interest. If yes, describe strategies for each,
Children (0-6): Yes 1) Assessment and diagnosis; 2) Individual, family and
group counseling and intensive wrap-around services available in schools,
Page 13 of 16
School Based Health Centers, main clinic and homes; 3) Skills training; 4)
Safe School Assessments; 5) Suicide prevention; 6) Parenting Wisely
curriculum.
Youth: Yes 1) Assessment and diagnosis; 2) Individual, family and group
counseling and intensive wrap-around services available in schools, School
Based Health Centers, main clinic and homes; 3) Skills training; 4) Safe
School Assessments; 5) Suicide prevention; 6) Parenting Wisely curriculum.
Young Adults in Transition (14-25 y/o): Yes 1) Assessment and diagnosis; 2)
Individual, family and group counseling and intensive wrap-around services
available in schools, School Based Health Centers, main clinic and homes; 3)
Skills training; 4) Safe School Assessments; 5) Suicide prevention; 6)
Parenting Wisely curriculum; 7) Early Assessment and Support Alliance
(EASA) early intervention program for first break psychosis.
Cultural Groups: Yes We 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. Staff attend cultural competency classes. We have Spanish
speaking therapists on staff and adjunct staff available who are fluent in a
variety of foreign languages, and interpreters are provided at no charge.
Co-occurring Disorders: Yes Deschutes County Health Services provides mental
health, alcohol and drug, and gambling treatment services in house. Many
staff are dually credentialed so that services are integrated within the agency
and often with a single provider.
Veterans: No specialized program. Federal VA community clinic is located next
door to the primary Bend location of Deschutes County Health Services.
Some veteran's served in regular programming.
Older Adults: Yes Deschutes County Health Services has four QMHPs and one
QMHA who have received special training in providing mental health services
and supports to the older adult population. Group and individual services are
provided in addition to consultation with physicians, residential providers and
families. Most of these services are provided at the client's place of
residence, and transportation is coordinated or provided for groups.
31. Mental Health carry over funds amount: It is difficult to project possible carry over
funding in June 2011. Richard Harris, AMH Director has expressed an interest in
removing grant funding streams to support our pilot integration efforts and we are
supportive of this change if it is made operational. This could allow us to invest
additional dollars in integration efforts. We are specifically requesting this change.
Potential areas for carry-over include EASA.
Alcohol and drug carry over funds amount: None
Page 14 of 16
33. Select the top three prevention priorities from Comprehensive Plan (S13555) by clicking
on three choices and complete the table in Question 34.
Reduce teen alcohol use
Increase parent disapproval of substance use
Increase community engagement
Prevention Priorities: Developed through a partnership with the Deschutes County
Commission on Children & Families.
Identified
Evidence-based
Projected
Outcomes Be Specific
priorities from
Program/Tribal Best Practice
Funding
uestion 33.
1a. Increase retailer ID checking skills by
20% as a result of training. 1b. Achieve 80%
or higher retailer compliance as measured by
minor compliance checks or
1. Communities Mobilizing
$37,000
reward/reminder initiatives. 1c. Conduct
Reduce teen
for Change on Alcohol
assessment of alcohol messaging by doing
alcohol use
2. Friendly Peersuasion
an environmental scan of alcohol
3. Positive Social Norming
establishments, advertising and prevalence
campaign
at community events. 2. 75% of
participating girls will report an increased
knowledge of coping and resistance skills.
3. Implement a positive social norming
campaign that reaches 80% of 8th graders
in Deschutes County. Collaborate with
regional partners--Jefferson & Crook
counties--as possible.
1. Implement a strategic media awareness
Increase parent
1. Strategic media
approach that reaches 80% of parents of
disapproval of
awareness 2. Parenting
$9,000
school aged youth. 2. 70% of participating
substance use
forums
parents will report an increased knowledge
of how to implement prevention strategies in
their home.
1. Provide ongoing technical assistance,
funding and training to 5 local coalitions,
la. 5 local coalitions will have work plans
grounded in the strategic prevention
framework. 2a. Advocate for and assist with
developing consistent policies and laws
around AOD use, possession, enforcement
Increase
1. Community based
$138,000
and referral. 2b. Support school district
community
coalitions 2. Community
implementation of prevention curriculum and
engagement
mobilization
policy/environmental strategies known to be
effective. 2c. Provide and support training
to increase the community's ability to
address the issues. 2d. Assist in resource
development and bringing community
resources together to work on the issue. 2e.
