HomeMy WebLinkAboutDoc 194 - Health Strategic Plani
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of April 11, 2012
Please see directions for completing this document on the next page.
DATE: March 23, 2012
FROM: Tom Kuhn (on behalf of Scott Johnson) Health Services (541) 322-7410
TITLE OF AGENDA ITEM:
Request for Approval and Signature of Document No. 2012-194, the Deschutes County Health Services
Strategic Plan 2012-2015
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
The Strategic Plan outlines a vision and set of goals to improve the health of our residents, strengthen
our organization and promote community collaboration. Strategic planning in Deschutes County was
launched in 2011 during a time of rapid change in a dynamic health reform environment. It is both
ambitious and a realistic presentation of our focus and planned actions over the next four years. It is
rooted firmly in goals that will lead to better community health, better care and work that will promote
health and lessen society's burden for unnecessary human and financial costs.
Goals created in the plan evolved from examining health report data, grant requirements and
opportunities, emerging health reform and gaps in service With an application for Public Health
Accreditation approaching, we are collaborating with the community on a Regional Health Report and a
Regional Health Improvement Plan for Central Oregon. The Strategic Plan is the final step in this
process to guide Deschutes County's work in public and behavioral health and enable Health Services
to apply for Accreditation.
FISCAL IMPLICATIONS:
There are no fiscal implications; however, the Strategic Plan will be used as a tool to help guide
programmatic funding decisions.
RECOMMENDATION & ACTION REQUESTED:
Approval and Adoption of Document No. 2012-194, the Strategic Plan.
ATTENDANCE: Scott Johnson, Director, Health Services and Tom Kuhn, Community Health
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1 Program Manager, Health Services. I DISTRIBUTION OF DOCUMENTS:
Orignal to Deschutes County Clerk and scanned copy of signed document to Health Services c/o
Thomas Kuhn.
I
Deschutes County Health Services
Strategic Plan 2012-2015
March 21, 2012
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
Page 2 of 34
Summary
This Strategic Plan outlines a vision and set of goals to improve the health of our residents,
strengthen our organization and promote community collaboration. It is a plan for action
that capitalizes on national, state and regional reform. It is both ambitious and a realistic
presentation of our focus and planned actions over the next four years. It is rooted firmly in
goals that will lead to better community health, better care and work that will promote
health and lessen society’s burden for unnecessary human and financial costs.
This new plan carries forward a commitment of Deschutes County Health Services to use
public health assessment practices and community guidance to frame a clear agenda,
mobilize our resources and act. Through this effort, we will continue to ensure County
government is accountable and helpful to our County’s residents and that we fulfill our
mission to promote and protect the health and safety of our community.
Over the past five years, we’ve acted on past plans, sponsored many projects, expanded our
services and improved access to care. A sampling of those accomplishments is listed in
Appendix iii. In 2009, our department was formed as a consolidation of the County’s Public
Health and Mental Health departments with Environmental Health added in 2010.
In 2012, we will help thousands of residents, offering health and human services at more
than 40 locations including schools, clinics, partner agencies and through a variety of
outreach efforts. We will also continue to increase our investment in our economy and the
workers at many local helping agencies.
While we are optimistic and excited by the promise of health reform, a difficult road lies
ahead. All signs point to reductions in public funds and rising costs as well as a need to push
forward with difficult changes in the way we work and the way people are served. Each fall,
with the help of our community advisory boards and the Central Oregon Health Board and
Health Council, we will review our progress, reassess health reform and our community and
regional needs, and update our priorities to remain current and relevant to the work at
hand. With this in mind, we look forward to a healthier Central Oregon in the years ahead.
We hope you will take the time to review the 71 goals in this document, to ask difficult
questions and to join us in this effort. With adoption of the plan we will move forward
immediately on a number of these actions. We do this with gratitude for the work of a
talented and dedicated staff, the thoughtful guidance of our community advisory boards
and volunteers, the help of community partners and the commitment of our Board of
County Commissioners to community health and well-being.
In partnership with our community and region -
Scott Johnson, Director
Deschutes County Health Services
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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Endorsements and Adoption
Adopted March 21, 2012 by the Deschutes County Public Health Advisory Board.
_______________________________
Kim Curley-Reynolds, Chair
Deschutes County Public Health Advisory Board
Adopted March 21, 2012 by the Deschutes County Behavioral Health Advisory Board.
________________________________
Darrel Wilson, Chair
Deschutes County Behavioral Health Advisory Board
Endorsed by the Deschutes County Health Officer and Medical Director.
________________________________ _____________________________
Dr. Richard Fawcett, Health Officer Dr. Marc Williams, Medical Director
Adopted April ___, 2012 by the Deschutes County Board of Commissioners.
______________________________
Anthony DeBone, Chair
______________________________
Alan Unger, Vice Chair
______________________________
Tammy Baney, Commissioner
ATTEST:
______________________________
Bonnie Baker, Recording Secretary
Health Services’ Reception and Support Staff
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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Table of Contents
I. The Triple Aim Page 5
II. Our Mission, Vision and Values Page 6
III. SWOT Analysis Page 7
IV. Strategic Plan Domains
A. Increase Access Page 9
B. Improve Health Page 10
C. Improve Care Page 11
D. Reduce Cost and Increase Cost Effectiveness Page 12
E. Increase Health Integration and Collaboration Page 13
F. Pursue Excellence Page 15
G. Expand Regional Efforts Page 15
H. Strengthen Our Organization Page 16
I. Promote Sound Health Policy Page 17
Appendices
i. Membership of the Strategic Planning Group Page 20
Accreditation Measure 5.3.1 A 1. a
ii. Strategic Planning Process Page 21
Accreditation Measure 5.3.1 A 1. b.
ii a. 2012-2015 Strategic Plan Development Timeline Page 23
ii b. Annual Strategic Planning Cycle Page 24
iii. Accomplishments in Recent Years Page 25
iv. Ten Likely Environmental Changes in 2012-2015 Page 28
v. Community Health Assessment for Public Health Accreditation Page 29
vi. Regional Health Improvement Plan: Ten Priority Areas Page 30
vii. County-Operated Behavioral Health Services Page 32
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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I. The Triple Aim*
Our Vision for A Healthy Central Oregon
*The “Triple Aim” is a health reform concept developed by the Institute for Healthcare
Improvement, an independent, nonprofit organization helping to lead the improvement of health
care throughout the world. Triple Aim thinking is intended to improve health and health care.
Triple Aim is now part of Oregon law and a founding concept for the Oregon Health Authority. It
has been adopted by the Central Oregon Health Council and Deschutes County Health Services.
BETTER HEALTH
Improve the health of people in
Deschutes County and
throughout Central Oregon
LESS COST
Contain per capita cost;
undertake preventive
care and offer health
education
BETTER CARE
Improve our service
quality, access, reliability,
safety and satisfaction
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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II. Our Mission, Vision and Values
Our Mission
To promote and protect the health and safety of our community.
Our Vision
Deschutes County residents experience excellent health and the highest quality of care.
Costs of health care gradually decline. We successfully advance public health policy, health
assessments and health solutions as well as affordable, accessible and coordinated services.
As an organization, we adapt effectively to health reform, focus on our strengths and areas
where we are most needed for the region’s success. We offer a capable workforce and a
commitment to excellence. We succeed by joining with other counties, the health care
system, the business and nonprofit communities and a responsible citizenry.
Our Values
Advocacy The pursuit of community health, healthy lifestyles and access to health care.
Collaboration True partnership with our customers, community agencies and coalitions.
Cultural competence Awareness and responsiveness to the diversity in our community.
Excellence A commitment to best practice and high quality service to the public.
Innovation A willingness to try new approaches to better serve our community.
Professionalism The highest level of personal integrity, conduct and accountability.
Stewardship The wise, effective and efficient use of public resources.
Workplace health Work sites that promote respectful interactions and healthy lifestyles.
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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III. SWOT Analysis
Strengths, Weaknesses, Opportunities, Threats . . . Winter 2012
The development of this Strategic Plan has included an analysis of data on health needs and trends in our county
and region (see Appendix v, Community Health Assessment) as well as this assessment of our agency and the
conditions in our county, region and state. We have used this information to frame our long-range goals and
fulfill our mission to promote and protect the health and safety of our community.
Summary of critical considerations:
Strengths:
1. Our workforce: talented, energetic, professional.
2. Our innovation and a commitment to improve.
3. Our partnerships and community providers.
Opportunities:
1. State, regional, local support of health reform.
2. Better care for our clients through integration.
3. Regional work with the Central Oregon Health
Council, our Coordinated Care Organization and
the Central Oregon Health Board.
Challenges/weaknesses:
1. Complex regulatory requirements.
2. Management in a changing environment.
3. Measuring the impact of our work (outcomes).
Threats:
1. A down economy: impact on community, funding.
2. The impact of any opposition to health reform.
3. The impact of the social determinants of health.
Within our organization . . .
