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2017-79-Minutes for Meeting January 04,2017 Recorded 2/23/2017DESCHUTES COUNTY OFFICIAL RECORDS c 2017,79 NANCY BLANKENSHIP, COUNTY CLERK r+ COMMISSIONERS' JOURNAL 02/23/2017 02:28:09 PM II 11111IIIII111111II11 II III 2017-7a For Recording Stamp Only Deschutes County Board of Commissioners 1300 NW Wall St., Bend, OR 97703-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS, WEDNESDAY, JANUARY 4, 2017 Present were Commissioners Phil Henderson, Tammy Baney and Anthony DeBone; and David Doyle and Connie Scorza, County Counsel. Attending for a portion of the meeting were George Conway, Health Director; David Inbody and DeAnn Carr, Health Services; Wayne Lowry, Finance; Whitney Hale, Information Officer; Jason Bavuso, Human Resources; Roger Olson, NAMI;, and Scott Willard, Lutheran Community Services. No other citizens or representatives of the media were in attendance. CALL TO ORDER Chair Baney called the meeting to order at 1:30 p.m. ACTION ITEMS 1. Consider Approval of a Federal Public Transit Grant Match to Support La Pine Public Transit Services. This item was rescheduled for the January 11 work session. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 1 of 13 2. Board Signature of a Letter Appointing Albert Bauer to the Newberry Estates Special Road District, through December 31, 2019. Commissioner DeBone explained how the Road District appointments work. The Board does not have authority over the Districts, but State law requires them to approval recommendations to the Districts. DEBONE: Move signature. HENDERSON: Second. VOTE: DEBONE: Yes. HENDERSON: Yes. BANEY: Chair votes yes. 3. Request for a Communications Position for Health Services. This item was rescheduled for the January 11 work session. 4. Request Approval of Deschutes County's Participation in the Federal Certified Community Behavioral Health Clinic Pilot Program. Commissioner DeBone said he asked PSCC for input on this program yesterday. There was some good discussion at that time. The Bend Police Chief was quite interested in getting the community more involved in this type of issue. There are concerns about where this might go in two years, when the grant expires. Mr. Conway stated that they have provided comprehensive briefings to Commissioners DeBone and Henderson; they also have a number of letters of support from various organizations, including the Sheriff's Office and Redmond Police Department. Tom Anderson stated that he read the minutes of the work session of last week. This was discussed in October, when the group was instructed to proceed with the application. There are unknowns at the federal and state level. He is concerned about other funding going away, which might result in cutbacks. If there are cutbacks, tenure takes precedence. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 2 of 13 They would be hired as limited duration employees with full knowledge that employment may end after the grant cycle. Hiring in general may be challenging as well, due to housing and other challenges. Also, they are adding a sizeable component to Health Services. A lot of work has been done in recent years to gain a better sense of how general fund dollars are being used. He spoke with Dr. Conway on how to handle this. It is important to segregate the grant funds from others, to show that it is neutral and not being subsidized. In terms of constituents, it is for Deschutes County residents. There are other nuances but he believes this is a positive thing for the community, and trusts the judgment of Health Services staff regarding the need. They need to manage finances as well as expectations. There need to be periodic updates and tracking to make sure this stays on course. Commissioner DeBone stated he called U.S. Representative Greg Walden's office and his staff was the policy coordinator for this program at the federal level. She feels that it is on track and not being challenged. He spoke to the director of Best Care, who is looking at this for Jefferson County although they don't have all it takes to make it work. Deschutes County has a bit of a head start on this kind of work. He thinks Deschutes County can be a good partner in this effort. He asked if there is a contracting opportunity with another provider in this program. DeAnn Carr said they looked at this earlier but the administrative burden makes it prohibitive. But they always look for opportunities to contract with community providers. The agency would have to be comfortable with the County having oversight of their charts, as well as audit capability. Commissioner Henderson felt he got a lot of good information from the Department and has no questions at this time. Chair Baney asked for more information about the positions. They have current openings for positions now, and this means more. She wants to know how people would be hired in this scenario and how it would be segregated. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 3 of 13 David Inbody said that every posted position is identified as regular or limited duration. The positions open now are regular positions. Applicants will have this option. Erik Kropp said it is identified in the posting, and the offer letter clarifies this as well. I someone is transferred into another position, it would be based on applying for it. David Doyle stated that the DOJ will provide more information on this, but someone who is in a limited duration position can apply for another position like anyone else. Mr. Inbody added that this happens on a regular basis. Chair Baney asked how they benchmark between now and April, when it is supposed to start, in case they can't get fully staffed. Therefore, they would not be able to meet the requirements. When do they decide if it isn't working. Dr. Conway stated that the federal agreement calls it a cooperative agreement, which allows more flexibility than a grant. If there is something that is unpredictable and they can't fill all the needs, is for the federal agency to check with other locales to see if they are having the same issues. Otherwise, the Department will want to keep them apprised early of any problems. Ms. Carr said they will have a somewhat phased recruitment since they want to stir up excitement, but not with all the same closing dates. They are also looking at applicants for similar positions from the recent past. A lot of the reporting that is required will be in the form of screenings, and this would not be adversely impacted. A lot of research has been done already on how the tracking works. Mr. Inbody has been working with H.R. regarding staging these recruitments, and they are committed to supporting this effort. Dr. Conway said that there were concerns about a layoff, but temporary positions are not considered this. Judge Sullivan had asked about paying unemployment. Mr. Kropp said it is a fixed percentage based on the number of weeks they are paid. It is paid out of Risk Management but is an indirect cost. Dr. Conway feels they can manage this by setting aside some of the grant funds. Mr. Kropp stated that departments pay this each year. