HomeMy WebLinkAboutMental Health Biennial Plan
DESCHUTES COUNTY
MENTAL HEALTH
2009-2011 BIENNIAL
IMPLEMENTATION PLAN
April 23, 2008
Contact information:
Scott Johnson, Director
Deschutes County Mental Health (DCMH)
541.322.7502
scott_johnson@co.deschutes.or.us
Additional information is available through
the DCMH Strategic Plan
DESCHUTES COUNTY MENTAL HEALTH (DCMH)
2009-2011 IMPLEMENTATION PLAN
Table of Contents
Page
Letter to Bob Nikkel, DHS Addictions & Mental Health Division ......................................
1
General Guidelines
Licensure/Approval .............................................................................................................................. 4
Services to Diverse Populations ........................................................................................................... 4
Standard Plan Requirements
County Contact Information Form ....................................................................................................... 5
County Planning Process ..................................................................................................................... 7
Current Linkages with State Hospital System and Mental Health Acute Care Inpatient Providers .... 8
Residential/Detoxification Services Coordination ............................................................................... 9
Coordination of Addictions Treatment with the Criminal Justice System ........................................... 10
High Priority Needs ............................................................................................................................. 11
Allocation and Use of Resources Provided by AMH .......................................................................... 14
Attachment 1: List of Subcontracted Services for Deschutes County ................................................ 15
Attachment 2: Board of County Commissioners Review and Approval ............................................ 17
Attachment 3: Local Alcohol and Drug Planning Committee Review and Comments
Attachment 4: Local Mental Health Advisory Committee Review and Comments ...........................
18
Attachment 5: Commission on Children and Families Review and Comments ................................. 20
Attachment 6: County Funds Maintenance of Effort Assurance ........................................................ 21
Attachment 7: Planned Expenditures of Matching Funds (ORS 430.380) and Carryover Funds ....... 22
Attachment 8: Review and Comments by the Local Children, Adults and Families District Manager
for the Department of Human Services .....................................................................
23
Attachment 9: Review and Comments by the Local Public Safety Coordinating Council ................. 24
Prevention Plan ...................................................................................................................... 25
Attachment 10: Prevention Strategy Sheet ......................................................................................... 28
Problem Gambling Services Plan ......................................................................................... 29
Children's Mental Health Services Plan .............................................................................. 29
Older Adult Mental Health Services .................................................................................... 31
April 23, 2008
Mr. Bob Nikkel, Administrator
Oregon Department of Human Services
Addictions & Mental Health Division
500 Summer Street NE, E86
Salem, OR 97301-1118
Subject: Cover Letter with Deschutes County Mental Health’s 2009-11 Biennial Plan
Dear Bob:
The Deschutes County Mental Health 2009-11 Biennial Implementation Plan is enclosed as well as the
2008-2013 Draft Deschutes County Mental Health Strategic Plan. I am including this cover letter with
additional information on our work in Deschutes County and several recommendations of interest to our
county.
PROGRESS TO REPORT:
First of all, I want to thank your office and you, personally, for your support and assistance on
several matters that affect our state and county. Two recent actions by the State of Oregon will have a
measurable impact on our mental health and addiction treatment services in our county and region.
Comparable funding of “need” for health care access—Passage of HB 3067 coupled with your
decision to fund behavioral health services based on the need (including projected population) in each
county has helped assure Oregonians they can expect more comparable services and capacities in all areas
of our state. While services remain limited, they are focused on mandated populations and those in
greatest need. We can now begin to think systemically with an agreement that we have invested State
resources more comparably throughout Oregon. In time, elected officials, providers and advocates will
gain a better understanding of what that level of funding will buy.
Funding a community system that supports the State Hospital—Secondly, the 2007 Legislature began
an investment in the community system of care in an effort to invest in essential local services to
complement development of the new State Hospital system. Your leadership and the work of your staff
helped a broad coalition of stakeholders craft the Community Services Work Group report and begin to
define, objectively, the needs for and cost of core best practice programs to serve people without access to
behavioral health care in this state.
Mr. Bob Nikkel, Administrator
April 23, 2008
Page 2
Critical, core services improved—For Deschutes County, these two actions are resulting in a multi-
faceted investment strategy that includes supported employment, additional residential program options,
more ECMU and PSRB residential capacity and a new early psychosis program for adolescents and
young adults. We have also stabilized funding for our regional acute care system, mobile crisis team and
mental health court while expanding jail diversion (reentry) services and case management. Lastly, new
addiction treatment funds will support addictions treatment services for individuals in jail and after jail
release and for parents and/or guardians with children in the child welfare system. The justice system
project comes with shared funding by our Deschutes County Sheriff, significantly improving our
continuity of care for people with addictions in the justice system.
RECOMMENDATIONS:
Since the 2009-2011 Biennial Plan is intended to help chart our course for the future, we want to
offer a set of recommendations for your consideration. I would encourage you to analyze the
information from all Local Mental Health Authorities and develop a Community Improvement Plan for
the next several years. Improvements are needed in several key areas.
1. Fund the Community System of Care for the uninsured. With support of the Governor,
Legislature and Dr. Goldberg, implement the Oregon State Hospital Community Services Work
Group Report and the Central Oregon Community Services Work Group Report. Articulate
clearly and consistently that the Oregon State Hospital Master Plan will fail without a sizable
investment in community services. We simply cannot shorten length of stay and fund community
placements without State investment.
2. Adopt a formal AMH Investment Policy. Fund community mental health based on the Kessler
formula (or other formal methodology) and a population forecast every biennium. A clear policy
must be in place to drive the calculation of need and costs in an objective manner. This will help
assure the legislative intent in HB 3067 will be realized. Without a clear policy and consistent
application, or with a change in leadership, fast growing counties could quickly fall behind again.