Our Strengths:
Dedicated, passionate and highly professional staff; staff stability; a high value placed on teamwork and support
for one another’s efforts; a progressive organization that values innovation in our programs and services;
promotion of creativity; use of evidence-based practices and programs; willing to explore new opportunities, to
continually strive to expand our benefit to the community; we value community involvement and partnerships,
we benefit from the help of several community advisory boards; we prepare for change rather than react to it;
actively participate in many community partnerships; we work to shape our environment, our reputation with
the State of Oregon is very good, client-focused in a client-centered community; we manage limited resources
responsibly; open to looking at outcomes; Deschutes County and the County Commissioners are very supportive
of our work; diversified, providing wide range of valuable services; developing a greater commitment to quality
improvement throughout the organization; forward thinking, undertaking a number of strategic efforts that take
time to develop and grow; a long-range financial approach, using our reserves wisely to limit program crises.
Our Weaknesses:
It is challenging to manage effectively in a changing environment; learning to adapt and adjust to new
opportunities while managing busy daily operations; our technology (electronic record system) needs an
upgrade, improvements are underway but are taking time and resources and will be difficult to implement; at
times, we have been resistant to change and to integrating our services and staff support although this is
changing on many levels; we need to become more adept at managing based on performance measures,
outcomes and the Triple Aim; unable to help everyone who needs assistance, particularly the uninsured; many
client issues are more complex than in the past, particularly with a range of health and economic issues facing
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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our clients; administrative support services have not kept pace with our program development; similar to
agencies in Oregon, with all the Federal and State regulations and complexity, we are vulnerable to State or
Federal audit and are working hard to improve in this area; we need to strengthen our planning processes and
health assessment capacity, using health, demographic and economic data; need effective internal and external
communication during a time of change; we can be guilty of “silo thinking”; at times it is difficult for staff to
understand the big picture; need to improve our billing practices by strengthening our Business Office, linking to
clinical records; have lacked an agency-wide commitment to quality improvement; need greater client voice and
involvement in our work.
In our environment . . .
Opportunities:
Oregon is well positioned for Federal and State health reform, especially with the new Oregon Health Authority
and recent Coordinated Care (HB 3650, SB 1580), Health Exchange (SB 99, HB 4165) and Early Learning Council
(HB 4165) laws; innovation will be highly valued in the next several years with Federal, State and regional health
reform; the formation of the Central Oregon Health Council (community-wide) and Central Oregon Health Board
(Crook County, Deschutes County and Jefferson County) is well regarded; potential to increase County
involvement in community health; potential to increase focus on prevention and population health; potential to
expand our geriatric services and focus in keeping with changing demographics in our region; our Board of
County Commissioners are likely to place a high value on collaboration and community involvement;
strengthening public health work through national public health accreditation; potential success of LAUNCH
(Linking Actions for Unmet Needs in Children’s Health) and early childhood health and education; prevention
(especially in public health) will be important to “bend the cost curve” in health care; the State Health
Improvement Plan calls for strengthening the public health infrastructure in Oregon; the number of insured
Oregonians will increase significantly in 2014, requiring a more robust workforce; federally qualified health
clinics (e.g., Mosaic Medical, La Pine Community Health Clinic) are likely to expand to meet an increasing need;
the Central Oregon Health Board will help integrate mental health and addictions treatment and the work
among our three counties; contracting OHP behavioral health through PacificSource helps integrate with
physical health, makes sharing health information easier as we seek better health for our clients and
community; improving quality assurance; ability to lessen bureaucratic requirements; peer services in behavioral
health; new community health worker concept.
Threats to our services and success:
Public resources are very limited; the Oregon economy is likely to remain difficult for several years and could
negatively impact funding and reform, increasing the need for our services but creating instability in the Oregon
budget; the State’s budget limitations may result in a loss of critical community services for vulnerable
populations, it will require reducing health costs over the next four years; our population is aging and will
require an increased focus on serving our seniors; County contributions are not likely to grow significantly; State
cuts will impact our clients and our ability to keep up with greater need for people with and without insurance
coverage; will our department services and provider network be adequate to able to shoulder a greater burden
of more people in need of more complex services; increases in costs of our services exceeds our likely revenue;
at times, a consensus must be reached before we can make the changes that are necessary, that can slow us
down; Medicaid regulations are complicated and the focus on compliance is difficult and threatens our
resources and programs; for behavioral health, the capitated system requires service to everyone eligible with a
need; the revised Oregon Administrative Rules for behavioral health require work force education and change in
our processes; national and global environment and economy will impact the State of Oregon and our future.
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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IV. Strategic Plan Domains
The goals listed in this plan are not listed in priority order.
Key:
CO HIP: Goals aligned with the Central Oregon Health Improvement Plan
OR HIP: Goals aligned with the Oregon Health Authority Health Improvement Plan
CFC: Goals aligned with Children and Families Commission planning priorities and functions
A. Increase Access
Definition: Improve access to health education, preventive services and health care. Provide timely care to
achieve the best possible health outcomes.
1. Cultural Competency: Reflect our community in hiring policies and services. a) Conduct a health assessment
of Oregon Health Plan members and other service populations by October 2012. b) Reassess current
programs to address the cultural needs of Hispanic clients and other groups by February 2013. c) Reassess
the composition of our community boards. d) Quantify specific personnel needs in each program; assure we
can serve clients needing help. e) In priority areas, assign added weight to bilingual candidates, recruit
workers or volunteers who are bilingual/bicultural by July 2013 or with next available opening(s). OR HIP
2. Dual Competencies: Develop behavioral health staff expertise in priority areas. a) Staff knowledgeable and
skilled in behavioral health practice for people with developmental disabilities. b) Staff knowledgeable and
skilled in behavioral health practice and service to veterans in our priority population groups; coordinate
with the veterans’ service system. c) Staff knowledgeable and skilled to serve clients with health issues
related to mental illness and to chemical dependency. d) Involvement of staff or partner agencies to
address chronic disease issues and general physical health.
3. Translation Services: Assure that Health Services Spanish interpreters meet State qualification criteria for
healthcare interpreters by January 2014. Track criteria through the Oregon Health Authority’s Office of
Multicultural Health and Services.
4. Hours of Operation: Offer additional hours of operation and services. a) Expand hours of operation to
evenings and Saturdays, piloted in Bend and the new Redmond Service Center January 2013. b) Clarify
potential need for variable work hours at time of hire. c) Assure needed support staff for such operations.
5. Redmond Service Center: Open the Redmond Service Center as a comprehensive health and human service
center by January 2013 with the State of Oregon Department of Human Services and Mosaic Medical.
6. School Based Health Centers: Strengthen the school based health center system in Central Oregon.
a) Open new Sisters School Based Health Center by July 2013. b) Complete a business plan and determine
the full complement of centers in a comprehensive county and regional system by July 2014. c) Complete an
analysis of the best options for system management and oversight by July 2014. CO HIP – OR HIP
7. South County Healthcare: Work with provider groups to increase access to healthcare for La Pine and South
County residents. a) Participate in the 2012 community task force working to increase access to primary
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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care, urgent care and behavioral health services in South County. b) If feasible, assist in educational
campaigns to reduce the amount of ambulance transports and emergency room visits.
8. Reproductive Health: Assure quality, timely access to reproductive health services within our community as
we move toward health care reform. Access can be measured through collaborations formed, service
contacts and through identifying and monitoring access points. Note: In 2010, an estimated 609 unwanted
pregnancies were averted in Deschutes County, saving the health care system $5 for every $1 invested.
9. Behavioral Health Access Standard: a) Meet OHP access to care contract requirements for members in need
of behavioral health services, reporting quarterly. b) Increase use of community behavioral health network
and outpatient services: Increase the percentage of unique OHP members served by panel providers by
100%, from a baseline of 694 unique people served in fiscal year 2011, by July 2013. CO HIP
10. Access to Geriatric Behavioral Health Care and Consultation: In partnership with the Central Oregon Health
Council and Coordinated Care Organization, seek to expand Deschutes County’s Seniors Treatment Services
program as a resource to the health system, care facilities, families and seniors in need throughout Central
Oregon. CO HIP
B. Improve Health
Definition: In collaboration, seek to assure the health of County residents through processes, activities or the
services of our organization(s). Health outcomes include morbidity and mortality; physical, social and mental
well being; nutritional status and quality of life.
1. Living Well Program Expansion: Improve the health of adults with chronic conditions in the region through
expansion of the Living Well program. Program enrollment of 1,700 people, with 1,100 completing the
course, saves an estimated $2 million in health care costs. Increase enrollment in the program annually by
25% from a baseline of 242 clients in 2011; measured each July through 2015. OR HIP – CO HIP
2. Wellness Marketing Campaign: Develop and promote Worksite Wellness tool kits to regional organizations
in order to achieve adoption and implementation from 2012 through 2015. Tool kits assist organizations in
developing wellness policies, promoting Commute Options, creating smoke-free campuses and referring to
chronic disease self-management programs. Success will be measured by the number of tool kits distributed
and implemented. The purpose of worksite wellness program is to reduce the cost of health insurance
claims by improving employees' health and maximizing the return on investment. OR HIP
3. Partner Violence: Create a plan to prevent intimate partner violence at the individual, community, agency
and policy levels by January 2015. The plan will be developed by public and behavioral health staff by
convening an intimate partner violence committee, developing the plan and advocating for the plan at the
community level. The Centers for Disease Control and Prevention recently identified intimate partner
violence as a widespread, major public health problem in the United States. Intimate partner violence
includes physical, sexual or psychological harm by a current or former partner or spouse.