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 4 of 13 There may be some other funds available in the future so they don't have to roll it all up at once. Some of these programs closely conform to this program. It might also help with the joint crisis center project with the Sheriff's Office. It is not their intent to brush them all away if there are other opportunities in the future. Commissioner DeBone said that maybe this can be updated at the budget session in a few months, and another update in twelve months. By then they may know more about the future of the program or other opportunities. Dr. Conway stated that they don't want to brand it as a separate project, but can track and address its progress. When they reach the mid -point, they will know a lot more. Commissioner Henderson said that he didn't get through all the metrics, but is more inclined to do it if it is a project rather than a transformation. It may be very hard to separate all this out since it is transforming the clinic to handle it. He is not worried about staffing because if they have trouble getting staff, everyone else will have the same issues. He doesn't think the federal agency will be worried about this. There are a lot of rules and measurements, and he is concerned about the work needing to be done without detracting from what they are already doing. He understands that they hope to do more outreach and involve more citizens. He is not sure it is cost neutral at this point. Dr. Conway stated that this won't be a federal clinic. Much of the funding they already get originates at the federal level, with a State match. The two groups that they will serve are people in need who are not being helped. The local V.A. won't take any more clients. Medicare patients have trouble finding providers. For this two-year period and possibly beyond, they can provide services to people with unmet needs. He does not see this being a slippery slope. Commissioner Henderson asked about what is being paid and how they can separate this out. Mr. Inbody replied they are providing some insight, but the needs assessment shows that most is already being provided, but those for veterans and seniors are not being adequately handled. The County will add those to what is already being provided with these funds. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 5 of 13 At this time, it is felt to be a critical service and the County already has to do this through general fund contribution. Commissioner Henderson confirmed that these people can't be served at this time, but it is a bigger program than that. It sounds like this is being folded in but might end in two years. Dr. Conway explained there are threshold expenses to be able to bill for those groups. More broadly, the substance of the program is to address the need by well -operating organizations that are already doing some of this. The advantages to the County are through billing improvements, and the tools that are built up to help these individuals. Some is expensive on a small scale but this program may provide support to put it into place. They can score how well people are doing so they can keep them out of jail and out of trouble, and having good life skills. Therefore, the program will subsidize the County's ability to use new and improved processes. If the federal agency was asking for this to take place without support, he would not want to do it. The establishment of the billing and other service related programs will remain and can be used into the future. This helps to subsidize other programs. Commissioner DeBone asked if there is a way to take some of the weight off local law enforcement. Dr. Conway hopes it will reduce this burden, in combination with the crisis diversion effort, to treat people early on to keep them out of the system. This should divert some of the burden. Commissioner DeBone would like Health to work with the Police Department to see what can be done. Dr. Conway wants to have a better idea of what these officers are doing, to see if this new program can help. Ms. Carr stated that they are excellent partners, and Health Services are seeking a grant for a mobile crisis person to work directly with law enforcement. They partner with law enforcement, which will need to still have some involvement but the right connections can help this. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 6 of 13 Roger Olson of NAMI said that the group grew out of CIG and he hopes it can be expanded countywide. Dr. Conway noted that this demonstrates the very deep connection between the agencies in dealing with these types of situations. This is a very necessary alliance. Commissioner DeBone asked how they handle no-shows. Ms. Carr stated that they do have no-shows already for a variety of reasons. They do reminder phone calls, try to help with transportation, etc. For the more severely affected persons, they try to use peer support staff. These individuals need help and they want to make sure they get it. This is a normal part of their world. Mr. lnbody added that they also go to where the people are, not just in their office. This will continue. Commissioner Henderson is concerned that it is a federal controlled program and they are going to be the ones deciding things. The Congress wants to measure and experiment. He doesn't want to bring in a program that our community or recipients will be dependent upon and won't continue to get funding. And he is worried about how healthcare will change given the uncertainties in Washington. He will not support it given these concerns. Mr. Kropp said the maximum unemployment amount would be around $10,000-$13,000 per position. Chair Baney feels there will be attrition so not all individuals will need this. Mr. Anderson stated that in terms of being careful, the Board and Budget Committee makes policy each year due to the general funds that are used for this. Part of the objective was to change the structure and have the decision - makers understand where the funds are going into health and behavioral health. They would need to incorporate the expenses and revenues, and may help with an expansion or support of other programs. There may be other funds available for parts of this later. He would work closely with Health to set it up so it is clear what it is doing, with policy -level decisions being made later. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 7 of 13 Dr. Conway indicated that they have already done much of the setup so it won't take months to get it going. They had to do this to be a part of the grant process. Planning and organizing energy has already been expended and they are ready to proceed. Commissioner Henderson stated that he is impressed with what they do. Chair Baney said this is a unique situation with an opportunity that doesn't come along often. They have been thorough in investigating it. Mr. Inbody said they got confirmation on the PBS rate, which is how they get paid. They requested $288 and it came back at $286, which is good news. Chair Baney noted that this is the safety valve that will keep them whole. Commissioner DeBone is looking forward to the budget session and learning more. This has been the history of this work, which is challenging. He would like to see support for other counties if this becomes possible. Commissioner Henderson wants to see regular updates. Dr. Conway said that they do this already but the Board can invite them to do this more often if desired. Chair Baney thanked the Department for its good work, but is worried about managing expectations in a vulnerable population. But because of the billing platform and increased access, she feels they have a responsibility to go forward. DEBONE: Move that they approve DC participation in this program. HENDERSON: Second. VOTE: DEBONE: Yes. HENDERSON: No. (split vote) BANEY: Chair votes yes. Ms. Carr stated that she appreciates the interest of the Board in the work that they do. OTHER ITEMS Discussion of appointments and affiliations for 2017. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 8 of 13 Chair Baney said she would take the Hospital Authority position previously held by Commissioner Unger. The Board was supportive. COIC and COACT basically go together, and Commissioner DeBone said he can handle these. He added that perhaps Commissioner Henderson could serve as alternate. Commissioner Henderson explained he is interested in several groups. He was advised by Commissioner Unger to contact some of the groups to find out more. He is interested in collaborative forest efforts and natural resources. He has some knowledge and background about water rights as well. He met with Karen Friend today regarding COIC, but doesn't know much about this except the transportation piece. Commissioner DeBone said that they can fill your day all day, every day, so it is a function of what they can do on top of the regular, expected workload. Commissioner Henderson stated that transportation is something that interests him, but some of this is a Bend issue. He would like to take a week or two to learn more before committing. Chair Baney said they get updates from many of these groups in a work session setting. Most important are those that require that a Commissioner be appointed. These include COACT, COIC and the Hospital Authority Board. The freight advisory group can be deleted, as can OSU-Cascades liaison at this point. She added that it is important to recognize that you are serving as a representative of the Board and the County. It was suggested that Commissioner Henderson will need to determine what involvement he wants with AOC groups. Commissioner DeBone said he will work with regional solutions at AOC, as it is important to be involved with this legislative session. He suggested that Commissioner Henderson work with Ed Keith and Joe Stutter to learn more about collaborative forest projects. Commissioner DeBone asked if someone wants to sit on Neighborlmpact's meetings. They handle HeadStart, a food bank, energy and housing assistance. Perhaps someone can rotate in on this. They meet once a month in Redmond. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 9 of 13 Commissioner Henderson indicated that he is interested in affordable housing issues. Commissioner DeBone said that some groups have alternates and he can become more involved that way. Chair Baney stated that COACT and COIC have alternates and Commissioner Henderson might be interested in the workforce component. Commissioner DeBone said he would speak with Commissioner Henderson on this. Regarding the Bend MPO, Commissioner DeBone indicated that they get federal dollars for planning, and Bend is a big part of this. The MPO approves funds for transportation and roads. This is a required appointment. Commissioner Henderson said he might be interested. Commissioner DeBone said that Project Wildfire is tied to forests. He is supposed to participate but can't make many of the meetings. Commissioner Henderson asked if the Board is involved in the Bend Economic Development group. Commissioner DeBone said that the Board works with EDCO, and help to fund economic development in La Pine and Sisters. Redmond has REDI and Bend has its own in-house program. Commissioner Henderson stated he might be interested in the Redmond group. Commissioner Henderson said he will try to get some meetings scheduled, and also goes to County College in a couple of weeks. Mr. Anderson explained that COIC came up with a legislative concept to change State law so they can work as a local jurisdiction and form a taxing district for transportation funding at the local level. The Board voted two to one to support this effort. It allows the cities in this area the option of being involved in the taxing district, or they can join when they feel the time is right. Mr. Anderson stated that he wants to reaffirm the Board's position or find out if they want to reconsider this. Karen Friend of COIC has just met with Commissioner Henderson. Chair Baney stated that they should ask COIC to make a formal presentation about the status of the proposed Bill. Commissioner Henderson noted that John Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 10 of 13 Huffman is carrying the Bill. Chair Baney said this is a work in progress but she supports the idea in general, meaning more local control. Commissioner DeBone said that Portland Metro allows some free ridership, but he doesn't like this and feels that people ought to be able to afford this small cost. Chair Baney explained that the Bill allows the cities to have a local discussion. COIC would be the umbrella organization, but each city has to decide if and when they want to participate. Fare boxes average about 17% statewide. This is the only district with no base rate to cover other costs. If it is done by just the City of Bend, the other areas would not receive revenue, but COIC as the umbrella organization would allow all cities the opportunity to participate if they wish. This is a fundamental question. Will the community support it? It would be up to the voters. It would not be controlled by Bend; but a countywide