We expect our county to experience a continuing influx of 7,000-9,000 residents annually. Our
Strategic Plan includes a three-year financial forecast and a realization that our local resources
will decline and service levels will diminish without further State investment.
3. Target co-occurring disorders, seniors' services and alternatives to incarceration. Particular
attention is needed in these areas given the State Hospital census projections and changing
demographics in State and community jail and corrections programs. We need system change
and development efforts in these areas including advancement of a project with our Chemical
Dependency Organization, State help in expanding senior services (through concepts like SB
1075) and methods to dramatically expand alternatives to incarceration as this county increases
the size of the local jail and forensic needs with the State hospital increase.
Additional note: Our reference to co-occurring disorders relates to alcohol / drug work as well as
needed improvements in our State and community capacity to work with cases that include both
developmental disabilities and mental health. From our perspective, there is a need for SPD and
AMH to work together to facilitate and help pay for services for co-occurring DD / MH cases.
Page 2 of 32
Mr. Bob Nikkel, Administrator
April 23, 2008
Page 3
4. Support local efforts to implement Oregon’s children’s wraparound program. It is critical
that we alleviate systemic barriers to services and better align resources to help children in need
of this level of care. We continue to work closely with community partners (school districts,
child welfare, juvenile services) but struggle to fully integrate services and blend resources. In
particular, our school partners continue to express concerns.
5. Pursue an initiative to increase productivity in community mental health through a
streamlined set of Administrative Rules and greater emphasis on client care. In conjunction
with the Division of Medical Assistance Programs (DMAP), seek ways to simplify medical
records and paperwork to maximize clinical time for direct client care. We request a clear
package of rule changes (linked to cost of care), an electronic record system, sample treatment
plans (that can help assure compliance) and DMAP support for a more efficient records system
and streamlined processes. Clear standards and review tools would also help local programs be
more efficient, effective and accountable and improve the site visit process. We are particularly
interested in tools that will greatly increase clinician productivity (more hours for direct care)
while meeting a streamlined set of rules and responsibilities.
6. Work with DMAP to limit risk of overpayments. As reported by AMH, the system lacks
resources to meet the needs of indigent Oregonians. Current Medicaid auditing and calculations
of overpayments threaten to erode some of the very resources that offer a foundation we can build
on to increase the capacity of our system. An aggressive technical assistance program is needed,
with the support of MHOs, to limit risk and loss of critical federal resources. We are also
appreciative of plans to launch a Medicaid Work Group in the coming weeks.
7. Improve and accelerate the AMH contracting processes. Delays in the development of
contract amendments have limited the ability of counties like ours to move quickly to invest
resources and demonstrate progress prior to the 2009 Legislative Session. In Deschutes County,
we are only now beginning hiring, contract amendments and RFPs in several areas. As of today,
we continue to wait for an amendment for the early psychosis project.
In closing, we are very appreciative of the work of AMH on behalf of residents of Central Oregon and our
entire state. We are hopeful you will act on these recommendations as well as those in other County
Biennial Plans as you prepare for the next biennium and the future of our mental health system in Oregon.
We look forward to working with you in this process.
Sincerely,
Scott Johnson, Director
Deschutes County Mental Health
cc: Len Ray, DHS Addictions & Mental Health Division
Deschutes County Commissioners Melton, Daly, Luke; Dave Kannner, County Administrator
Dolores Ellis, Chair, & Members, Deschutes County Addictions & Mental Health Advisory Bd.
Central Oregon legislators Sen. Westlund, Rep. Burley, Rep. Whisnant
Gina Nikkel, AOCMHP
Robin Henderson, Cascade Healthcare Community
Page 3 of 32
GENERAL GUIDELINES
1. Licensure/Approval
Deschutes County Mental Health (DCMH) is certified by the State of Oregon Office of Mental Health
and Addiction Services. The current Certificate of Approval for mental health services is valid until
June 9, 2008. The current Certificate of Approval for alcohol and drug services is valid until June 30,
2008. The current Certificate of Approval for children's ICTS services is valid until September 28,
2009.
2. Services to Diverse Populations
As noted in the 2007-2009 Biennial Plan, DCMH will seek to maintain alcohol and drug treatment for
ethnic and minority populations through our own services and investment in groups such as BestCare
Treatment Services, Serenity Lane, Rimrock Trails, and Pfeifer & Associates.
BestCare Treatment Services is a valuable community resource in our efforts to better serve people of
color. BestCare provides two Spanish language, culturally specific alcohol and drug groups a week in
Bend and plans to start another in Redmond May 1, 2008. That agency is also converting its
outpatient services to Matrix Model in Spanish to make them evidence-based. These services are an
essential part of our Deschutes County system.
Internally, Deschutes County Mental Health has initiated a work group to critically review our
operations and to make recommendations for improving our cultural competency. While we
recognize more work is needed in this area, we will struggle to make the improvements that are
needed without resources, better collaboration with the Latino community and a more effective
recruitment and workforce development process. At a minimum, we will actively work to attract
qualified bilingual/bicultural staff over the next several years as called for in our Strategic Plan. Any
assistance possible from AMH and higher education institutions to recruit and train qualified
professionals will be greatly appreciated.
Page 4 of 32
STANDARD PLAN REQUIREMENTS
1. County Contact Information Form
1. County Contact Information
County: Deschutes County
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Name and title of person(s) authorized to represent the county in any negotiations
and sign any agreement:
Name Dave Kanner Title County Administrator
Name Scott Johnson Title Mental Health Director
2. Addiction Treatment Services Contact Information
Name Lori Hill, Adult Treatment Program Manager
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7535 Fax (541) 322-7565
E-mail lori_hill@co.deschutes.or.us Note: Barrett Flesh, service to adolescents.
