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2014-95-Minutes for Meeting January 14,2014 Recorded 2/24/2014 DESCHUTES COUNTY OFFICIAL RECORDS CJ X i.95 NANCY BLANKENSHIP, COUNTY CLERK COMMISSIONERS' JOURNAL 02/24/2014 09:34;15 AM � Do not remove this page from original document. Deschutes County Clerk Certificate Page „5,-Esc. ,,,,,., ot,.. ,...., , ,e,,,_ 40,, e _, . . , .....,„ ,, , -,,,,_,,„, ,,,, . MINUTES OF MEETING BOARD OF COUNTY COMMISSIONERS January 14, 2014 Allen Room, Administration Building, 1300 NW Wall Street, Bend, Oregon Present were Commissioners Tammy Baney,Anthony DeBone and Alan Unger. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator;Jan Kaplan, Manager Community Liaison, Oregon Public Health Division; David Givans, Internal Auditor; Elon Glucklich, The Bend Bulletin; and Health Services staff: Scott Johnson, Director; Michael Ann Benchoff, Program Support Manager; Tom Kuhn, Community Health Program Manager; Kate Moore, Maternal Child Health Program Manager; Cherstin Callon, Public Health Quality Improvement Specialist; Lori Hill, Adult Behavioral Health Program Manager; Melissa Rizzo, Developmental Disabilities Program Manager, DeAnn Carr, Behavioral Health Deputy Director; Hal Sexton, Behavioral Health Medical Director; Michelle Townsend,Adult Diversion Specialist(DD); Erica Drake, Children's Diversion Specialist(DD); Brenda Kappus, Developmental Disabilities Supervisor; Kathe Hirschman, Administrative Supervisor Chair Baney opened the meeting at 1:00 p.m. PUBLIC HEALTH TRIENNIAL REVIEW: Jan Kaplan described his role as Community Liaison with the Public Health Division of the Oregon Health Authority, and the Triennial Review process. Every three years the Public Health Division conducts a comprehensive review of public health programs in Oregon. The review of Deschutes County Health Services was conducted in November, 2013. Program reviewers from the state were here about one week and reviewed 20 program areas. Mr. Kaplan reported highlights of the review. The full report has been sent to the Health Services department. Mr. Kaplan reported that the review looks at approximately 1,200 items, and the department had very view areas to be addressed. The department is already working to address those areas. The Public Health Division will send the Commissioners a letter every three months updating them on what findings have been resolved, and a final letter when all findings have been resolved. The expectation is that all findings will be resolved in the next six months. Mr. Kaplan highlighted the strengths of the department. The Environmental Health program is doing an excellent job; the overall inspection rate for restaurants is good, inspections are very thorough and focus on critical risk factors associated with food borne outbreaks. There were no findings or deficiencies in the Drinking Water program, which is remarkable. It is a huge commendation that nothing is wrong. Reviewers had many positive comments about the Maternal Child Health programs—home visiting and Oregon Mothers Care are extremely well organized. Reviewers commended the Page 1 of 7 Nurse Family Partnership program and noted that it is a regional program and the good partnerships it takes to make that happen. The Tobacco Prevention program is one of the better programs in the state. Deschutes is the first county in the state to have all County facilities smoke-free. Tobacco Prevention & Education and the Healthy Communities programs are seen as mentors for other programs in the state. Fiscal services are excellent and receive highest commendation because there were no deficiencies noted. It is rare that counties are in compliance with all the fiscal requirements and speaks to the hard work of the department's fiscal team working in concert with the County's Finance Department. Commissioner DeBone thanked all involved and noted that it takes time to grow and evolve into a good team. The reviewers had very enthusiastic commendations around the Communicable Disease program, which was also in full compliance. Twos staff received high accolades which are quoted in the full report: regarding norovirus outbreaks in long-term care facilities, "Patty Thomas (Hutton) is one of the best" and "It's really a pleasure to work with Sari Ourada." Mr. Kaplan also noted the amount of work done trying to improve and increase dental services, partnering with Advantage Dental, in School Based Health Centers. The department's health educators did over 200 educational presentations to high school students on various issues, and the department was very successful in increasing the use of flu vaccines among health care workers. Commissioner Baney noted that in providing public health services, we don't often hear how good things are. We appreciate hearing the positive comments and the opportunity for a review to hear how we compare with other counties and how we are meeting the needs of residents. Commissioner Unger appreciates that the reviews are done as a problem-solving exercise. It is more valuable to work together to figure out how we can do better rather than just looking to find fault. Scott Johnson noted one component of the review is a civil rights self-assessment—making sure the department meets a number of federal requirements around accessibility. A copy of the self-assessment and plan to address findings has been sent to the Commissioners. Cherstin Callon explained the department's action plan to address findings. There is an internal tracking system listing the findings, staff responsible, and timelines. Public Health supervisors and managers will work with program staff to resolve all findings. There were more than 1,100 items reviewed and 29 findings, which is a great compliance rate, about 97%; and 45% of the findings have already been resolved. Page 2of7 Mr. Johnson thanked Kate Moore and Tom Kuhn, Public Health Program Managers, because they are instrumental in making sure the department is on the right track and has such a great compliance rate right out of the gate. Commissioner DeBone stated it is good to know that any findings will be taken care of and they are not critical issues. Tom Anderson asked if there is a similar process in behavioral health. Mr.Johnson explained that there is a review similar process which is also on a three-year cycle. The reviewers were last here in July of 2012 so the next review is expected by July of 2015. The behavioral health