taxing authority and each community can decide if they want to participate. Commissioner DeBone supports community connectors, but rural people choose to live there and should not expect it. He doesn't want the rural areas included. Commissioner Henderson stated that there is a problem because land use laws force people to live away from work, and it is not always a choice since rural areas are often less expensive. He is concerned about the numbers and knows that it has to be subsidized. He wants to do more research on this. He is not sure about the legislative part. He suggested that Ms. Friend should come in to talk about it more, and advise which cities are supportive. Mr. Anderson indicated that all cities are supportive, as are the other local counties and organizations. Commissioner DeBone said he is worried about diffusing the transportation needs of Bend with others paying for it. He wants to see more support at the State level. He is not convinced that those in the rural areas need this kind of transportation. Commissioner Henderson noted that people are being forced to live outside the cities because they can't afford to live in them. Commissioner Henderson acknowledged that Tammy Baney will be Chair and Anthony DeBone will be Vice Chair for this calendar year. Mr. Anderson explained that an off-duty Deputy was in a fender bender collision in a parking lot in Bend, and purportedly grabbed the person's arm during the Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 11 of 13 confrontation. She filed a police report and the D.A. will file charges against the Deputy. A press release will be sent out by the D.A. David Doyle added that the person is a 70 -year old woman, and there is video. Mr. Anderson said that due to the severe weather, some departments have closed early or opened late because of driver safety concerns. He authorized the department heads to do this, but the employees have to use time management or vacation leave or flex their hours. He does not get involved at that level. Some departments are 24/7 and have to remain staffed. Code allows for a declaration to close offices and grant vacation time. He is reluctant to do this since some don't have those choices. He doesn't think the bad weather has risen to this level, even though ODOT, the State and other agencies are closed. This hasn't come up more than a few times in decades. Commissioner Baney said that it seems if that if they are closed to customers, this signals that the employees would be paid for the time off. It's different if the office is open and customers don't come for that reason. Mr. Anderson noted that almost every position has work to do that doesn't directly involve the public. Commissioner DeBone asked if they have had any weather-related facilities problems. Erik Kropp said they will work on clearing more of the parking lots, but he knows of no building issues. Mr. Doyle stated that he heard that the Deputy D.A.'s all got sent home with pay. Those in Health Services were allowed to start late. Community Development staff can go home at 4 p.m. today. He asked if there is a uniform decision process for this. Mr. Anderson said that the D.A. doesn't have the right to do this. It needs to be part of a declaration of emergency. Commissioner Baney noted that she doesn't want to end up with a mutiny, so perhaps they should revisit the policy. It needs to be consistent and the department heads need to know. She did think this morning was a problem. ODOT and other State agencies were closed today because they felt the roads were too dangerous. All schools were closed. She wants to know the potential cost of this problem. Commissioner DeBone said he did not think it is dangerous. It is just slow going. Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 12 of 13 Mr. Anderson said he will communicate with the departments. Chair Baney said she talked with representatives of Bethlehem Inn and found they are not even at capacity for some reason. They have no way to slow plow their parking lot. Before they were given the property, the County handled maintenance. ODOT goes down the highway and makes entry into the lot impassable. She asked if there is anyone at the County who can drive through their lot to help with this. Commissioner DeBone said he doesn't want to start doing this, since others might want the same service. They already got the property free. They need to plan for things like this. ADJOURN Being no further discussion, the meeting adjourned at 3:45 p.m. APPROVED this Day of jo-r' `A'�r 2017 for the Deschutes County Board of Commissioners. ATTEST: Recording Secretary Tammy Baney, Chair Anthony DeBone, Vice Chair t l Philip G. Heiderson, Commissioner Minutes of Board of Commissioners' Work Session Wednesday, January 4, 2017 Page 13 of 13 Deschutes County Board of Commissioners 1300 NW Wall St, Bend, OR 97703 (541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/ WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS, 1:30 PM, WEDNESDAY, JANUARY 4, 2017 Allen Conference Room - Deschutes Services Building, 2ND Floor — 1300 NW Wall Street — Bend Pursuant to ORS 192.640, this agenda includes a list of the principal subjects anticipated to be addressed at the meeting. This notice does not limit the ability of the Board to address additional subjects. Meetings are subject to cancellation without notice. This meeting is open to the public and interested citizens are invited to attend. Work Sessions allow the Board to discuss items in a less formal setting. Citizen comment is not allowed, although it may be permitted at the Board's discretion. If allowed, citizen comments regarding matters that are or have been the subject of a public hearing process will NOT be included in the official record of that hearing. Work Sessions are not normally video or audio recorded, but written minutes are taken for the record. CALL TO ORDER ACTION ITEMS 1. Consider Approval of a Federal Public Transit Grant Match to Support La Pine Public Transit Services - Judith Ure, Management Analyst 2. Board Signature of a Letter Appointing Albert Bauer to the Newberry Estates Special Road District, through December 31, 2019 3. Request for a Communications Position for Health Services - George Conway, Health Services Director 4. Request Approval of Deschutes County's Participation in the Federal Certified Community Behavioral Health Clinic Pilot Program - George Conway, Health Services Director OTHER ITEMS These can be any items not included on the agenda that the Commissioners wish to discuss as part of the meeting, pursuant to ORS 192.640. Board of Commissioners Work Session Agenda Wednesday, January 4, 2017 Page 1 of 2 At any time during the meeting, an executive session could be called to address