3. Prevention Services Contact Information
Name Robin Marshall, Prevention Coordinator
Agency Deschutes County Commission on Children & Families
Address: 1130 NW Harriman, Suite A
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-4802 Fax (541) 325-1742
E-mail robin_marshall@co.deschutes.or.us
Page 5 of 32
4. Mental Health Services Contact Information
Name Scott Johnson, Director
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7502 Fax (541) 322-7565
E-mail scott_johnson@co.deschutes.or.us
5. Problem Gambling Treatment Prevention Services
Contact Information
Name Fred Doolin
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7507 Fax (541) 322-7565
E-mail fred_doolin@co.deschutes.or.us
6. State Hospital / Community Co-Management Plan
Contact Information
Name Lori Hill, Adult Treatment Program Manager
Agency Deschutes County Mental Health
Address: 2577 NE Courtney Drive
City, State, Zip: Bend, Oregon 97701
Phone Number (541) 322-7535 Fax (541) 322-7565
E-mail lori_hill@co.deschutes.or.us
Page 6 of 32
2. County Planning Process
2001-2010 Comprehensive Community Plan—Deschutes County’s social service system has a rich
tradition of collaborative and integrated planning and program development efforts between local
agencies, systems and community members. This work is ongoing and occurs within the framework
of the Comprehensive 2001-2010 Deschutes County Community Plan compiled by the Deschutes
County Commission on Children & Families (CCF). DCMH and our local (and integrated)
Addictions and Mental Health Advisory Board (AMHAB) contributed to numerous sections. The
AMHAB had primary responsibility for the mental health and chemical dependency sections of the
plan. CCF also publishes a Report Card periodically reporting to the community on our progress on
critical priorities in the Community Plan.
Deschutes County Mental Health Strategic Plan—In the fall of 2004, the Deschutes County Mental
Health, Alcohol & Drug Advisory Board commissioned a Strategic Planning Committee composed of
Advisory Board members, County officials and the DCMH Management Team to develop a four-year
Strategic Plan to establish a financial plan and priorities for the next several years. Information was
solicited from numerous groups, both formally and informally, in the preparation of this document.
The Plan was adopted by our Advisory Board in 2005 and by the County Commissioners in 2006.
We are finalizing an update to this Strategic Plan for 2008-2013. The Strategic Plan draft is included
as part of this Biennial Plan. Our Commissioners are likely to adopt this plan update by May, 2008.
A copy is available upon request by contacting Scott Johnson, Mental Health Director.
Consumers and Family Members—There are a number of consumers, family advocates and
representatives of NAMI of Central Oregon on our Advisory Board. These individuals are involved
in the development, review and approval of our Strategic Plan. The Directors of the three community
mental health programs in Central Oregon meet with the NAMI Board at least quarterly.
Central Oregon Plan to Complement the State Hospital—In December, 2006 the Central Oregon
region published a plan titled “A Regional System to Support the Oregon State Hospital Master Plan,
Critical Community Service Needs & Plans For Central Oregon 2007-2013.” The plan was adopted
by the Deschutes County Board of Commissioners and many other groups. The Plan was also
included in the State Community Services Work Group Report to help illustrate advancements needed
in the community system of care if the new Oregon State Hospital System is to be successful.
2009-2011 State Biennial Implementation Plan—This document is a synopsis of ongoing and recent
developments and priorities for our county and the people we serve. Since the Strategic Plan is the
primary document used to outline our priorities, measure our progress and assist us in prioritizing
resources and program development activities, much of that material is referenced and reflected in
this submittal. It is considered part of our Biennial Plan by reference.
Professional Advisory Council and Other Stakeholder Groups—By statute, Deschutes County has a
Council of more than 20 community providers to advise the Commission on Children & Families
(organizer of the Community Plan) and to help coordinate and improve the local service delivery
system. DCMH participates on this Council.
Page 7 of 32
DCMH works closely with many groups in planning and service coordination. Examples include:
• Addiction treatment providers
• Bend-La Pine, Redmond and Sisters School Districts
• BestCare Treatment Services and Jefferson County (regional matters)
• Cascade Child Center
• Cascade Healthcare Community
• Consumers and family members
• Deschutes County Addictions and Mental Health Advisory Board
• Deschutes County Addictions Committee
• Deschutes County Adult Parole and Probation
• Deschutes County Commission on Children & Families
• Deschutes County Juvenile Department
• Deschutes County Local Public Safety Coordinating Council and public safety officials
• High Desert Education Service District
• KIDS Center (child abuse assessment and intervention)
• Local Developmental Disabilities Planning Committee
• Lutheran Community Services Northwest and Crook County (regional matters)
• NAMI of Central Oregon
• Oregon Department of Human Services Regional Office
Cultural Competency and Service to Minority Populations—DCMH is making an effort to improve
our services and accessibility to minority populations. Strategic Plan references follow:
"Increase the public’s access to services and the quality of our services for county residents who face
language or cultural barriers.
1) "Bilingual staff—Develop a bilingual (Spanish speaking staff) capacity within all department
programs, including reception staff. Long-term goal, resources may be required." The
Department has few bilingual staff at this time.
2) "Translation of Materials—Assure that key print and web information is available in
Spanish." All application materials including the statement of client rights and
responsibilities, the release of information form, and the document describing the reason for
seeking service are available in Spanish. Several brochures regarding mental illness and
substance abuse are also available in Spanish.
3. Current Linkages with the Oregon State Hospital system and Mental Health Acute
Care Inpatient Providers
We are fully committed to a high level of coordination between Deschutes County Mental Health and
acute care services for consumers who are residents of Deschutes County, particularly for indigent
clients and members of the Oregon Health Plan.