4. Childhood Obesity Prevention: Support community activities that seek to reduce childhood obesity. Review
research and implement best practices in Central Oregon. a) As public and behavioral health, participate
with the Kids @ Heart Program in developing an action agenda by December 2012. b) Identify opportunities
to engage with local and state partners, including hospital systems, school based health centers and schools.
Seek funding and/or other support as needed. CO HIP – OR HIP
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5. Maternal Mental Health: Using the Substance Abuse and Mental Health Services Administration’s model,
collaborate with community partners to develop a maternal mental health system to screen and treat
women at risk. a) Conduct a survey of behavioral health, medical and community providers; identify gaps
and report to Public Health/Behavioral Health Advisory Boards by July 2012. b) Conduct maternal mental
health trainings and grand rounds for physicians by September 2012. c) Facilitate a community taskforce to
develop an integrated care plan, funding sources and evaluation method. d) On an ongoing basis, assess the
need through standardized screening, reporting and tracking by September 2015. CO HIP – OR HIP
6. High-Risk Drinking Prevention Ages 18-25: Develop and implement a strategic plan to prevent and reduce
high-risk drinking, and associated consequences, among 18-25 year olds. Other goals will be to impact the
key community factors which allow high-risk drinking to occur, strengthen the substance abuse prevention
system and strengthen community partnerships to prevent substance abuse. Key milestones are: a) by
February 2012 complete assessment, b) by June 2012 complete strategic plan and c) by July 2012 begin
implementation. CFC
7. Substance Abuse Prevention: Using the Substance Abuse and Mental Health Services Administration’s
Strategic Prevention Framework, support evidence based practices for environmental change to prevent and
reduce alcohol and marijuana use and prescription drug abuse among youth under 20 years. Specific
technical assistance will include resource development, prevention skill training, coalition support and
community education and awareness. CO HIP – OR HIP – CFC
8. Decrease Child Abuse and Neglect: In spring/summer of 2012, convene the Child Abuse System Task Force
and regional partners to review current data trends, issues and barriers related to child abuse in the tri-
county area. Identify and prioritize issues common to the tri-county area to be addressed on a regional and
local level. Develop local and regional plan and strategies to reduce child abuse and neglect in Central
Oregon by end of FY 2013. Continue to identify resource development opportunities to fund and address
identified needs and service providers working to decrease child abuse. CO HIP – CFC
C. Improve Care
Definition: Improve the care people experience and our associated practices and processes. Identify areas
for improvement, monitor compliance and manage risk. A premium is placed on connecting staff to the
performance of the organization.
1. Early Learning Council Development: Participate in the Central Oregon Health Board’s development of a
regional Early Learning Council system. Integrate public health and behavioral health services with this new
Oregon child development model. Measurement: Role definition and measures by July 2013. CO HIP
2. Information Technology: Electronic Health Records: Use electronic health record software in all HEALTH
SERVICES’ clinical programs. a) Launch behavioral health and public health systems in July 2012. b) Meet
“meaningful use” requirements; receive American Recovery and Reinvestment Act fund incentive payments.
c) Long-term, assure interoperability with regional Health Information Exchange and Early Learning Council.
OR HIP
3. Quality Councils: Commit to quality improvement through Quality Councils. Roles will include quality
priorities and standards, workforce knowledge, use of improvement processes and tracking, and reporting
performance. a) Support a Public Health Quality Council and a Behavioral Health Quality Council within the
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Deschutes Recovery Center
organization or regionally with the Central Oregon Health Board by July 2012. b) Participate on the Regional
Quality Council with other health stakeholders. c) Develop organizational competence in use of the Plan-Do-
Study-Act improvement model through training by July 2013. d) Each division will undertake at least two
such projects by July 2014. Measured through quarterly reports. CO HIP – OR HIP
4. Focus County Behavioral Health Operations: Place emphasis for County-operated services on specialty
programs, safety net services and integrated services for community members with complex care behavioral
health needs. Expand points of service to increase access. See Appendix vii.
5. Holistic Services to Improve Health: Within billing regulations and feasibility, develop fully integrated health
services (for behavioral health clients across the age spectrum) that are family-centered, evidence-based,
recovery oriented and outcome driven. Promote access by removing barriers to holistic services (i.e.,
wellness services and activities, healthy eating, nutrition, exercise, parenting, budgeting) by July 2015.
6. Public Safety Preparedness: Sustain essential public safety programs and services supported by Health
Services including a) 24/7 crisis services; b) co-sponsorship of Crisis Intervention Training (growth expected);
c) coordination, service or support to treatment courts; d) shared investment with the Sheriff’s Office in
chemical dependency treatment; e) the civil commitment process; and f) public health roles in emergency
preparedness and response. From time to time, additional public safety work will be considered in
consultation with the Local Public Safety Coordinating Council and its members.
7. Housing for People with Mental Illness: a) Update
the Deschutes County Housing Continuum as a
regional framework by July 2013 in collaboration
with the Central Oregon Health Board, Housing
Works and the Oregon Health Authority. b) Identify
target population(s) and project(s) for development.
c) Increase access to rental assistance for our clients
in supportive housing and independent living
(resources needed).
8. Client Engagement and Reduction in No-Show Rates: For clients seeking behavioral health outpatient
services, establish a standard of three appointments in the first thirty days of service to increase
engagement in the therapeutic process. Ensure appropriate training in engagement for front-line staff.
Measurement: Set baseline by January 2013. CO HIP
D. Reduce Cost and Increase Cost Effectiveness
Definition: Reduce the cost of health care through better health and care options. Increase efficiency and
effectiveness. Invest in strategies that best accomplish this goal.
1. Billing and Coding Audit: Use an external certified coding consultant to review and revise public health
billing practices and annually audit provider coding for accuracy. Annual, ongoing.
2. Preferred Provider Contracts: Gain preferred provider contracts with the major insurance carriers by
annually assessing the department’s top 15 most commonly billed commercial payers. Execute contracts to
increase reimbursement rates and reduce patient out-of-pocket costs by July 2013.
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3. Assertive Community Treatment: a) Strengthen the Assertive Community Treatment (ACT) team including 1)
determining the necessary staffing level, and 2) expanding the use of peers to coordinate care. b) Meet the
ACT Program fidelity standard by December 2013. CO HIP
4. Children’s Intensive Treatment Services: Improve Intensive Treatment Services for youth enrolled in wrap-
around Services thereby reducing Psychiatric Residential Treatment Services (PRTS) costs. Create County
team to respond in collaboration with St. Charles Medical Center to serve high acuity youth in need of
emergency services. Reduce the number of youth enrolled in wrap around services requiring hospital
admissions to 1.5% or less annually.
5. Early Assessment and Support Alliance (EASA): Reduce symptoms of psychosis, mental health crises and
hospitalizations by expanding the EASA program in the region. a) Screen and refer a minimum of 18 clients
quarterly. b) Maintain a minimum caseload of at least 28 clients while growing program service capacity. c)
Maintain level of EASA hospitalizations under 25% of total enrolled clients. CO HIP
E. Increase Health Integration and Collaboration
Definition: Improve health practice and care by combining activities, services and care.
1. Communications with Clients: Implement secure texting with clients by July 2012 (e.g., breastfeeding
support, appointment reminders).
2. Information Technology: Remove barriers to communicating electronically with clients and community
providers. Develop or purchase information technology resources which allow electronic communication
via email, phone texts and electronic health records. a) Offer secure web mail with encryption to
communicate with clients and agencies. b) Develop policy by July 2012. OR HIP
3. Communication with the Community: Use traditional and social media to ensure broad dissemination of
public health information. Measure: create Facebook and Twitter accounts for Health Services as well as a
seasonal calendar of media releases and public service announcements by July 2013. CO HIP
4. Health Communications: a) Implement a three-year communication plan for Health Services that includes
strategies and resources to enhance public awareness of our programs and services by July 2013. b) Meet
with program leaders to identify communication needs and priorities. c) Increase media outreach and
dedicate resources to implement the communication plan.
5. Community Health Workers: Expand use of community health workers (including peer support) to
coordinate care. a) Establish measurement tools for behavioral health peer positions by December 2012.
Begin tracking and reporting to Quality Councils and management. b) Develop an operating model agency-
wide including financing and measurement by December 2012 for implementation in FY 2014. c) Finalize a
development plan by February 2013 for our organization including targeted program areas. Reflect the
improvement plan in the FY 2014, FY 2015 and FY 2016 operating budgets. Measurement: 2011 baseline: 2
behavioral health peer specialists. CO HIP – OR HIP
6. Coordinated Care for Health Services Clients: To better serve our clients, establish a coordinated care model
for easier client engagement in our services. Track clients served by multiple programs and care experience.
a) Convene an interdisciplinary team to construct a policy, protocol and training plan by December 2012. b)
Prioritize clients for needed services across Health Services programs to assure a “warm hand off.” c) As a
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Immunizations are great protection!
specialized need, develop internal staff capacity (e.g., health worker position) to offer health services for
specific client groups, to include clients with developmental disabilities, by July 2013.