issues relating to ORS 192.660(2)(e), real property negotiations; ORS 192.660(2)(h), litigation; ORS 192.660(2)(d), labor negotiations; ORS 192.660(2)(b), personnel issues; or other executive session categories, Executive sessions are closed to the public; however, with few exceptions and under specific guidelines, are open to the media. ADJOURN To watch this meeting on line, go to: www,deschutes.orq/meetincis Please note that the video will not show up until recording begins. You can also view past meetings on video by selecting the date shown on the website calendar. F. Deschutes County encourages persons with disabiities to participate in all programs and activities. To request this information in an alternate format please call (541) 617-4747. FUTURE MEETINGS: Additional meeting dates available at www,deschutes.orWmeetinacalendar (Please note: Meeting dates and times are subject to change. All meetings take place in the Board of Commissioners' meeting rooms at 1300 NW Wall St., Bend, unless otherwise indicated. If you have questions regarding a meeting, please call 388-6572.) Board of Commissioners Work Session Agenda Wednesday, January 4, 2017 Page 2 of 2 Communication Needs for Deschutes County Health Services Primary Communications Officer for public bealth emergencies: • During a disease outbreak, or other public health emergencies, provide accurate, timely and clear information to the public through multiple communication outlets (including social media). • Add expertise in risk communication. Translate complex health and scientific information into easily understood messages and provide ongoing and pro -active health communications and outreach to the public: � Pro -active with media instead of re -active. w Maintain up to date and relevant information on our website and through social media. • Build community trust and understanding of Iocal pubflc health issues. w Work with the Epidemiologist to interpret data and "paint a picture" that people understand and value. Community Liaison: • Build community partnerships and educate local agencies and coalitions about what we do and the services and benefits we provide to the community. Marketing of Health Services: • Create consistent and unified Health Services messaging. • Utilize wefl known services to hetp promote other services and programs. • Add to our graphic design and presentation capabiUties. � Prioritization of advertising and marketing expenditures. Implementation: We are requesting an additional 1.0 FTE to meet this communication need. This position would be filled as a Management Analyst, v3, Public Information Officer (Bargaining Unit: Non -Represented; Class Code: 1807, Grade K) 111 /'` 1 I u i i ninny flfMi i II rr����r / m n ear n fl i 11 \ n\ i nirfn 1 ori b To: Board of County Commissioners From: George A. Conway, MD, MPH, Health Services Director Date: December 28, 2016 Subj: Certified Community Behavioral Health Clinic (CCBHC) On December 21, 2016, SAMHSA informed the Oregon Health Authority that Oregon was selected as one of the eight CCBHC demonstration states. What Does This Mean: Oregon has been funded as a CCBHC demonstrations state, which results in DCHS being certified as one of thirteen CCBHCs in Oregon. This funding will permit us to expand services for our county's veterans, seniors, and some other currently underserved groups. The additional 29 staff will be dedicated to ensuring that DCHS can meet the requirements of a CCBHC. Additional benefits will include improving our data and outcomes reporting, enhanced fiscal capabilities, and increased collaboration with community partners, all toward improving services for our population. Request: Deschutes County Health Services (DCHS) requests final authorization from the Board of County Commissioners to implement program and staffing activities necessary to become a Certified Community Based Health Clinic. The "go live" date for CCBHC is April 1, 2017. This gives CCBHCs 90 days to complete the necessary activities. In order to meet this deadline, DCHS will need to take the following actions: • Recruit, hire, and train 29 limited duration CCBHC staff. o Posting recruitments by January 13, 2017 o Hire date of March 1, 2017 • Utilize Behavioral Health reserves to cover initial expenses until Prospective Payment System (PPS) reimbursement is received (Quarterly basis) Organizational Readiness: In order to ensure organizational readiness, DCHS has taken the following steps: • Completed and submitted to the Oregon Health Authority (OHA) a 184 item Needs Assessment, including a Demand and Capacity analysis • Established a task list based upon the CCBHC requirements • Developed and implemented a project management plan • Identified a dedicated project manager to facilitate the completion of required elements • Task specific subgroups are actively working on assigned activities Certified Communit Health Clinic (1 On December 21, 2016, SAMHSA Informed the Oregon Health Authority (OHA) that Oregon was selected as one of the eight CCBHC demonstration states. Deschutes County Health Services (DCHS) is one of thirteen programs in Oregon certified by OHA as a CCBHC. CD i0. October $ Identified existing billing processes for commercial clients Identified needed care coordination agreements Identified DCHS's target veteran population November s Ongoing sub- } workgroup activities (e.g., service menu t1 design, assessment redesign) Looking into collaborative documentation 6 DLA 20 training Training completed .t.l in preparation for £ & ACORN implementation December a Began research on sliding fee schedule and copay collection process Submitted system change to OCHIN for metric tracking 6 additional functionality Launched depression screening & suicide risk assessment subgroups Certified Community Behavioral Health Clinics Provide a comprehensive range of mental health and substance use disorder services, particularly to vulnerable individuals with the most complex needs. Benefits of becoming a CCBHC include providing clients with comprehensive care, positively impacting the unmet need gap, and contributing to national behavioral health modernization efforts. Core Workgroup DeAnn Carr Janice Garceau Wil Berry CURRENT WORKGROUPS: Assessment Redesign Sub-Workgroup Barret Flesh Nancy Tyler Shannon Vandegriff . Service Menu Sub-Workgroup Barret Flesh Kara Cronin Ryan Cheney Janice Garceau Elizabeth Holden Karen Tamminga Treatment Readiness Sub-Workgroup Nancy Tyler MaryAnne McDonnell Shannon Vandegriff Holly McCown Amber Clegg Tara Hare 90 Day Assessment Sub-Workgroup Karen Tamminga Kara Cronin Ryan Cheney All BH supervisors Amber Clegg Bethany Wart Christal Rothrock Kacy Burgess Janice Garceau Seeley Gutierrez Jennifer Paulsen Rich Drombetta Karen