Central Oregon Regional Acute Care Council—The Council was formed in 2005 to help develop and
support an expanding regional acute care system for the benefit of residents of Crook, Deschutes and
Jefferson counties. The Council includes representatives from Cascade Healthcare Community, the
Addictions & Mental Health Division, Accountable Behavioral Health Alliance, the three Central
Oregon Community Mental Health Programs, NAMI of Central Oregon, local public safety officials
Page 8 of 32
and other community representatives. This group also oversees use of our indigent acute care (SE 24)
resources to assist indigent mental health consumers needing acute care help in Central Oregon.
Central Oregon Hold Rooms—Deschutes County residents benefit from expanded hold room capacity
(5 beds) in Bend at St. Charles Medical Center and from a transport hold room at the system's
Redmond hospital. In Bend, consumers with acute mental health needs are placed in St. Charles
Medical Center. Once stabilized, clients are transferred to Sage View when that is deemed beneficial
and necessary.
Sage View—This Bend secure inpatient psychiatric facility for adults needing stabilization and short-
term treatment for mental health issues was opened in February, 2005, by Cascade Healthcare
Community, our largest hospital system in Central Oregon. Deschutes County Mental Health staff
work regularly with Sage View clients and staff.
Wait List Reduction Project—We coordinate placements with any state hospital facility for Deschutes
County residents in need of long-term care. DCMH staff work closely with each of the out-of-area
facilities to coordinate intake, care and discharge planning. Central Oregon counties continue to
make every effort to reduce our use of out-of-area facilities by using our limited local options.
Development of viable community systems remains a high priority for Central Oregon. Residential
options will be increased in the next two years with Springbrook’s opening of a 5-bed residential
treatment home (PSRB), Telecare’s development of a 10-bed secure residential treatment facility
(with construction by Deschutes County) and Telecare’s development of an 8-bed residential
treatment facility.
Utilization Management Improvements—The Central Oregon region has a utilization manager hired
by ABHA as our shared Mental Health Organization. The manager oversees, monitors and helps
coordinate services, admissions and discharges for indigent and OHP consumers at any acute or sub-
acute facility serving our clients. DCMH staff are actively involved in this process as well, including
care coordination and transition planning.
Other Services and Changes Since 2007-2009—While the general system has seen notable
improvements, respite care options and diversion services remain insufficient. We are continuing to
evaluate and explore options for other step-down and respite services and other sub-acute care. All
available SE 24 and Oregon Health Plan resources are invested in the system at this time.
A note of caution: Indigent resources provided through the State of Oregon, while increased, will still
be inadequate to meet acute care needs in our region over the next several years. Our three-year
investment plan for these resources is not sustainable, requiring selection of our more effective
strategies or additional investment by the State of Oregon.
4. Residential/Detoxification Services Coordination
When detoxification and / or residential alcohol / drug treatment is needed, the DCMH case manager
will facilitate admission to the appropriate treatment facility and will maintain contact with the client
and the facility's treatment staff. The treatment facility will coordinate ongoing outpatient care with
the DCMH case manager when the client is ready for discharge from the facility.
Page 9 of 32
5. Coordination of Addictions Treatment With the Criminal Justice System and Drug
Court Referral Process
Much of the County’s SE 66 funding goes to local alcohol and drug outpatient providers. The
corrections population is identified as one of the priority populations for these services. DCMH
recently released a Request for Proposals, in cooperation with the Deschutes County Sheriffs Office,
to provide ongoing addiction treatment services both while incarcerated and sustained upon release
from the jail. SE 66 funding also helps to support the Bridge Corrections Program wherein DCMH
staff work with the local Adult Jail and Parole & Probation Department to connect clients with a
serious mental illness and co-occurring addictions problem to treatment and other social services.
Deschutes County Family Drug Court Referral Process:
Any community agency that is involved with a defendant who is a potential candidate for the
Deschutes County Family Drug Court (DCFDC) program can refer a case to the program. If the
referral meets the admission criteria, it is processed in the following way:
The referral is forwarded to the DA’s Office and DHS for review. The DA’s representative and
DHS representative determine whether the referral is appropriate for the DCFDC based on
criminal and DHS history.
If deemed appropriate by the DA and DHS, the referral is then sent to the DCFDC Judge and the
treatment team for consideration.
If deemed appropriate by the DCFDC Judge, a hearing is scheduled for the referred party to
appear in front of the DCFDC Judge in order for the court to provide information about the
program and determine if the referred party is interested in participating in the program.
If the referred party is interested in participating, the contracted treatment provider on the team
conducts an initial alcohol and drug treatment screening to determine whether the referral is
appropriate for the level of care offered by the DCFDC program.
After the treatment screening occurs, the treatment team meets to discuss the referral then makes
a recommendation to the DCFDC Judge regarding whether to admit the referred party into the
program.
If the DCFDC Judge decides to admit the participant into the program, the participant is eligible
to begin services with DCFDC immediately after he/she is accepted into the program.
Deschutes County Family Drug Court Admission Criteria:
The participant must have an active dependency and/or criminal case.
The participant must have a child(ren) that he/she is responsible for parenting. The child(ren) can
be in the custody of the participant, DHS or other relative placement at the time of DCFDC entry.
The participant must have an active substance abuse problem as demonstrated by one or more of
the following: current drug related criminal charges, a dependency case resulting from drug
related circumstances, a history of positive drug tests administered by DHS and/or the probation
department, or pending probation violation proceedings resulting from drug related
circumstances.
The drug abuse problem may involve methamphetamine, other drugs, alcohol, or a combination
thereof.
Page 10 of 32
6. High Priority Needs
Program Priorities:
Goal 1: Health care services for high need clients—Sustain and expand critical community
services to Deschutes County residents.