7. Integrate Primary Care and Behavioral Health: Create integrated health homes throughout Deschutes
County including primary care and behavioral health services. Improve access for Medicaid and safety net
clients. a) Measure the health and care benefits of integrated services in the school-based health centers.
b) Complete 2012 expansion to include 1) primary care services at Health Services’ Bend specialty behavioral
health clinic (the Annex) for people with a serious mental illness, 2) co-location and care coordination
(Mosaic and Health Services) at the Redmond Service Center, and 3) investment in behavioral health
services at Mosaic Medical’s Bend Greenwood clinic. c) Improve collaboration with primary care physicians
who treat Health Services’ behavioral health clients. OR HIP
8. Consulting Psychiatrist: Through leadership of the Health Services Medical Director and behavioral health
team, develop a capacity and model to offer short-term consultation to primary care practices (children and
adults) by July 2013. Critical considerations include viable funding model. CO HIP
9. Maternal Child Health: As a partnership between maternal child health and behavioral health
developmental disabilities teams, implement an integrated transition process for CaCoon clients
transitioning from adolescence to adulthood by January 2013. OR HIP
10. Living Well: Continue to improve and sustain relationships with Central Oregon community partners to
improve access and availability to the Living Well program. Through 2015, regional referrals made by
providers and other partners will increase annually by 20%, from a baseline of 271 referrals in 2011. OR HIP
11. Immunization Exemptions: Collaborate with Bend-La
Pine Schools (or other districts with high exemptions),
pediatric and family practice clinics, hospital birthing
units and parent education classes to decrease the
kindergarten immunization religious/philosophical
exemption rate. Provide education and targeted
outreach to these groups by July 2013. Become more
aligned with State immunization rates. Baseline 2010-
2011 kindergarten religious exemption rates:
Deschutes County: 9.0%; State: 5.6%. OR HIP
12. Internship Program: Establish a formal collaboration with the OSU Master of Public Health Program and
OSU Cascades Extension Office by September 2012. a) Establish a Master of Public Health Internship
program with regular student rotations at Health Services. b) Expand program to include at least one
additional institution no later than September 2014. Note: Any direct service activity will require assurance
of ability to serve, document and bill for such service. CO HIP – OR HIP
13. Parent-Child Interaction Therapy (PCIT): a) Increase capacity for PCIT throughout the County in conjunction
with LAUNCH. Collaborate with community partners (Dept. of Human Services, Family Access Network,
KIDS Center, Mtn. Star Relief Nursery) to identify at-risk families and youth ages 2-8 to participate. b)
Provide training for minimum of eight therapists within the County and in community practice by January
2014. c) Increase positive interactions between family members with a measurable baseline by July 2012.
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F. Pursue Excellence
Definition: Maintain standards of practice and performance that ensure accountability and peak performance
to operate effectively and keep our communities safe and healthy.
1. Health Assessment Capacity: By July 2013 a) Create the capacity to serve as the regional hub for the
collection, analysis, interpretation and dissemination of primary and secondary health related data to guide
programmatic decisions, resource distribution and gauge outcomes. b) Through the Central Oregon Health
Board, launch a web-based regional and community health data site with shared investment and public
health leadership. CO HIP – OR HIP
2. National Accreditation: Receive accreditation from national Public Health Accreditation Board by July 2014.
CO HIP – OR HIP
3. Environmental Health: Assure that Deschutes County’s Environmental Health Program meets seven of the
nine standards of the Food and Drug Administration Voluntary National Retail Food Regulatory Program by
July 2015.
4. Behavioral Health Outcome Tools: Measure therapeutic outcomes and increase diagnostic expertise.
Through the Central Oregon Health Board and Coordinated Care Organization, identify and use specific
outcome tool(s) by January 2013. CO HIP
G. Expand Regional Efforts
Definition: Collaborate with local and State governments, our hospital system, local providers, private insurers,
health collaboratives, our community and the people we serve.
1. Regional Health Coordination Among Counties: Help develop the Central Oregon Health Board. Develop
and expand regional services offered by our three counties. a) Inventory regional programs shared by
Central Oregon counties by December 2012. b) With our Coordinated Care Organization, help create a
Health Board unit to coordinate and improve the Central Oregon behavioral health system to benefit all
communities in the region. Emphasize service to OHP and indigent residents. Track core metrics at least
semi-annually. Develop by October 2012. Measurement: Track work plan deliverables; new resources and
successful project completion. CO HIP – OR HIP
2. Health Information Exchange (HIE): Within HIPAA guidelines and Exchange protocols, include County client
data in a regional HIE by June 2015. Benefits include public health analysis of population data, individual
access to personal health information and an ability to meet Federal “meaningful use” requirements. Health
Information Exchange is defined as the mobilization of healthcare information electronically across
organizations within a region, community or hospital system. CO HIP – OR HIP
3. LAUNCH: Evaluate the LAUNCH early childhood wellness media campaign to help unify the early childhood
wellness service community and to educate and mobilize the public and policy makers around the issue;
report to the Public Health Advisory Board by July 2012. CO HIP – OR HIP
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4. Emergency Preparedness: By July 2013, develop regional liability protections for activation of Public Health
Reserve Corp volunteers when mutual aid is requested in an emergency. Note: Includes Central Oregon
Health Board, local health departments and tribal governments. CO HIP
5. Nurse Family Partnership: Implement a regional Nurse Family Partnership home visiting program serving at-
risk families with young children. Maintain caseloads (2012: 138 clients for Deschutes, Jefferson and
Crook), establish a regional Advisory Council and identify diverse funding streams. Expand capacity to meet
the demand for service. Measurements: a) perinatal outcomes for the three Central Oregon counties
posted on web site annually and b) number served. CO HIP
6. Suicide Prevention Outreach: Prevent and reduce suicide attempts and completions among all age ranges.
Regional partners will develop a plan to increase the capacity to deliver evidenced based suicide prevention
education. Key milestones are: a) by September 2012 develop a business plan, b) by December 2012
develop regional communication materials, c) by December 2012 train four additional suicide prevention
education presenters and d) by January 2013 implement suicide prevention trainings for the general public
across the region. CFC - CO HIP
H. Strengthen Our Organization
Definition: Build the internal infrastructure necessary to create a robust, healthy and flexible organizational
environment which fosters teamwork, progressive thinking and cutting-edge programming.
1. Organizational Structure: At least biennially, evaluate our organizational capacities and structure to assure
that we are efficiently and appropriately staffed and organized to accomplish our goals. a) Hire a Behavioral
Health Division Director to manage day-to-day direct service operations related to mental health, chemical
dependency and developmental disabilities by August 2012. b) Work with the Children & Families
Commission (CFC) staff and volunteer leadership to determine how best to sustain and organize critical CFC
health and social services by February 2013. c) Reassess the organization and structure with department
leadership by December 2013 and December 2015.
2. Integration: a) Annually, offer integrated activities for public health, behavioral health and support
personnel (e.g., joint staff meetings, collaborative program discussions, cross-training or presentations
between programs). b) Convene periodically a Support Staff Team to strengthen department processes and
communication as well as help execute special projects by July 2012.
Public and Behavioral Health Advisory Boards
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3. Emergency Preparedness: In conjunction with the public health preparedness program, develop behavioral
health preparedness capacity including: a) Train essential staff serving vulnerable populations (e.g., teams
serving people with a serious mental illness, crisis personnel) by July 2013. b) Name a behavioral health
preparedness team and leadership position by November 2012. c) Incorporate the team into the Incident
Command System Structure through requisite training by July 2013.
4. Streamline and Strengthen Staff Development: a) Implement a new employee orientation for new Health
Services employees by July 2013. Include attention to documentation required, licenses, system access,
team orientation and payroll. b) Implement a supervisory orientation for new managers and supervisors by
January 2013. c) Implement an employee exit interview process complementary to the County’s process;
analyze results annually during the fall Strategic Plan review and development process by January 2014.
I. Promote Sound Health Policy
Definition: Advocate and support clear, overarching policy interests and expectations for population health
and the region’s health care system.
1. The Triple Aim: We will promote and advance the Triple Aim. Support programs, services, practices and
activities that lead to “better health, better care and less cost.”
2. Resiliency and Recovery in Our Practice: We will promote resiliency and recovery for people of all ages who
experience developmental disabilities or psychiatric and/or substance abuse disorders. Policies and
procedures governing service delivery will attend to factors known to impact individuals' resilience and
recovery. This work will include:
a. A high quality of life for each individual or family;
b. An ability to develop and maintain social relationships;
c. Inclusion as a member of the community;
d. Participation in community activities of the individual's choice;
e. Improved health status and function;
f. Success in work, school or living situation; and
g. An ability to measure our success in implementing this policy.
This will be achieved by providing services that are:
a. Client directed. We will work in partnership with the individual. The individual will identify personal
goals and have control of the resources to achieve these goals.
b. Individualized and client centered. The plan for reaching goals will be designed to meet the specific
needs and strengths of each individual.
c. Empowerment. Services will help the individual plan for and direct his/her own services.
d. Holistic. Within regulatory guidelines, services will encompass many aspects of an individual’s life.