Tamminga Depression Screening Sub-Workgroup Amber Cleggg Elizabeth Fitzgerald Shannon Vandegriff Bryant Vette Nancy Tyler Treatment Readiness Sub-Workgroup Janice Garceau Amber Clegg Jackie Clark Melissa Frazier Vicki Boudinot Shannon Brister Jill Montecucco Kevin Shaw Lindsay Nokell C. What's the future of CCBHC? Oregon has been selected as one of eight CCBHC demonstration states. Currently Oregon has thirteen CCBHCs participating in the demonstration program. Our project launch date is still scheduled for April 1, 2017, and the demonstration period will run for two full years. January s. Develop Epic workflows for 90 day assessments Develop client CCBHC messaging February March April Establish service models for clinical teams v.0 Implement 90 day assessment change Collaborative documentation ' training for staff O + - Review and "Go Live" revise billing policies Train staff on new screening tools 8 clinical processes There are many more required tasks that will need to be accomplished prior to the "Go Live" date. These are just highlights for the next several months. There are also tasks that are not limited to one month duration. The timing of tasks is subject to adjustment. If you would like to learn more or would like to participate in a sub- workgroup, please contact your supervisor 017 program manager. POTENTIAL FUTURE WORKGROUPS: Care Coordination Sub-Workgroup Commercial Billing Sub-Workgroup CCBHC Policy & Procedure Sub-Workgroup Care Transition Sub-Workgroup Ambulatory Detox Sub-Workgroup Crisis Plan Sub-Workgroup CCBHC Additional Staff Requirements Through a needs assessment, developed as part of the CCBHC review process, it was determined that in order for Deschutes County Health Services to meet the requirements of a CCBHC, 29 additional employees are needed. The following is a breakdown of the necessary positions: Clinical Positions (16) • 3 Psychiatrists/Psychiatric Mental Health Nurse Practitioners — These positions will enable increased outpatient services to be provided, including the expansion of child psychiatry services • 3 Public Health Nurse II — These positions will support increased outpatient and medication related services • 3 Behavioral Health Specialist II —These positions will provide expanded outpatient services, including services for veterans and older adults • 2 Behavioral Health Specialist I —These positions will provide expanded outpatient services and supports • 4 Peer Support Specialists—These positions will provide additional outpatient services and supports • 1 Quality Improvement Specialist—This position will support quality improvement efforts and ensure compliance to CCBHC clinical requirements Operational Positions (7) • 1 Management Analyst — This position will address increased electronic health record needs • 1 Administrative Analyst —This position will address CCBHC reporting requirements • 1 Administrative Analyst —This position will address client referrals and assist with OHP registration • 1 Patient Account Specialist II —This position will provide insurance -related expertise providing guidance and support to clients and staff, most notably for commercial insurance • 1 Patient Account Specialist II —This position will address increased billing obligations associated with CCBHC • 1 Senior Accounting Technician —This position will address increased fiscal requirement due to CCBHC • 1 Health Services Administrative Specialist I —This position will enable front office coverage during non-traditional hours Administrative Positions (6) • 6 Senior Secretaries —These positions will provide support to clinical staff and programs across five (5) sites in order to meet CCBHC requirements (e.g., tracking documentation/evaluation deadlines, data collection, generating program and staff specific reports, etc.) SLTCharles HEALTH SYSTEM To: Board of County Commissioners From: Molly Wells Darling, Director Inpatient Behavioral Health Services Date: 12/28/16 Subject: Certified Community Behavioral Health Clinic 2500 NE Neff Road Bend, Oregon 97701 541.382.4321 www.stcharleshealthcare.org As a representative of St Charles Health System, I support and encourage the efforts of the Deschutes County Health Services - Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. I appreciated the opportunity to meet with DCHS' Behavioral Health Deputy Director, on November 9th, to discuss DCHS' goal of becoming a CCBHC and how this would serve to improve services. I was pleased to hear about the opportunities for increased responsiveness to our shared clients. St. Charles and DCHS have a longstanding partnership in addressing the needs of high risk individuals who are in acute crisis. This partnership is built around a shared responsibility to address the needs of these individuals. Critical to the success of these efforts is coordination of care and collaboration between staff. The very elements that bring success to this partnership are central to the philosophy of CCBHC. Building upon Deschutes County's community based service model through their evolution into a CCBHC will increase their ability to address the needs of our most vulnerable citizens and strengthen the success of the St. Charles/DCHS partnership. Sincerely, Molly Weds Darling, LCSW Director, Inpatient Behavioral Health Services St. Charles Health System St. Charles Health System Certified Community Behavioral Health Clinics (CCBHC) Overview of Veterans' Services and Needs in Deschutes County Overview: CCBHC planning efforts have included reaching out to U. S. Department of Veterans Affairs (VA) representatives to gather information about current service delivery, unmet needs, and population priorities. This information is being used to inform CCBHC planning activities. The following is a summary of information gathered and potential underserved target veteran populations. Deschutes County has a population of 16,000 service veterans spanning all ages. The local VA provides heafth and mental health services to veterans in our community. Other services and supports include 1) Central Oregon Veterans Outreach (COVO) which provides outreach and supports to homeless veterans, 2) Bend Veterans Center, which provides counseling and other supports to combat veterans, 3) Central Oregon Veterans Ranch, which provides housing and support to a small number of homeless veterans, and 4) Deschutes County Veterans' Services, which assists veterans in applying for benefits to address heaith and mental health needs. In spite ofthe resources available in Deschutes County,the number of veterans in the community their diverse needs across age spans, and combat experiences/trauma create challenges in meeting the behavioral health needs. Deschutes County Veterans' Services staff identifies that between 