• Emergency Preparedness—Adopt a County behavioral health plan by 12/08. Include staff
readiness; help for vulnerable populations and first responders. Department-wide
• Cultural Competence and Service—Develop strategies to help people of color; emphasize the
Latino community. Department-wide
• Children’s Mental Health Services—(a) Develop the Early Assessment and Support Alliance
(early psychosis) (28 young people). (b) Sustain therapeutic service levels, including in at
least 25 schools as well as safe school assessments. (c) Provide therapeutic services to
victims of abuse and neglect and analyze treatment capacity for the KIDS Center. (d) Offer
community-based clinic services and mediation assistance for divorcing families with
children. Child & Family
• Children’s Intensive Services—Help 40-60 children with significant mental health needs.
Provide community options through wraparound services, respite options, therapeutic foster
homes and intensive community services. Support Tamarack Center development and day
treatment options. Maintain low use of psychiatric residential treatment. Child & Family
• Acute & Crisis Care—Increase Crisis Team services. Analyze trends for commitment
investigation and civil commitments. Evaluate performance of new Mobile Crisis Team.
Sustain Sage View and Psychiatric Emergency Services indigent care. Begin to develop
crisis respite option(s). Adult Program
• Chemical Dependency—Increase addictions treatment services for indigent adolescents with
an emphasis on North and South County. Child & Family
• Chemical Dependency—Increase treatment services for adults in the justice system, parents
in the child welfare system and adults with co-occurring disorders. Adult Program
• Chemical Dependency—Work with our Chemical Dependency Program, the State and ABHA
to blend Medicaid funds to help people with co-occurring disorders. Adult Program
• Justice Services—Expand alternatives to incarceration with jail expansion. (a) Assist with
jail mental health program planning. (b) Participate in jail Reach In Program. (c) Expand
Mental Health Court (25 clients) and Bridge Program (75 clients). (d) With Sheriff, expand
addictions treatment during and after jail stay. (e) Sustain Family Drug Court. (f) Continue
law enforcement training; support Crisis Intervention Training. Resources requested for
Bridge and Mental Health Court in the 2008 County Budget Process. Adult Program
• Employment—Expand staffing and Supported Employment services (65 clients). Adult
Program
• Housing—Increase County’s bed capacity. (a) Help Telecare develop 10-bed secure and 8-bed
residential treatment programs. (b) Help Springbrook reopen a 5-bed home (forensic clients).
(c) Help Housing Works develop transitional housing for people with mental illness. (d)
Develop a DCMH housing specialist position by 2009. (e) Expand supported housing and
homeless outreach if possible. Adult Program
• Veteran’s Services—Initiate improved coordination regarding community services to
veterans. Adult Program
• Developmental Disabilities—Expand case management and respite services for DD clients
and their families. Participate in State discussions of County role(s) in DD services; promote
primary role for County in planning, services coordination and quality monitoring. Expand
the number and expertise of residential resources to allow individuals to remain in the
community and receive the services they need. DD
Page 11 of 32
• Seniors' services—Measure current and needed capacity to serve this growing population.
Participate in the statewide advocacy to increase geriatric services. Document performance
and benefit. Resources requested in the 2008 County Budget Process. Seniors
Goal 2: A Healthy Workforce and Work Place—Recruit, train and support a highly
qualified, motivated and effective staff. Involve staff in strengthening our organization and
services. Fairly and consistently evaluate performance. Maximize productivity, professionalism
and effectiveness.
• Workplace improvement—Complete biennial staff survey. Use results for team and
department improvements. Report progress to staff by 7/09. Department-wide
• Cross-Training—Strengthen Department support through cross-training of support
personnel. Business Services
• Professional Development—With programs, conduct training survey. Set training priorities
through December, 2010. Emphasize best practice. Department-wide
• Competitive Salaries—With County Administration, seek to offer competitive salaries (for
recruitment and retention). Continue reviews including reception, adjust as needed.
Business Services
• Work Place Safety—Assess work place safety for staff, volunteers and clients utilizing results
of Bend Police review and other information. Develop and implement protocols and training
as needed. Department-wide
Goal 3: Resiliency and Recovery Based System; Client and Family Involvement—
Encourage clients to take control of their lives and participate fully in the community 1 . Actively
involve clients in services, program development, evaluation, education and advocacy.
• Resiliency and Recovery—Promote resilience, recovery, and self-sufficiency for our clients.
Include client recovery goal(s) in treatment plans and progress notes. Department-wide
• NAMI—Collaborate with NAMI of Central Oregon on projects of mutual interest including
the Peer to Peer Program and training for law enforcement. Department-wide
• Participation and Leadership—Continue participation of clients and family members on
decision making committees and involve them in the hiring process for new staff. Promote
and support consumer leadership through continued support of People First and Self-
Advocates as Leaders training opportunities. Seek to implement recommendations from
2008 Consumer planning project. Department-wide
• Evaluation—Emphasize client involvement in quality improvement. Review Deschutes
County client satisfaction survey results. Gain feedback from non-OHP clients as well.
Business Services
Goal 4: Accountability, Access and Public Benefit—Strive for excellence. Emphasize best
practice, compliance, quality improvement, and productivity. Complete our Audit Action Plan,
conduct outreach, offer local services; reduce wait lists and no shows where possible.
• Access—Continue to assess public access to our services. Seek equitable access for indigent
and OHP clients in North and South County. Re-examine mobile crisis region in 2009.
Participate in plans for a County campus in Redmond. Sustain school services (Redmond
and La Pine). Seek resources to serve seniors. Department-wide
• Access—Continue providing services in the most convenient appropriate location for the
client recognizing the transportation difficulties faced by the seniors’ population. Seniors
• Medicaid Compliance (Medicaid Work Group)—Assure compliance with Medicaid rules (2007
Fraud & Abuse Training). Consult with ABHA and State agencies. Manage project through
a DCMH Medicaid Work Group. Department-wide
1 Paraphrased from Partners in Crisis, an advocacy and education group seeking to improve services for people with mental illness at risk of
contact with the justice system
Page 12 of 32
• Contracting—Improve DCMH document management and contract monitoring. Develop a
contracts specialist position. Business Services
• MMIS Replacement—Participate in Oregon’s upgrade of its Medicaid Management
Information System (claims processing/provider payments). Use new system in 2008.