Services will address needs such as housing, employment, community participation, transportation,
family involvement, education and treatment for health, mental health and addiction issues.
e. Strengths based. We will work with individuals to identify the inherent strengths of each individual and
build on those strengths to achieve the identified goals.
f. Peer support. Services will be designed to encourage peer support including sharing of experiential
knowledge and social learning.
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g. Respect. Respect will be the basis of all relationships. We will work to ensure that the individual's rights
are protected, to eliminate discrimination and stigma, to assist the individual to regain or maintain self-
respect and to encourage the individual's participation in all aspects of life.
h. Hope. Services will convey the motivating message of a better future. Both the individual and the
provider believe that things can get better, barriers can be overcome and goals can be achieved.
3. Regional Development: We will use a regional approach to program development, direct services, resource
management and advocacy when the benefit to our County and our residents outweighs any associated
costs. Criteria for measuring benefit will include a) a tipping point: we can accomplish something as a
region that is less likely to be accomplished by a single County, b) an ability to increase resources and
expand services, c) better coordination with regional organizations, d) greater efficiency, and/or e) improved
education and advocacy. Whenever Deschutes County takes a regional approach to its health work, we will
identify the benefit of regionalization.
4. Strategic Plan and Regional Health Improvement Plan as Core County Documents: The Strategic Plan and
the regional Health Improvement Plan will reflect the intended direction of the Deschutes County Board of
Commissioners. Within State or County guidance, advance the principles, policies and priorities contained in
these plans, subject to any further direction or guidelines set forth by the Board. A progress report on our
success in implementing the Strategic Plan shall be provided to the Board at least biennially.
5. County-Operated Behavioral Health Services: We will focus County-operated programs and services in areas
where the department has particular skills and expertise and where the Central Oregon Health Board and
Coordinated Care Organization determine our work is most beneficial. Work with the Health Board to
advance a network of agencies and services for outpatient care and treatment when such options are of
high quality and more cost effective and/or provide for consumer choice. In such instances, Health Services
will serve as one of several agency options or will refrain from offering such services, based on the direction
of the Health Board and/or the Deschutes County Board of Commissioners.
6. Adherence to Policies: We will operate within statutes, administrative rules and grant requirements as well
as County and Department policies. Additional guidance for our work will also be established, when helpful,
at the division and program levels. Policy guidance will be posted for staff, and supervisory staff will work to
assure staff are aware of and operating within these policies.
7. Public Health Policy Approach: We will collaborate with others to reduce the burden of chronic disease in
Deschutes County by way of policy, systems and environmental change. We will: a) use data to develop and
implement health related policies to address priority population health needs and disparities; b) inform
decision makers and stakeholders about potential health impacts of proposed plans, projects or policies
wherein health is not a consideration; c) promote no- and low-cost community resources that support
health related policies; and d) collaborate with land use and transportation agencies on projects that impact
population health (e.g., Health Impact Assessments, membership on Regional Transportation Planning
Steering Committee and active transportation initiatives). OR HIP – CO HIP
8. Integrate Primary Care and Behavioral Health: Through the Central Oregon Health Board and Central
Oregon Health Council, we will develop integrated behavioral health and primary care settings. We will
evaluate various models including care through a) co-location of County personnel, b) contracted behavioral
health providers, and c) primary care employment of behavioral health personnel.
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9. Tobacco Cessation Billing: We will work with the Central Oregon Health Board and PacificSource to establish
an approved method to bill for tobacco cessation treatment for behavioral health clients. With a viable
billing option, we will offer tobacco cessation groups for behavioral health clients by December 2013. CO
HIP – OR HIP
10. Tobacco Policy: Exposure to second-hand smoke can lead to heart disease, cancer and many other diseases.
Bans on smoking in public places, including all indoor workplaces, protect people from the harms of second-
hand smoke, help smokers quit and reduce youth smoking. We will seek to a) Implement a 100% tobacco-
free policy at all Deschutes County facilities and all local government properties. b) Assess the desire for
downtown tobacco-free campuses in Bend, Redmond and Sisters. c) Coordinate a regional approach to
collect data on tenants of multi-unit housing and their preferences toward smoke-free housing and smoke-
free multi-unit properties. d) Work toward implementation of smoke-free multi-unit housing properties. e)
Assist in the implementation of tobacco-free policies where people connect with physical and mental health
services or support. OR HIP
11. Breastfeeding Policy Advocacy: a) Collaborate with community agencies to strengthen place-based (e.g.,
child care facilities) obesity prevention policies and practices that address nutrition, physical activity, screen
time (e.g., computer, television) and breastfeeding. b) Advocate that a mother’s infant feeding decisions be
supported and protected in a variety of settings. c) Through WIC program investment, promote the Baby
Friendly Hospital designation at St. Charles Bend and Redmond by July 2013. d) Educate the public and at
least ten employers about Oregon’s breastfeeding laws and regulations by July 2014. OR HIP
12. Nutritional Guidelines: We will promote healthy foods in Health Services’ worksites. Develop and
implement nutritional guidelines for foods and beverages available to staff, clients and visitors through
2015. a) Adopt a healthy vending machine policy that sets nutrition standards for foods sold in vending
machines in Deschutes County agencies. b) Create guidelines for healthy foods and beverages at County
sponsored meetings and events. c) Expand the Farm to Work program to include additional drop sites, a
comprehensive outreach campaign and educational opportunities related to healthy nutrition. OR HIP
13. Community Based Service Options: We will support the concept of a community system of care through
which County residents have local access to a wide range of health services. On a case-by-case basis, it is
understood that an out-of-area placement for some health services may be necessary though it is not
usually as beneficial as an effective local option that allows continued family and community involvement
and a smooth transition to local services and supports.
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Appendix i.
Membership of the Strategic Planning Group
Public Health Accreditation Measure 5.3.1 A 1. a.
We are grateful for the support and contributions of our department leadership and staff in the development of
this Strategic Plan. Participating leaders included Dana Bennett, Kacy Burgess, Cherstin Callon, Kathy
Christensen, Jim Denman, Kathy Drew, Jeffery Emrick, Shelly Falconer, Barrett Flesh, Lori Hill, Kathe Hirschman,
Scott Johnson, Tom Kuhn, Maggi Machala, Tim Malone, Virginia Mayhill, MaryAnne McDonnell, Jean
Mendenhall, Eric Mone, Kate Moore, Sherri Pinner, Travis Sammon, Terry Schroeder, Elaine Severson, Laura
Spaulding, Martha Steigleder, Karen Tamminga and Patricia Thomas.
Our Advisory Boards also contributed to this plan, offering feedback and suggestions throughout the
construction and approval process. These individuals included:
Advisory Board Participants
Public Health Advisory Board Behavioral Health Advisory Board
Kim Curley-Reynolds, Chair
Commute Options
Glenda Lantis, Chair (2011)
Central Oregon Community College
Jock Pribnow, Vice Chair
Retired Physician
Darrel Wilson, Chair (2012)
Opportunity Foundation of Central Oregon
Anthony Rosenthal
Retired Physician
Pat Croll
Retired Geriatric Specialist, Provider
Keith Winsor
Academy Medical Systems
Jay Harris
Telecare Mental Health Services of Oregon
Cynthia Barnes
OHSU Dentistry School
Chuck Hemingway
Deschutes Family Recovery
Mike Bonetto
Health Policy Advisor, Governor Kitzhaber
Marty Miller
Bend-La Pine Schools Special Education
Eric Alexander
Partners in Care
Roger Olson
NAMI of Central Oregon
Jane Dey
Retired RN (Public Health)
Kristin Powers
St. Charles Health System
Blake Drew
Family Dental Care
Lee Ann Ross
Retired Economist
Charles Frazier
Retired Pharmacist
Julie Rychard
Full Access Brokerage
Holly Remer
Healthy Beginnings
Lindsay Stevens
Vocational Rehabilitation Counselor
Katrina Wiest
Bend La Pine School District
Marianne Straumfjord
Retired Psychiatrist
Susan Keys
Inspire USA Foundation
Bert Swift
Retired Professor of Healthcare Administration
Aylett Wright
Community Volunteer, COCC
Patricia von Riedl
Peer Specialist, Deschutes County Health Services
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Appendix ii.
Strategic Planning Process
Public Health Accreditation Measure 5.3.1 A 1. b.
Introduction: Strategic planning in Deschutes County was launched in 2011 during a time of rapid change in a
dynamic health reform environment. With an application for Public Health Accreditation on the horizon, we are
collaborating with the community on a Regional Health Assessment, an update of our 2009 Health Report and a
Regional Health Improvement Plan for Central Oregon. The strategic planning became a final step to guide
Deschutes County’s work in public and behavioral health. A more detailed summary of the process follows:
1. Accreditation Beta Site: In May 2010, Deschutes County hosted the nation’s first site visit from the Public
Health Accreditation Board as part of a major effort to strengthen our nation’s public health system. The
goal of public health accreditation is to improve and protect the health of the public by advancing the
quality and performance of all health departments in the country, so that residents can feel confident that
their public health department is providing the highest quality services possible. Deschutes County was one
of the 19 local health departments chosen to beta test the accreditation process in 2009 through 2010.