60% and 70% of alt veterans' claims processed are for mental health services. While the VA provides mental health services, there are often long waits (up to two months) to access care. Veterans needing substance use disorder treatment are often referred to the VA in Portland. Many ofthe additional service providers for veterans in the community only serve veterans with active combat experiences, leaving a large number of service veterans with the VA as their only option. Unmet needs identified by those that serve veterans in the community include: o The need for additional services for non -combat veterans struggling with depression and anxiety disorders. o The need for dual diagnosis services for veterans struggling with a combination of mental health and substance use disorders. o The need for services to retirement -aged veterans who are now manifesting anxiety and depression after many years of healthy post -combat functioning. o The need for behavioral health supports to children and families of veterans. Coordination with local VA and Veterans organizations: DCHS currently serves veterans throughout the organization as a result of their presenting for services via routine access channels. Expansion of services to veterans will be accomplished through the addition of a full-time outpatient position to specifically target services to underserved veterans in the community and to provide additional training to other DCHS staff. This person will help address some of the veterans' unmet needs, e.g., provide care coordination and treatment to veterans with depression, anxiety, and/or co-occurring substance use disorders. In addition, this position will partner with Deschutes County Veterans' Services and community partners to improve DCHS' overall response to veterans. l flflmI Ore ton National Alliance on Mental Illness www.namicentraloreeon.org namicentralormona2mail.com, Honorable Board of Deschutes County Commissioners: Our board of the National Alliance on Mental Illness -Central Oregon were very excited to hear our Deschutes County Behavioral Health department was under consideration for the Certified Community Behavioral Health Clinic program, under the National Council for Behavioral Health. A few of us have had the opportunity to hear about DCHS's goal of becoming a CCBHC. We believe it will serve to improve and increase mental health and addiction services available to our family and friends here in Deschutes County. DCHS and NAMI-CO have a long standing association with mutual goals to improve and maintain a quality continuum of services for Deschutes County. The CCBHC demonstration project is a vehicle for furthering those goals. We ask for your support for this important project. Sincerely, NAMI-CO Board, Eileen MK White, President DESCHUTES COUNTY SHERIFF'S OFFICE L. Shane Nelson, Sher Pro - To: Board of County Commissioners From: Sheriff L. Shane Nelson Date: January 3, 2017 Subject: Certified Community Behavioral Health Clinic Com unity for As Sheriff, I support and encourage the efforts of the Deschutes County Health Services - Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. The Deschutes County Sheriff's Office and DCHS have a longstanding partnership in responding to high risk individuals. This partnership is built around a share responsibility to address the needs of individuals with behavioral health challenges who come into contact with law enforcement. Critical to the success of these efforts is coordination and collaboration between our staff. The very elements that bring success to this partnership are central to the philosophy of CCBHC. Citizens in need come from a variety of backgrounds and often have very complex needs. Increasing the number of people served and funding available to provide those service will be a valuable addition. Building upon Deschutes County's community based service model through their evolution into a CCBHC will increase their ability to address the needs of our most vulnerable citizens and strengthen the success of the Deschutes County Sheriff's Office/DCHS partnership. ane Nelson Sheriff Main Office 63333 W Highway 20 Bend, OR 97703 541-388-6655 sheriffideschutes.org Adult Jail 63333 W Highway 20 Bend, OR 97703 541-388-6661 Lutheran Community Services ~=== Health • Justice • Hope Mental Health Counseling 1251NEElm Street Prineville, OR 97754 Phone: (541) 323-5330 Fax: (541) 447-6694 Intellectual/Developmental Disabilities 1251 NE EIm Street Prineville, OR 97754 Phone: (541) 323-5330 Fax: (541) 541-447-4418 Adult Alcoho& Drug Services 365 NE Court Street Prineville, OR 97754 Phone: (541) 323-5330 Fax: (541) 416-0991 Resource Center/ Community Services Support 365 NE Court Street Prineville, ORQ7754 Phone: (541) 323-5330 Fax: (541) 416-0991 Mental Health Counselirig 2330 NE Division St. Suite 9B Bend, OR 97703 Phone: (541) 323-5332 Fax: (541) 323-5854 Web site: COA A tinned Way Agency To: From: Date: Board of County Commissioners Scott Willard January 3, 2017 Subject: Certified Community Behavioral Health Clinic (CCBHC) As Lutheran Community Services Northwest's (LCSNW) Area Director and Director of Healthcare Innovations, I support and encourage the efforts of the Deschutes County Health Services Behavioral Health Division in becoming a Certified Community Behaviorai Health Clinic. The ExceUence in Mental Heafth Act and infusion of 1.1 biUion doliars in the community behavioral health system is the largest federal investment in mental health and addiction treatment in more than a generation. This creates a rare opportunity to transform service delivery and to increase the number of individuals served. As fellow Community Mental Health Programs ([MHP) LCSNW and Deschutes County Health Services (DCHS) have a longstanding partnership in building the systems/programs that provide services to the citizens of Central Oregon. These efforts have served to improve the services available while also highlighting the ongoing levels of unmet needs in our communities. DCHS is in a unique position to become a CCBHC and continue efforts to improve the continuum of care within Deschutes County. This CCBHC demonstration pject will increase access to services, quality of care, and coordination with community partners, all of which will improve the health of Deschutes County residents. 