Assure DCMH systems and processes interface effectively. Business Services
• Community Report—Publish an annual report on our services and performance.
Department-wide
• Web Site—By June 2009, update Department web site; include service, performance, and
resource information. Consider use of Network of Care system. Business Services
• Performance Review—Use a quality improvement process and review of service data
quarterly (including client care rate, quality measures, chart improvements, complaints and
critical incidents, OHP penetration rate). Business Services
• Electronic Record—With programs, initiate 2008 needs assessment. Identify software
options that meet our needs and resources. Complete feasibility study and business plan in
2009. Consider acquiring a new information system to support treatment, reduce
paperwork, document services and secure revenue. Resources will be needed to implement.
Business Services
• Licenses—Complete state processes to renew service licenses including alcohol and drug
treatment and prevention (June 2008), mental health treatment services (June 2008) and
children’s intensive services (September 2009). Department-wide
Goal 5: Sustainability, Stewardship and Resource Development—Sustain core services,
meeting the needs of a growing community whenever possible. Manage resources wisely and
balance our budget while meeting our legal and contractual obligations.
• New Funding—(a) Work with the County; seek new resources for school-based services.
Child & Family; (b) Work with the County; seek new resources for alternatives to
incarceration. Adult Program; and (c) Seniors' Mental Health. Seniors
• Sound Financial Management—Prepare 2008-10 budget in support of Strategic Plan.
Update the three-year financial plan semi-annually; use operating funds and reserves to
balance the budget and cover essential costs. Develop contingency plans as needed.
Business Services
• Patient Fees—Prepare an assessment of our fee scale. Assure patient fees are calculated
accurately and analyze our collection process. Business Services
• Encounters—With programs, assure services are documented accurately and (where
possible) at levels that meet or exceed revenues used. Each spring; calculate service unit
costs based on expenses and within Medicaid rules. Business Services
Page 13 of 32
7. Allocation and Use of Resources Provided by AMH
DCMH uses State resources according to the guidelines laid out in the AMH / Deschutes County
Financial Assistance Agreement. These resources are used to provide in-house and subcontracted
services. The increase in use of subcontracted providers relates primarily to alcohol and drug
treatment services for those involved in the criminal justice or child welfare system. Resources are
used to increase and improve the use of evidence based practices by training DCMH staff in
Collaborative Problem Solving, Acceptance Commitment Therapy, Motivational Interviewing, and
Seeking Safety. All these techniques are used in many of the different services we provide. There
are no reallocations to service elements.
Page 14 of 32
Addictions and Mental Health Division – Attachment 1
LIST OF SUBCONTRACTED SERVICES FOR DESCHUTES COUNTY
For each service element, please list all your treatment provider subcontracts
on this form. In the far right column indicate if the provider delivers services
specific to minorities, women, or youth. *Contracts may be annual or biennial.
Note: For the purpose of review by the Deschutes County Board of
Commissioners, this table also includes other Deschutes County Mental
Health contracts that may not require use of any AMH Funds.
Provider
Name
Approval / License
ID Number
Service
Element
AMH Funds in
Subcontract 2
Specialty
Service
BestCare
Treatment Services
93-1269087 66 $140,000 Bilingual
in Spanish
Commission on
Children & Families
93-6002292 70 $180,000 Youth
Gayle Woosley
200050099NP 22 $140,000 Youth
Dr. Joseph A. Barrett
MD 24477 20, 25,
30, 35
$60,000
Dr. Marc Williams
MD 22829 20, 25,
30, 35
$400,000
Pfeifer & Associates
93-1254885 66 $140,000
Rimrock Trails
Adolescent Treatment
93-1019081 66 $85,000 Youth
Cascade Healthcare
Community, Inc.
93-0602940 24 $1,000,000
Pfeifer & Associates
Child Safety Initiative 3
93-1254885 66 $237,286
est’d
Jail & post incarceration
treatment project 4
To be determined 66 $200,000
est’d
Client-specific and
project start up funds.
As needed varies To be determined
2 Contracted amounts may vary in 2009-2001 based on the level of state resources available and a local
determination of need for investment. Adjustments will be made by Deschutes County Mental Health in
consultation with Deschutes County Administration.
3 Deschutes County is currently completing a Request for Proposals process. A final decision on this vendor is not
expected until late April, 2008. Pfeifer & Associates is the recommended provider.
4 Deschutes County Mental Health is investing up to $100,000 annually with an additional $100,000 from the
Deschutes County Sheriff in a comprehensive alcohol and drug treatment program for people in the justice system.
Services will begin during incarceration and continue post release. The Request for Proposal process is underway, a
contract will likely be awarded in May, 2008.
Page 15 of 32
Other DCMH Contracts NOT Related to Funds Received From AMH
Provider
Name
Service/Program
Service
Element
Contract Amount
Specialty
Service
ABHA CDO management
services, Jeff Emrick
n/a $101,650
ABHA Utilization
management, Jeff
Emrick
n/a $56,500
Central Oregon Family
Resource Center
Drug Court n/a $35,000
Deschutes Family
Recovery
Drug Court n/a $80,000
Department of Human
Services
Drug Court n/a $90,000
Ready-Set-Go Drug Court n/a $32,000
Oregon Judicial
Department
Drug Court n/a $58,885
Pfeifer & Associates CDO n/a $113,000
Rimrock Trails CDO n/a $124,000
Serenity Lane CDO n/a $40,000
BestCare Treatment CDO n/a $120,000
Bend Guest Home DD n/a $70,000
Central Oregon Resources
for Independent Living
DD n/a $550,000
Opportunity Foundation DD n/a $7,500,000
Residential Assistance DD n/a $4,500,000
Summit Assisted Living DD n/a $75,000
Page 16 of 32
Addictions and Mental Health Division – Attachments 3 and 4
ADDICTIONS AND MENTAL HEALTH ADVISORY BOARD
(Combined Local Alcohol & Drug Planning Committee and Local Mental Health Advisory Committee)
REVIEW AND COMMENTS
County: Deschutes
Advisory Board review and approval April 2, 2008
See attached roster.