review is a very similar process but with a much smaller team of reviewers. Commissioner Baney noted that we has invested County general funds into public health because we feel pretty strongly about making sure we have the appropriate level to meet the needs of our residents. We are doing a lot to ensure we are thinking regionally, while keeping County general funds County specific, because we recognize our citizens frequently cross those County lines. When looking at the future of public health in Oregon, we are going to play a role in making sure any decisions and recommendations will enhance what we have, to continue to have these great services. DEBONE: Moved signature of letter affirming findings will be addressed. UNGER: Second. VOTE: DEBONE: Yes UNGER: Yes BANEY: Chair votes yes. PERFORMANCE MANAGEMENT: DeAnn Carr, Lori Hill and Barrett Flesh gave a brief overview of current behavioral health programs and services. The Access team is new, set up to get folks into services quickly by doing assessments and determining the level of care needed. Hal Sexton described the newly created behavioral health Medical Team, which consists of a Medical Director, 4 FTE Licensed Medical Practitioners—psychiatrists and psychiatric nurse practitioners—and registered nurses. The team will be hiring an RN supervisor whose duties will include coordination with physical care providers. The team will improve integration and provide a collaborative model of working within and beside physical health systems. Ms. Carr explained that two very significant events in 2014 will influence the coming years dramatically. With Medical Expansion, we will have a broader OHP membership meaning more individuals receiving services. We expect the primary impact will be in the adult population. We've ramped up the Access Team for quicker access, and we are working with the Medical Director to transform service models to be ready for this population. Page 3 of 7 The other significant change in 2014 is that Medicaid portion of residential funding will be managed by PacificSoure as the Coordinated Care Organization rather than the funds coming from the State directly to the County. This means the contracting will be changing. Health Services, as an outpatient provider to individuals in residential programs, will have to contract with Coordinated Care Organizations across the state in order to be able to provide services to an individual from another county who comes into a residential program in Deschutes County. We do not yet have information on how the State will allocate the funds across the Coordinated Care Organizations or how to ensure PacificSource gets enough funding to support our residential programs. We are meeting with PacificSource regularly to look at the numbers, and as they get information on the funding we can make sure it is in line with what is needed. Commissioner Baney asked whether this change would impact our ability to have access to a certain number o beds for Deschutes County residents. Ms. Hill explained that we always prioritize Central Oregon residents, but if there is not a Central Oregon individual in need of a bed when a bed is empty, we have to take referrals from elsewhere. Ms. Hill is confident this will continue. We have demonstrated with the Assertive Community Treatment that it very beneficial for individuals to be placed locally; she does not have a concern that PacificSource will not admit individuals locally. Ms. Carr reviewed top priorities for 2014-2015, which will be works in process over a period of time as we begin to transform services and look long-term at how we use the dollars in the most effective and efficient way to serve most individuals with best outcomes. Strengthening the partnerships and working effectively with primary care providers is a key piece in the whole person care approach. Future focus is on bi-directional integration—bringing the behavioral health element into the physical health setting and bringing the physical health element into the behavioral health setting. There are multiple steps involved in working toward the person- centered primary care home, and we will be involved with this over the next few years. The focus of the community mental health provider as a safety net is the high-need/high-risk population—treating these individuals in house and contracting out the less complex levels of care. We need to continue to look at whether we are using acute care in the best way possible and providing specialty wrap around intensive services when needed in the community. Examples of these specialty services are Supported Employment, Supported Housing, Assertive Community Treatment, EASA early psychosis program, behavioral health services at the KIDS Center. All these are best practice models of addressing the complex needs of our clients. Mr. Anderson asked about integration, cooperation and partnerships with other agencies such as Community Justice. Mr. Flesh described the C4 (Community Care Coordination and Collaboration) group which brings together community partners such as Juvenile, PacificSource, Developmental Disabilities, schools, etc., to look at this. A Young Adults in Transition program would look at how to treat and work together to intervene early to reduce juvenile risk as well as ongoing behavioral health problems. The plan is to work with other entities to be able to Page 4 of 7 provide these services as well as working to engage the family. A Young Adults in Transition hub would be great place to partner with Juvenile. The focus and philosophy is to get upstream, get individuals in early, do prevention and intervention, focus on brief intervention and treatment, teaching some skills then moving the individual into other natural supports. Integration and partnering with other agencies helps to find and access those natural supports to provide more holistic care. Dr. Sexton noted the major change seen over the past few years is away from a one-size-fits-all approach to what fits the individual best. That overall transformation and continuing to enhance our outcomes with person-centered care is what we will be working on over the next five years. Other priorities are fully staffed clinics in Redmond and La Pine, a Young Adults in Transition hub, and enhancing the School Based Health Centers for use as a warm hand-off to specialty programs for adults. Dr. Sexton feels strongly that Redmond needs a good-sized clinic based