2. Health Report: Published in 2007 and again in 2009, The Deschutes County Health Report has provided
County and regional data that can be used by local government and community agencies, health care
providers, school districts and others to identify and address the health needs of area residents. The health
indicators examined in the report are used to track needs and measureable changes over time. The report
identifies health areas where Deschutes County has improved as well as areas in need of improvement. The
report has been used as a starting point in creating goals in each Strategic and annual planning cycle.
3. Central Oregon Health Assessment Task Force: The most recent regional planning began late in 2010 when
stakeholders formed a task force to gain access to health information for planning and program decisions.
This group also identified a web-based health indicator tool to be used by all health systems and the
community. The data work and new web project will support current and future Health Reports and help
our work on a Regional Health Improvement Plan. This task force will continue to support the work of the
Central Oregon Health Council.
4. Regional Health Report Update: In the fall of 2011, the department developed a research analyst role to
update the Deschutes County 2009 Health Report. This work was funded by a State Accreditation Support
Grant. This research analyst has presented updated health report data at regular intervals to our Behavioral
and Public Health Advisory Boards, the Regional Health Improvement Plan Committee and our Board of
County Commissioners. Feedback from these interactive presentations resulted in identification of ten data
priority areas to be addressed by the Regional Health Improvement Plan and our Strategic Plan.
5. The Regional Health Improvement Plan: In 2011, the Central Oregon Health Council began development of
a regional Health Improvement Plan (RHIP) as required in SB 204 (2011 session). RHIP development ran
concurrently with the Deschutes Health Services’ strategic planning process and similar efforts in Crook and
Jefferson County Health Departments. This concurrent platform supported plan alignment and focus. The
RHIP was completed in March 2012, effectively linking regional and County efforts. Lead members of the
Deschutes County Strategic Planning Committee actively participated in the development of the RHIP. With
the emergence of significant health reform in Oregon in 2012, the RHIP will be developed and modified
periodically over the next several years.
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6. Strategic Planning Process:
a. Mission, Vision, Values – Adapted from inclusive work during the merger of Health and Behavioral
Health Department. Values complement Deschutes County values.
b. SWOT Analysis – Prepared during annual fall 2010 and 2011 management retreats with our Health
Officer and Medical Director. The document in the appendix entitled “Ten Likely Environmental
Changes in 2012-2015” further examines external factors impacting public health and care delivery.
c. Domain Creation and Development – Health Services management developed these domains, or
chapters, for the plan in collaboration with Health Departments in Crook and Jefferson counties. The
domains for the regional Health Improvement Plan are very similar.
d. Staff and Workgroup Input – An inclusive staff process was used to generate a preliminary list of
potential plan priorities. Using available data and program information, staff worked in small groups
over approximately ten weeks to brainstorm and identify proposed priorities.
e. Workgroup Process – Planning rooms were established at two department locations. The nine domains
were posted on wall boards in both rooms. Considerations included Health Report data, grant
requirements and opportunities, emerging health reform and gaps in service. Suggestions were created
using “post it” style notes. Recommendations were collected and formed the basis of the first plan
drafts. Staff participation and response to this open process was very positive and produced a large
number of goals.
f. Stakeholder Input – Once the draft was assembled, it was critiqued by the Behavioral and Public Health
Advisory Boards, regional partners, Board of County Commissioners and department leadership. The
Advisory Boards, comprised of stakeholders with a broad spectrum of expertise and perspective, were
very helpful in editing the plan draft. Additional health data was also developed during this stage.
g. Oregon Health Improvement Plan – The Oregon Health Improvement Plan was also examined for
alignment and gaps. This comparison document is available for review.
Timeline – The timeline follows in Appendix ii a. Minutes for these meetings were recorded to document
input and feedback in developing the plan.
Annual Planning Cycle – The planning cycle in Appendix ii b. visually demonstrates the annual process that
Health Services will engage in throughout the duration of this plan. The plan will be reviewed and revised
annually and will help form the basis of annual plans and budget priorities.
Link to Quality Improvement Plan – Health Services has adopted and is implementing a Quality Management
Plan (QMP), focusing on continuous quality improvement in everyday operations. The organization operates
with two Quality Councils (Behavioral Health and Public Health), two Quality Improvement Specialists,
project teams, and workgroups. The QMP and project priorities are reviewed quarterly. This includes a plan
for a more intensive review each fall to include a Strategic Plan evaluation and update, the selection of
priorities for the next annual plan and the early development of budget priorities for the next year.
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Appendix ii a.
2012-2015 Strategic Plan Development Timeline
Date Item/Meeting Outcome
2011
Sept 16 Deadline for program areas to submit
goals for Strategic Plan
-Mission/Vision/Values
-9 Strategies & Goals
Sept 20 1st Draft completed (rough)
Sept 20 PH Leadership Team Review of 2008-11 Strategic Plan
Sept 21 BH Advisory Board -Review of Strategic Plan
-Health Assessment update
-Review of 2008-11 Strategic Plan
Sept 26 Management Team
Sept 28 PH Advisory Board
Oct 12 Board of County Commissioners -Health Assessment update
BH & PH Leadership Meeting -Review Draft
Oct 26 Combined BH & PH Advisory Board
Meeting
Review & edit Strategic Plan
Oct 31 Management team retreat -Review & edit Strategic Plan
-Update SWOT Analysis
Nov 4 2nd Draft completed
Nov 8 PH All staff
BH All staff
Share with staff
Nov 15 Review by Kuhn & Emrick Detailed editing
Nov 16 BH Advisory Board Review if needed
Dec 07 PH Advisory Board -Strategic Plan update
-Health Assessment update Dec 21 BH Advisory Board
Dec – Mar Central Oregon Health Council Health Improvement Plan
2012
Jan – Feb BH & PH work on FY 2013
Work Plan
2012-13 Work Plan Draft
Jan 3 Regional Health Improvement Plan
Committee
Health Assessment Review and input (top
10 priorities)
Jan 18 BH Advisory Board Health Assessment Review and input (top
10 priorities) Jan 25 PH Advisory Board
Feb 7 Final Draft completed (all input due)
Feb 15 BH Advisory Board -1st Read of Plan
Feb 22 PH Advisory Board
Feb 27 Board of County Commissioners Work Session to present Strategic Plan
and review
Mar 21 Combined BH & PH Advisory Board
Meeting
-Adopt Strategic Plan
-Adopt 2012-13 Work Plan
Mar Central Oregon Health Council Health Improvement Plan completed
Mar Budget Development Actions & Measures to County
Administration
April Board of County Commissioners Adopt Strategic Plan
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Appendix ii b.
Winter
Review Regional Health
Improvement Plan
Make Adjustments to
Strategic Plan
Create Annual Work Plan
Fall
Evaluate Strategic
Plan Progress
Review Health
Report Data
Spring
Budgets Aligned
with Plan Priorities
Adoption of Plans
and Priorities
Summer
Review Legislative
Session Outcomes
Begin implementing
Work Plan
Annual Strategic
Planning Cycle
Central Oregon Health
Board
County Commissioners
Public & Behavioral
Health Advisory Boards
Community Partners
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Appendix iii.
Accomplishments in Recent Years
Over the past eight years, previous Strategic Plans, grant applications and program development efforts have
resulted in considerable growth in our services and our contributions to our communities and our region.
“Better Access to Help” for People in Need
a. OHP coverage: Increased community behavioral health services for Oregon Health Plan members through
employees and contracts as members increased 211% from 8,134 (2004) to 25,340 (2012).
b. More agency options: Increasing mental health options by end of 2012 by certifying and funding six more
behavioral health agencies since 2004. Authorized help for 649 people in FY 2011 alone.
c. New integrated Redmond Center: With Building Services, secured State and Mosaic Medical commitments
to open an extensive integrated Redmond Service Center by January 2013.
d. School centers: Expanded Health Services school-based health centers to six centers, opened new centers in
Sisters and Redmond (High School) in 2011. Note: Includes Gilchrist school-based center in Klamath County.
e. Construction in Sisters: With Deschutes County grant writer, secured a Federal grant to construct a multi-
purpose, integrated health center in Sisters to serve children and seniors. Scheduled to open July 2013.
f. Klamath County: With the support of the Klamath County Commissioners, became responsible for providing
behavioral health services to Oregon Health Plan residents living in Gilchrist, Chemult and Crescent.
“Better Health” for County Residents
a. County health ranking: As the County’s public health agency, contributed to favorable county health
rankings. Deschutes County ranks 4th of 33 Oregon counties in health factors; 7th in health outcomes.
b. #1 in health behaviors: Deschutes County ranked first of all Oregon counties in “health behaviors” (measures
of smoking, diet and exercise, alcohol use, and risky sex behaviors).
c. Teen pregnancy prevention: With all area school districts, became the first Oregon County to develop new
policies and implement My Future My Choice (sexuality education) in middle schools countywide; secured a
regional grant to implement Cuidate, a prevention program for Latino youth.
d. Immunizations: Expanded immunization capacity with local private and public clinics, helping to assure
access and education about vaccine. In 2010, added Mosaic Medical’s Bend Clinic as a delegate clinic;
increasing free vaccine for people at high risk.
e. Wellness: Promoting worksite wellness in the community; sponsored an agency Health Improvement
Committee. Continuing to pilot a Farm to Work program and offering other improvements.