In accordance with ORS 430.342, the Deschutes County Addictions and Mental
Health Advisory Board (AMHAB), a combined Local Alcohol & Drug Planning
Committee and Local Mental Health Advisory Committee established in
accordance with ORS 430.630(7), recommends the state funding of alcohol and
drug treatment services as described in, and further recommends acceptance of, the
2009-2011 County Implementation Plan. Further AMHAB comments and
recommendations are attached.
Name of Chair: Dolores Ellis
Address: 2577 NE Courtney Drive
Bend, Oregon 97701
Telephone Number: (541) 322-7504
Signature:
Date:
Page 18 of 32
DESCHUTES COUNTY MENTAL HEALTH
ADDICTIONS AND MENTAL HEALTH ADVISORY BOARD
2008 ROSTER
Name Address Phone Number
Dolores Ellis, Chair 19492 Sugar Mill Loop, Bend, OR 97702 617-5901
Pat Croll 120 SW 17th Street, Bend, OR 97702 388-2577
Chuck Frazier 1363 NW City View Drive, Bend, OR 97701 617-1020
Chuck Hemingway 1715 NE Sonya Court, Bend, OR 97701 318-1897
Glenda Lantis 2534 NE Jenni Jo Court, Bend, OR 97701 385-8645 (H)
318-3753 (W)
Alison Lowe 2190 NW Canal Blvd, Redmond, OR 97756 548-5578
David Marchi 2058 NW Pinot Court, Bend, OR 97701 383-3150
Mary Martin 60823 Windsor Drive, Bend, OR 97702 385-6879
Jennifer McKague 2325 NW Antler Court, Redmond, OR 97756 504-0083
Kristin Powers 2576 NE Lynda Lane, Bend, OR 97701 385-6144 (H)
693-5855 (W)
Beth Quinn 61247 King Solomon Lane, Bend, OR 97702 419-6521
Lee Ann Ross 3062 NW Underhill, Bend, OR 97701 312-2568
Nancy Ruel P. O. Box 3668, Bend, OR 97707 593-7493 (H)
317-9623 x 233 (W)
Julie Rychard P. O Box 1678, La Pine, OR 97739 420-3741 (H)
749-2158 (W)
Marianne Straumfjord 569 North Tam Rim Drive, Sisters, OR 97759 549-1455
Bert Swift 64750 Saros Lane, Bend, OR 97701 617-8754
Pat Tabor 63360 Britta St., Building 2, Bend, OR 97701 383-4385 (W)
617-1255 (H)
Patricia von Riedl 1875 NE Purcell, #100, Bend, OR 97701 317-0586
Darrel Wilson 19810 Connarn Road, Bend, OR 97701 382-3796 (H)
548-2611 (W)
Page 19 of 32
Addictions and Mental Health Division - Attachment 5
COMMISSION ON CHILDREN & FAMILIES REVIEW & COMMENTS
County: Deschutes
The Deschutes County Commission on Children & Families has reviewed the
alcohol and drug abuse prevention and treatment portions of the county’s Biennial
Implementation Plan for 2009-2011. Any comments are attached.
Name of Chair: Renee Windsor
Address: 1130 NW Harriman Street
Bend, Oregon 97701
Telephone Number: (541) 385-1717
Signature:
Date:
Page 20 of 32
Addictions and Mental Health Division - Attachment 6
COUNTY FUNDS MAINTENANCE OF EFFORT ASSURANCE
County: Deschutes
As required by ORS 430.359(4), I certify that the amount of County funds
allocated to alcohol and drug treatment and rehabilitation programs for 2009-2011
is not projected to be lower than the amount of County funds expended during
2007-2009. The County Budget process occurs annually and future revenue
available to Deschutes County is uncertain. Final amounts are subject to the
recommendations by the County Administrator and the annual County Budget
Committee process as well as final action by the Board of Commissioners. The
County has consistently supported mental health and other human services with
County General Fund and discretionary resources. While the County’s contribution
is not expected to decline, some cuts could occur if circumstances warranted. This
information is available in June of each year at the time of budget adoption.
Scott Johnson, Director
Signature
Date
Page 21 of 32
Addictions and Mental Health Division – Attachment 7
PLANNED EXPENDITURES OF MATCHING FUNDS (ORS 430.380)
AND CARRYOVER FUNDS
County: Deschutes
Contact Person: Sherri Pinner, (541) 322-7509
Matching Funds
Source of Funds Amounts Program Area
None
Carryover Funds
AMH Mental Health Funds
Carryover Amount from
2007-2009
Planned Expenditure
Service Element
New resources for the
Central Oregon acute
care system
Sage View and other
acute care services
2007-2011
24
AMH Alcohol & Drug
Funds Carryover Amount
from 2007-2009
Planned Expenditure
Service Element
None
Page 22 of 32
Addictions and Mental Health Division – Attachment 8
REVIEW AND COMMENTS BY THE LOCAL CHILDREN, ADULTS
AND FAMILIES DISTRICT MANAGER FOR THE DEPARTMENT OF
HUMAN SERVICES
County: Deschutes
As Children, Adults and Families District Manager for the Department of Human
Services, I have reviewed the 2009-2011 Biennial County Implementation Plan
and have recorded my recommendations and comments below or on at attached
document.