on population. Our current behavioral health facility in Redmond is inadequate and we are trying to find a short-term lease arrangement to give more capacity, particularly around adult services. We haven't lost sight of having a larger, more full service center in Redmond; this is a shorter-term lease arrangement to fill an immediate need. Commissioner Baney noted that the times are changing and, while there will be a core population we care for due to the complexity of the needs,there may come a time when in a medical setting more complex individuals could be treated. We should watch that, especially when thinking of building facilities. She didn't see a lot of senior services. We know there's a lot of them coming. How are we ready for that expansion when some will be relying on us to be the safety net. We do not have a good continuum of care of young children in our community and that's not acceptable. Mr. Flesh noted that the C4 community of care partners is working o develop this continuum of care and has gone through the first model of what that will look like. A request for proposals will be issued inviting services such as respite, diversion, etc. Melissa Rizzo described future plans for the Developmental Disabilities program. She noted that the program contracts with Oregon's Department of Human Services, and is funded by State general funds, County general funds and Federal matching funds which are made possible by the County general funds. Services are provided from birth to end of life and include case management to coordinate and monitor services received, protective service investigations and supports, and licensing of foster care facilities in the community. Services are provided in the lease restrictive environment possible and are based on the needs and preferences of the individual and family. Ms. Rizzo explained the Community First Choice State Plan, also known as the K Plan, which gives Oregon the opportunity to provide home and community based services and supports while receiving a 6% increase in federal medical assistance funds for those services. The funds will help fund an array of services that have not been available in the past. Children will receive Page 5 of 7 funding based on their income, rather than the parents' income. This will mean that most children in Oregon will be eligible. The State's Employment First policy is rooted in the belief that meaningful employment is a desire of us all. Every time a service coordinator sits down with an individual they need to be talking about the individual's needs around meaningful employment—whatever employment makes sense for the individual. All providers are trying to figure out what that means and how to fulfill by creating meaningful jobs; Opportunity Foundation, Abilitree and other community groups involved are meeting monthly to assess. Erica Drake reported on an opportunity for a children's residential group home in Redmond, which we hope will open in late spring or early summer. When children need residential care, our goal is always to get them back to family; when they have to be placed in facilities "over the mountain" it is difficult for families to get there to build relationships and supports. Another opportunity is a possible facility in La Pine. There are a group of investors with a former assisted living facility who have approached us asking for assistance. We've encouraged them to talk with agencies serving veterans and those with mental health issues as well as those in their community who need housing. We are hopeful the facility will move toward more inclusion and not just for those with developmental disabilities. There is a tour of the facility scheduled for January 31 at 10:00 a.m. We are actively engaged in holding monthly staffings with behavioral health and developmental disabilities staff meeting to talk about dual diagnosis and how best to work together to meet the needs of the individual. This can be very difficult when dealing with the separate funding streams. There are exciting opportunities for job growth opportunities, both for the individuals and for their support workers. Areas of need are affordable housing for individuals and for their support providers and accessible public transportation. Continued support with County general funds will allow continued receipt of Federal matching dollars. Ms. Rizzo noted that we're recently found many children eligible because of the K Plan. When we can get them the supports they need at an early age, then they can go on to have a job and live independently. It is a big change for the better. Michelle Townsend explained that she provides training for families and support workers in the Oregon Intervention System, which teaches successful intervention techniques. If we cannot come up with the least restrictive care possible, these individuals will end up being served in jail, or the hospital. So, we continue to broaden our services in Deschutes County and bring in more supports, so we can continue to send fewer over the mountain and help them stay in their homes. Commissioner Baney asked if there is an opportunity for Deschutes County to be doing things differently around hiring processes. Can we create opportunities for employment or work Page 6 of 7 experience for these individuals? Erik Kropp noted that some organizations have created programs where they educate the department on how to integrate disabilities into the work and provide paid internships. Brenda Kappus noted that often for employers it is the ability to carve out what an individual can do. Mr. Anderson noted that in conversations about collaboration and sharing information among agencies, HIPAA privacy regulations are a big obstacle. How might that evolve? We are not sure how much, if any, HIPAA will evolve. All the larger health agencies are wrestling with this now—how to share information while protecting the individual's privacy. There is a community group meeting around a health information exchange, and there will be a lot of work over the next few years. Being no further items discussed, the meeting adjourned at 3:20 p.m. SENT to Bonnie 1.15.2014 \\ZEUS\katheh\MY DOCUMENTS\MINUTES IN PROCESS\NOTES from Jan 14 meetings with BOC.docx DATED this Zf day of 2014 for the Deschutes County Board of Commissioners. l� ^f; L Ji,44/ TAMMY BANEY, Chair ANTHONY DEBO Vice Chair ALAN UNGER, Commissioner ATTEST SIGNATURES: � V l / , Recording Secretary Page 7 of 7