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“Better Care and Safety” for Our Community
a. Primary care in specialty clinic: In cooperation with Mosaic Medical, primary care services are offered at the
Annex, our specialty clinic for people with a serious mental illness.
b. Behavioral health care in primary care clinic: Financed first specialty behavioral health clinician at Mosaic
Medical in Bend (Greenwood Avenue). Clinical services begin in 2012.
c. Regional Nurse Family Partnership: Beginning in 2011, co-sponsored a best practice, regional Nurse Family
Partnership program, improving maternal and child health for high-risk families in Central Oregon.
d. Peer specialists: Created our first Community Health Worker positions; employed two peer support
specialists in our Behavioral Health Division, preventing ill health and coordinating services.
e. Quality Program: Beginning in 2011, created a new Quality Improvement Program addressing access, critical
incidents, client concerns; sponsoring projects focused on better health and care. Formed Quality Councils.
f. Environmental health: Successfully transitioned Deschutes County Environmental Health to Deschutes
County Health Services, integrating the staff and services with our Community Health team.
g. Housing options: In 2010-11, completed the largest increase in residential options for people with mental
illness in the County’s history (48 more units or slots) focused in Bend and Redmond, preventing
homelessness, hospitalizations, improving health and safety and reducing costs.
h. Emergency preparedness: Participating in County emergency preparedness; staged successful emergency
preparedness exercise with the U. S. Postal Service, health providers and law enforcement; health site at
Health Services for affected workers.
i. Parent Child Interaction Therapy: Offering a best practice Parent Child Interaction Therapy program,
improving parent child interactions and preventing abuse and neglect. Expanding locations for PCIT in 2012.
j. Crisis training for police: Co-sponsored best practice Crisis Intervention Training with law enforcement,
providers and advocates. In 2011, trained 25 law enforcement officers.
k. Day treatment: With ABHA, contracted with The Child Center to come to Central Oregon and offer day
treatment services to children in Central Oregon.
“Less Cost” for Our Health Services in Oregon and Nationwide
a. Chemical dependency prevention: Secured multi-year State Strategic Prevention Framework grant for
alcohol and drug prevention focused on binge drinking by young adults; managed by Children & Families
Commission.
b. Living Well: Continuing to expand Living Well with Chronic Conditions, a regional, evidence-based chronic
disease program, helping Central Oregon residents to manage chronic conditions and lessen hospital stays.
Offered to the community in both English and Spanish.
c. Early Assessment & Support: Sponsored and expanded a regional early intervention EAST program; helping
transition age youth experiencing psychosis for first time. Offers better care, reduces hospitalizations.
d. Less State hospitalizations: Helping people return to the community from the State Hospital; participating in
Oregon’s new AMHI (Adult Mental Health Initiative). Reduces hospital stays and improves care.
e. Assertive Community Treatment (ACT): Developed a best practice ACT team, improving care with 24/7
behavioral health service for people with severe mental disorders and reducing unnecessary hospitalizations.
f. Children’s wrap-around services: Developed and strengthened our Children’s Wrap Around team, offering
intensive community services to high-need children with serious emotional disorders. Assures better care
and reduces hospitalizations and out-of-community placements.
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a. Federal LAUNCH program: Implemented Oregon’s first five-year federally funded Linking Actions to Unmet
Needs in Children’s Health program, enrolling more than 100 at-risk children and families. Integrated
services are provided by a multi-disciplinary team with a nurse practitioner, mental health therapist and
Family Access Network advocate. Strengthens families and prevents abuse.
b. Central Oregon Health Board: With the Commissioners, formed a regional Health Board to replace
Accountable Behavioral Health Alliance (five-county Behavioral Health Organization); developing regional
services among counties for greater efficiency, an increase in resources and better services.
c. Central Oregon Health Council: Helped pass SB 204, forming Central Oregon Health Council to serve as
community governance over State required Coordinated Care Organization (HB 3650 2011 session).
d. State integration pilot: With Central Oregon partners, recognized as the first State of Oregon demonstration
site for service integration in partnership with the hospital system, insurance groups and health providers.
e. Health data web site planned: As a region, lead organization(s) for health assessment; launching community
web site with health assessment data by January 2013 to increase community awareness and response.
“A Stronger County Department” with A Focus on Accountability
a. Department merger: In 2009, merged the Health and Behavioral Health Departments to increase integration,
effectiveness and efficiency. In 2010, added the Environment Health program to the Public Health Division.
b. Certification: Successfully achieved State certification of the mental health and chemical dependency
programs in 2009. Successfully completed the State Public Health Triennial Review. Addressed all findings
and recommendations, completing the process in September 2010.
c. Contracts unit: Established a contracting unit within the department to centralize and streamline contracting
and contract monitoring processes.
d. Utilization management: Added staff person to authorize behavioral health services for OHP members
through certified mental health agencies in Deschutes County.
e. Chart auditing: As part of effort to improvement clinical chart documentation; added a chart auditor to the
staff to identify errors and train clinicians and supervisors. A second auditor will be hired in 2012.
f. Public Health Accreditation: First county in nation to participate as a beta site for public health accreditation
through the Public Health Accreditation Board; improving our operations through this process.
g. Business services: Continuing improvements and integration in our business services area with greater
emphasis on billing systems and processes, critical business functions as part of health reform.
h. Electronic health records systems: Improving our health record systems with new technologies;
implementing Unicare system in behavioral health in 2011; preparing to select and implement the OCHIN
system in public health in 2012-13.
“A Better Community and Regional System” During A Time of Health Reform
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Appendix iv.
Ten Likely Environmental Changes in 2012-2015
1. Regional development. The Central Oregon
Health Council, a new Coordinated Care
Organization (CCO) and the Central Oregon Health
Board (counties) as well as limited funding and the
numerous other regional groups in Central Oregon
all point to an expansion of collaborative work
across the three-county area.
2. A shared goal of care coordination1
with clients and between providers.
Integration of primary care and behavioral health
care throughout Central Oregon and a close working
relationship with Federally Qualified Health Clinics
(Mosaic Medical, La Pine Community Health Clinic).
3. Formation of a Coordinated Care
Organization in our region. Our CCO will
manage all Medicaid and Medicare-Medicaid funds.
This role may expand in the future to more public
and commercial business including PEBB and OEBB2.
PacificSource may become a major player in this
work. Our Medicaid behavioral health work will
transition to the Central Oregon Health Board.
4. National accreditation of the three
Public Health agencies in Central
Oregon. This will improve our practice and make
us more competitive for grants. It will require
ongoing improvement and reporting efforts.
5. Oregon Health Authority Addictions &
Mental Health Div. system change.
Beginning in July 2012, State General Funds for
behavioral health will require a common statewide
system of core services, global budgeting, a new
statistical reporting platform and accountability for
outcomes. Service Elements will end.
1 Coordination will particularly focus on improving our
Health Services’ clinical work with primary care
practices and the hospital as well as between public
health, public health clinical and behavioral health .
2 Public Employee Benefit Board and Oregon Education
Benefit Board.
6. Outcome based systems and greater
accountability required. The State plans to
move to a global budgeting model with payment
made based on outcomes achieved. Fee for service
payments may go by the wayside. Failure to
perform (evidence of measurable outcomes) may
result in loss of funding.
7. Health insurance coverage for 95% of
Central Oregon residents in 2014.
Federal reform and the national movement toward
health insurance exchanges (see SB 99 in Oregon)
will provide coverage to most uninsured. Working
poor could still struggle for access.
8. A potential crisis in health care. While
more people will be insured, we may lack the
primary care provider capacity to serve people. If
new payment systems are difficult for providers,
people could be excluded from service. Access will
remain a critical issue in our county. We must
assure timely access to quality care.
9. Changes in professions and the need
for work force development. We will see a
continuing push for people to work at the top of
their licenses and the emergence of a new work
force: “community health workers” (i.e., para-
professionals including peer support specialists) who
help to coordinate care.
10. Unknown changes in the roles of
County government. The roles as the “local
mental health authority” and the “public health
authority” are increasingly uncertain over the next
several years. Work on safety net issues will remain
as the community continues to turn to County
government to help with social, health and safety
issues that must be addressed.
Appendix v.
COMMUNITY HEALTH ASSESSMENT For PUBLIC HEALTH
ACCREDITATION
Conduct and disseminate
assessments focused on
population health status and
public health issues facing the
community
*Focus: Systematic monitoring of
health status; collection, analysis, and
dissemination of data; use of data to
inform public health policies,
processes, and interventions; and
participation in a process for the
development of a shared,
comprehensive health assessment of
the community.
DOMAIN INCLUDES FOUR STANDARDS:
1. Participate in or Conduct a Collaborative Process Resulting in a Comprehensive
Community Health Assessment.
2. Collect and Maintain Reliable, Comparable, and Valid Data That Provide Information on
Conditions of Public Health Importance and On the Health Status of the Population .
3. Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public
Health Hazards, and Social and Economic Factors That Affect the Public’s Health .
4. Provide and Use the Results of Health Data Analysis to Develop Recommendations
Regarding Public Health Policy, Processes, Programs, or Intervention.
*Public Health Accreditation Board (2011). Standards & Measures, V 1.0, May 2011. http://www.phaboard.org/ pg. 9.
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Appendix vi.
Regional Health Improvement Plan: Ten Priority Areas
In conjunction with the Central Oregon Regional Health Improvement Plan, ten priority areas were identified
from the Regional Health Report. They will serve as a driving force in planning and community action. The
complete Central Oregon Regional Health Report, with all indicators and data elements, will be available at
http://www.deschutes.org/Health-Services.aspx in April 2012.
(The following items are not listed in order of importance.)
1. Disparity & Inequity
Comparative mortality ratios in areas of southern Deschutes County and northern Jefferson County are
significantly higher than state average, and are considered a health disparity (or difference) in health. Mortality
in this case is related to geographic area. But the disparity is also inequitable because it is avoidable and unjust.
It is no surprise to many Central Oregonians that our rural areas have high rates of poverty, less access to
services, greater distances to travel for needed care, and many individuals struggle to meet basic needs. These
systematic barriers needlessly impact individuals’ health. This is one example of disparity and inequity in our
region. Many other disparities exist, warranting investigation to determine if these differences are equitable
and just or not.
Improving public health will require work toward health equity—aiming for communities where all individuals
have the opportunity to attain their full health potential, and no one is disadvantaged from achieving this
potential because of socially determined circumstance.
2. Access to Resources
The ability to access resources, services or assistance is impacted by numerous factors including transportation,
travel distance and time, finances, social and cultural barriers, waiting time, and the systems of care in place. An
elderly person living alone and unable to drive may have financial means but limited access to care. Similarly, a
working single mother with no car may have access to public transportation but cannot afford the cost of unpaid
leave from work to access resources. Central Oregon’s rural and urban population: More than 41% of Central
Oregonians live in unincorporated areas and towns with less than 2,500 people.
3. Early Childhood Wellness
A child’s growth begins in pregnancy and continues into adulthood. Many factors impact childhood wellness:
social, environmental, physical, cognitive. Children in environments unable to meet their needs have increased
risk for poorer health, safety, development, and ability to learn. These unmet needs during childhood pose
threats to health long into adult and later life. Early childhood wellness is a short-term investment for today and
a long-term investment for the business, health, education and social sectors in decades to come.
4. Food Insecurity
Crook County and Jefferson County were among the top five Oregon counties with highest food insecurity.
Deschutes County has the largest total number of food insecure individuals in Central Oregon. In Crook County,
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the average cost per meal is nearly $1 higher than in Deschutes County and the rest of Oregon. It is estimated
that more than 37% of children in Jefferson County and Crook County may be food insecure. In Deschutes
County, of all the food insecure adults and children, 45% are not eligible for SNAP (Supplemental Nutrition
Assistance Program) or other federal food programs—a sizeable number of children and adults who may not be
able to access much needed assistance.
5. Oral Health
Though frequently identified by providers and community members as a problem in Central Oregon, there is
little recent data to estimate total burden of poor oral health in the region. Poor oral health can cause pain,
discomfort, and disfigurement; it can affect an individual’s quality of life, ability to eat and to speak, and can
interfere with opportunities to learn, work, participate, engage and contribute. What’s more, poor oral health is
related to chronic disease in later life.
6. Safety, Crime and Violence
Central Oregon counties have higher rates of abuse and neglect victims (confirmed cases) than the state of
Oregon. This may be due to differences in reporting and resources in the system of care, or an actual higher
rate of abuse/neglect. In 2009, Deschutes County and Crook County were ranked in the top ten Oregon counties
with highest crude rate of total violent crimes reported. In the same year, Jefferson County was in the bottom
ten Oregon counties for number of police per 1,000 of population. Last year, more than 1,450 individuals in
Central Oregon called an emergency crisis line about domestic violence alone.
7. Chronic Disease
In the past 65 years, adult chronic disease has grown into the main health problem for industrialized nations.
Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account for at least 50% of
the global mortality burden. In Central Oregon, chronic diseases are the leading causes of death for each
county. Crook County’s age-adjusted prevalence of adults with high blood pressure is 46.2%, significantly higher
than 25.8% of adults for all of Oregon. Exposures, modifiable behaviors, and risk factors all play a role in the
development of chronic disease in later life.
8. Alcohol, Drug and Tobacco Use
In 2009, more than 19% of adult males reported binge drinking in the past 30 days. In Central Oregon, adults
age 18-25 years old report higher rates of alcohol dependence in the past 12 months than individuals over 26
years old. Heavy drinking, drug use and tobacco use is associated with higher rates of all-cause mortality,
chronic disease, violence and abuse.
9. Behavioral Health
In Deschutes County today, suicide claims nearly as many lives as motor vehicle accidents. It is estimated more
than 9,000 adults in the tri-county region have serious mental illness. Roughly 1/3 of Central Oregon 11th
graders reported having a depressive episode in the past year. High depression scores are associated with poor
academic achievement, anxiety, poor peer and teacher relationships. The extent of the need for behavioral
health services and the capacity to provide services should be looked into. Early risk factors and prevention data
also need to be investigated.
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Appendix vii.
County-Operated Behavioral Health Services
Policy: Health Services will continue to focus County-operated programs and services in areas where the
department has particular skills and expertise and where the Central Oregon Health Board, in consultation with
our Coordinated Care Organization, determines our work is most beneficial. By policy, we will also work with
the Health Board to advance a network of agencies and services for outpatient care and treatment when such
options are of high quality, more cost effective and/or provide for consumer choice. In such instances, Health
Services will serve as one of several agency options or will refrain from offering such services, based on the
direction of the Central Oregon Health Board and/or the Deschutes County Board of Commissioners.
Areas of County employee focus: based on resources and need; subject to further review.
Prevention services and activities
Community support services for people with severe disorders
Specialized health and social services funded by the Oregon Health Authority Addictions & Mental
Health Division and/or the Central Oregon Health Council and Coordinated Care Organization
Clinic-based outpatient services (as part of a network of outpatient providers)
Health integration projects and models
Other services as prioritized by the Deschutes County Board of Commissioners
Program Area
Primary services offered by Deschutes County staff:
A. Prevention
services
1. Alcohol & Drug Prevention including the Strategic Prevention Framework Federal grant
(currently in cooperation with the Children & Families Commission
B. Child & Family
Program
1. Early Assessment and Support Alliance (prevention and early intervention) regional
2. School-Based Health Centers (integrated physical, behavioral and public health care)
3. Community hubs (e.g., Redmond Service Center; La Pine Service Center)
4. KIDS Center treatment services (trauma informed care)
5. Wrap-Around Program (intensive services for high-need children and families)
6. Parent Child Interaction Therapy (a highly effective parent-child treatment modality)
7. Safe School Assessments for area school districts
8. Mediation for divorcing parents
C. Adult
Treatment
Program
1. Integrated, intensive services for the seriously mentally ill, including primary care
embedded in our specialty clinic(s) in Bend
2. Assertive Community Treatment (wrap-around services for our highest need clients)
3. Supported education, employment and housing
4. Homeless outreach, case management and care coordination
5. Services for individuals involved in the justice system including support to treatment
courts and post-incarceration programming to improve health and prevent re-arrest
6. Coordination and treatment for people under the jurisdiction of the Psychiatric
Security Review Board and the Addictions & Mental Health Review Board
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Adult
Treatment
continued
7. Dual diagnosis treatment for individuals with co-occurring mental health and
substance use disorders
8. Residential treatment sites and services coordination and treatment
9. Outpatient services for high-need individuals requiring specialty coordinated care:
intensive outpatient, dialectical behavior therapy, eating disorder treatment, trauma
care
10. Linkage and coordination with the service system for veterans
11. Consultation with primary care practices (care coordination for transitioning clients)
D. Geriatric
Services
1. Care and consultation to individuals and families, primary care practices and assisted
living facilities; recommended to be developed into a specialized regional program
2. Care coordination with community safety net and health providers
3. Enhanced Care Outreach Services (ECOS) program for high-need clients
E. Crisis Services:
Coordination with
hospitals, justice
system, primary
care
1. Crisis Team – day services
2. Mobile Crisis Team as a 24/7 service to Crook and Deschutes counties; regional
3. Civil commitment
4. Protective services investigations
5. Care coordination with primary care and safety net providers
6. Psychiatric consultation to primary care providers
7. Participation in Crisis Intervention Training
F. Developmental
Disabilities
1. Eligibility determination
2. Case management
3. Coordination of family support
4. Crisis and diversion services
5. Foster care licensing and monitoring
Some services or activities may be developed regionally in the future.
— END —
Behavioral Health Electronic Health Records Team
Deschutes County Health Services Strategic Plan 2012-2015 3/14/2012
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Deschutes County Health Services
2577 NE Courtney Drive
Bend, Oregon 97701
541-322-7400 (Public Health)
541-322-7500 (Behavioral Health)
http://www.deschutes.org/Health-Services.aspx