1 am pleased to express my support and encouragement for this exciting opportunity. Scott Willard Area Director/ Director of Healthcare Innovations switlard@lcsnw.org Lutheran Community Services Northwest partners with individuals, farnilies and communities for health, justice and hope. To: Board of County Commissioners From: Dave Tarbet Chief of PoLice Date: 12/30/3016 Subject. Certified Community Behavioral Hea(th Clinic 777 SW Deschutes Redmond, OR 97756 Phone: (541) 504-340 Fax: (541) 504'8490 www,ci.redmond.or.us As Chief of Police for the City of Redmond, 1 support and encourage the efforts of Deschutes County Health Services Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. The Redmond Police Department and DCHS have a longstanding partnership in responding to high risk individuals. This partnership is built around a shared responsibility to address the needs of individuals with behavioral health challenges who come into contact with law enforcement. Critical to the success of these efforts is coordination and collaboration between our staff. The very elements that bring success to this partnership are centrat to the philosophy of CCBHC. Citizens in need of these services come from a variety of backgrounds and have very complex issues to address. Increasing the funding and the number of people served will be a valuable service to our area. Over the years DCHS has worked very hard to develop relationships with partner agencies. They have listened to our needs and adjusted as well as increased services. The next step in their evolution would be to become a CCBHC. This would increase their ability to address the needs of our most vulnerable citizens and help strengthen the partnership between the Redmond Police Department and DCHS. Sincerely, Dave Tarbet Chief of PoUce 555 NE 15T" STREET PO Box 118 BEND, OR 97709 541-322-2960 TEL Relay Users Dial 7-1-1 541-312-1934 fax bendoregon.gov MAYOR Jim Clinton MAYOR PRO TEM Sally Russell CITY COUNCILOR Nathan Boddie Barb Campbell Victor Chudowsky Doug Knight Casey Roots CITY MANAGER Eric King POLICE CHIEF Jim Porter CITY OF BEN\ To: Board of County Commissioners From: Cory Darling, Support Division Commander Date: January 3, 2017 Subject: Certified Community Behavioral Health Clinic POLICE DEPARTMENT As Captain of the City of Bend Police Department's Support Division, I encourage and support the efforts of the Deschutes County Health Services - Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. The City of Bend Police Department and DCHS have a longstanding partnership in responding to high risk individuals. This partnership is built around a share responsibility to address the needs of individuals with behavioral health challenges who come into contact with law enforcement. Critical to the success of these efforts is coordination and collaboration between our staff. The very elements that bring success to this partnership are central to the philosophy of CCBHC. Citizens in need come from a variety of backgrounds and often have very complex needs. Increasing the number of people served and funding available to provide those service will be a valuable addition. Building upon Deschutes County's community based service model through their evolution into a CCBHC will increase their ability to address the needs of our most vulnerable citizens and strengthen the success of the City of Bend Police Department/DCHS partnership. Sincerely, v Cory Darling Support Services Division Commander City of Bend D LaPine Community HEALTH CENTER 51600 Huntington Rd. P.O. Box 3300 La Pine. OR 97739 p: (541) 536-3435 t: (541) 536-1040 To: Board of County Commissioners From: Charla DeHate, CEO Date: December 29, 2016 Subject: Certified Community Behavioral Health Clinic I support and encourage the efforts of the Deschutes County Health Services - Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. The Excellence in Mental Health Act and infusion of 1.1 billion dollars in community behavioral health system is the largest federal investment in mental health and addiction treatment in more than a generation. This creates a rare opportunity to transform service delivery and to increase the number of individuals served. La Pine Community Health Center and DCHS have a longstanding partnership in responding to high risk individuals. This partnership is built around a share responsibility to address the needs of individuals with health challenges. Critical to the success of these efforts is coordination and collaboration between staff. The very elements that bring success to this partnership are central to the philosophy of CCBHC. Building upon Deschutes County's community based service model through their evolution into a CCBHC will increase their ability to address the needs of our most vulnerable citizens and strengthen the success of the partnership between La Pine Community Health Center and Deschutes County Health Services. Sincerely, Charla DeHate Chief Executive Officer BestCare . (' , December 30, 2016 Deschutes County Board of Commissioners 1300 NW Wall Street Bend, Oregon 97703 RE: Certified Community Behavioral Health Clinic Dear Board of Commissioners: I support and encourage the efforts of the Deschutes County Health Services - Behavioral Health Division in becoming a Certified Community Behavioral Health Clinic. As the Chief Executive Officer of BestCare Treatment Services, I am the Community Mental Health Director for Jefferson County and leader of the organization that is the largest substance use disorder treatment provider in Central Oregon. As President of the statewide addiction treatment provider association, the Oregon Prevention Education and Recovery Association (OPERA), I advocated that the State of Oregon should apply for one of the original planning grants and have been a part of a planning team at the State of Oregon on CCBHCs for the past year. The Excellence in Mental Health Act is an infusion of 1.1 billion dollars in community behavioral health system, the largest federal investment in mental health and addiction treatment in more than a generation. This creates a rare opportunity to transform service delivery and to increase the number of individuals served. BestCare and DCHS have a longstanding partnership in building the systems and programs that provide services to the citizens of Central Oregon. These efforts have served to improve the services available while also highlighting the ongoing levels of unmet need in our communities. DCHS is in a unique position to become a CCBHC and continue efforts to improve the continuum of care within Deschutes County. Many of the infrastructure issues and recruitment issues that led us to withdraw from the CCBHC initiative in Jefferson County are actually strong points of the Deschutes County plan. This CCBHC demonstration project will increase access to services, quality of care, and coordination with community partners, all of which will improve the health of Deschutes County residents. I am pleased to express my support and encouragement for this exciting opportunity. Sinc Rick Tret'eaven, LCSW CEO It 'd11nun!1 ()utlriii 11 , t'it'+' I.:;(11 :'1t. i I 11,P 1 .11!; : 11! wt uiti'''.!1:_, kpChiu nd, (1R, r'rf,t