Employ media campaigns to inform the
public on important issues. 2f. Assist the
community in applying the strategic
prevention framework to all prevention
work.
Page 15 of 16
Identified
List strategies to support
Projected
Outcomes
Priority
and maintain local
Funding
coalitions
Assist in resource
development and bringing
Apply for grant funds to assist in
Strategy 1
community resources
$200,000
prevention coalition activities in local
together to work on the
communities and school districts
issue.
Provide ongoing technical
5 local coalitions will have work plans
Strategy 2
assistance, funding and
$90,000
grounded in the strategic prevention
training to 5 local
framework.
coalitions.
Provide and support
Provide 3 training opportunities to
Strategy 3
training to increase the
$10,000
community coalitions. Participants will
community's ability to
return to the community and apply new
address the issues.
knowledge.
36. List planned strategies the prevention program will use to address gender and cultural
considerations.
Deschutes County will continue to support programs and services for adolescent
girls. Strategies include implementation of Friendly Peersuasion, Girls Circle and the
Girls Summit. In addition, contractors and employees are encouraged to attend
cultural competency training each fiscal year. All local programs are notified of
cultural competency trainings as they are made available.
37. Is the county Prevention Coordinator CPS Certified? Yes
3.18.2010
S:\Mental_Health\Scott\Strategic Plan\Implementation Plan\Implementation Plan 2011-13\Survey Review at Feb
25 2010.doc
Page 16 of 16
Attachment 6
Deschutes County
2011-2013 Biennial
Behavioral Health Plan
state requirement
UOC)
Our mission: O (D C
to promote and protect the health 0000 0
0000
and safety of our community 00000
0000
0000
LPSCC April 5, 2010 review & comment o 0
Deschutes County Health Services o c(8) r
0000
Who we are O o
• Help for community of 175,000; 12,000 clients
• County department / agency
• Public health: $8.8 million; 69.45 fte
• Behavioral health: $15.5 million; 106.15 fte
• Investor in community agencies
• Local health and mental health authority
• Over 40 community locations plus outreach
• Regional and community collaboration
1
J
What we do
PUBLIC HEALTH
• Community health
• Environmental health
• Communicable disease
• Family planning
• Maternal child health
• School health centers
• WIC food nutrition
000
0000
00000
0000
00000
0000
000(-)
0 0
BEHAVIORAL HEALTH
• Mental health & A&D
• Treatment
• Case management
• Housing and jobs
• Crisis services
• Acute care
• DD services; case mgmt
Our Environment
CHALLENGES
• State budget 2011-13
• Medicaid regulation
• Capacity limited
• Local options for care
• Lifespan of clients
• Stigma
• Health reform
• Cost of expensive care
• Community growth
0 0
00,66
n(DnC)
OPPORTUNITIES
• A change environment
• OR Health Authority
• Integration
• Technology
• Recovery movement
• County support
• Community support
• More insurance
coverage
2
000
0000
00000
0000
r
i
th
P
t
00000
0
0
v
e rea
ew
erspec
ives -
0
0
• Recovery model
• > EASA early
intervention
• > School health centers
• New Launch (5 yrs)
abuse prevention;
wellness
• > intensive services for
children
+ > Insurance coverage
• > Crisis services
including mobile team
• > Acute care services
Sage View, hold rooms
• > Justice and safety
related services
• > Alcohol, drug
treatment
• > Housing
development
000
0000
00000
0000
t lies ahead
P
r
h
ti
-
00000000
°
w
a
ves
e
spec
0000
0 O
• > Health promotion: personal & community
• > recovery and hope; less stigma
• > health services integration; + lifespan
• > school based health centers
• > housing and residential options
• > access to help in north and south County
• > client led services
• > CIT training and system reassessment
3
,,00
00)00
P
hi
artners
p:
0000
health & public
safety
• Child safety and treatment; safe school assessments
• Crisis services and mobile crisis team
• Investment: Sage View and Hold Rooms
• Treatment courts: family drug, mental health
• Civil commitment process
• Crisis services and mobile crisis team
• Bridge program post incarceration
• Investment: A&D treatment w. DCSO
• Treatment and case management
• Crisis intervention training
is
Summary
Next steps:
• Gather any feedback and finalize for BOC
• LPSCC comments?
Crisis Intervention Conference - Texas
• Follow-up to DCSO hosted fall v-con
• Local group attending; reassess current work
• Bexar County Texas model?
• CIT trainings here in Deschutes County
4