Name of District Manager: Patrick Carey
Signature:
Date:
Page 23 of 32
Addictions and Mental Health Division – Attachment 9
REVIEW AND COMMENTS BY THE LOCAL PUBLIC SAFETY
COORDINATING COUNCIL
County: Deschutes
The Local Public Safety Coordinating Council has reviewed the 2009-2011
Biennial County Implementation Plan. Comments and recommendations are
recorded below or are provided on an attached document.
Name of Chair: Judge Michael Sullivan, Presiding Judge
11th Judicial District
Address: 1100 NW Bond Street
Bend, Oregon 97701
Telephone Number: (541) 388-5300
Signature:
Date:
Page 24 of 32
PREVENTION PLAN
Deschutes County's prevention efforts are effective due to the strong community-based input received.
Oversight by the Addictions and Mental Health Advisory Board (AMHAB) and the local Commission on
Children and Families (CCF), in addition to the input of the Deschutes Prevention Partners Coalition and
rural coalition members, has allowed a melding of separate community plans and needs into one
comprehensive county plan. The Deschutes County Prevention Team has been involved in all aspects of
local Partners for Children & Families planning and fund allocation process. The Prevention Coordinator
assists in the allocation of monies in order to fund prevention projects through SB 555.
The current Deschutes County Ten-Year Community Plan cites reduction of eighth grade alcohol, tobacco
and other drug use as one of the long-term outcomes. The comprehensive plan submitted to the State
OCCF for eighth grade alcohol, tobacco and other drug use outlines expectations of our family
management skills training programs, evidence-based school curricula, advocacy and policy making and
other projects, activities and mobilization to address this outcome.
Community mobilization will be conducted through support to local prevention teams. The vast majority
of funds needed to support these adult and youth teams comes through the Drug Free Communities grant
and the Safe and Drug Free Schools state dollars. However we will use a small portion of AD 70 funds to
assist the rural coalitions with prevention focused projects and activities. These rural prevention
coalitions, supported by Prevention Team staff, conducted their initial needs assessments in 2001-2002
and update their strategic plans annually. The individual rural coalitions have identified priorities and
continuously implement strategies to reduce adolescent substance abuse to address the community’s
needs.
Deschutes County will keep focus on social and health consequences of underage alcohol and other drug
use through the implementation of evidence-based middle and high school programs for youth and/or
their families, public awareness of the issues county-wide, support of local surveillance operations, and
youth-led projects.
Public awareness about alcohol, tobacco and other drug use will continue to be woven into all prevention
work within the county. In the past the Prevention Team has sponsored various trainings on curricula and
issues surrounding alcohol, tobacco and other drug use and will continue to do so as funding is available.
Although this is not a major component of our plan, we will continue to educate the community through
our local prevention teams, press releases, town halls and trainings. Deschutes County currently uses the
following Substance Abuse and Mental Health Services Administration programs. These programs are
coordinated through several different agencies and are not necessarily funded through AD 70 or
prevention funds.
Model:
Communities Mobilizing for Change on Alcohol
Guiding Good Choices
Incredible Years
Life Skills Training
Project Towards No Drug Abuse
Second Step
Strengthening Families
Functional Family Therapy
Healthy Families America
Preparing for the Drug Free Years
Effective:
Big Brothers/Big
Sisters
Promising:
Friendly PEERsuasion
Nurturing Parenting Programs
Preschool and Toddler
School-Aged Children
Families in Recovery
Spanish Families
Making Parenting A Pleasure
Page 25 of 32
The support and advocacy for implementation and continuation of evidence-based curricula in both
middle and high school will be continued. The goal is to continue implementation of Friendly
PEERsuasion at its current sites and assist in implementation at other sites through mobilization efforts.
By providing the curriculum and free training to the sites, we have found it has been easier for the schools
and other youth serving organizations to implement the program.
The annual Youth Conference will be held in the fall at the local Fair and Expo Center. Past conferences
have hosted more than 350 youth and advisors who spend the day attending prevention-focused breakout
sessions and a school-team debrief meeting to assist in integrating the day’s message into a prevention-
focused activity with an action plan. Teams are asked to submit their prevention plan activity, and in
recent years over 70% of teams completed their activity! Planning for the conference is a collaborative
effort and includes local agencies, businesses, fraternal organizations and community volunteers. A small
amount of AD 70 funds is used to support the conference, with over 75% of the needed revenue received
through community donations.
The county will continue to support alcohol and drug assessments for school-aged youth through other
funding sources. By providing assessments to youth within the school system or in their local
community, we have broken down one of the many barriers to identification and referral. Youth
completing the assessments are tracked to keep data on the percentage of youth following the
recommendations received based on the assessment.
Deschutes County contracts with Latino Community Association, which is a telephone and face-to-face
information referral service. They also provide oral and written translation service to individuals and
programs throughout the county. Through partnerships with community programs, cultural awareness
activities and Cultural Competency trainings provided by the Latino Community Association, the entity
has developed a strong collaboration of efforts throughout the county. Each contractor receiving CCF,
JCP, AD 70 or County funds is encouraged to attend cultural competency training each fiscal year. All
local programs are notified of cultural competency trainings as they are made available.
As state and federal funds shift, the ability to continue on-going professional development for staff will
become more available. Staff will be attending the two mandatory Prevention Coordinators meetings at
the state level, and the National CADCA conference (as long as federal funds are available) and will
continue to attend the statewide prevention conferences as they are provided. The County will also keep
in mind the WestCAPT internet classes and other free or inexpensive trainings that may be available in
the future.
The quarterly meetings of the Deschutes Prevention Partners Coalition, the blending of efforts through
Commission on Children and Familes, Juvenile Community Justice, Tobacco Free Alliance, Addictions
and Mental Health Advisory Board, and the many other collaborative efforts underway within our
community facilitate coordination of prevention efforts within the county. It is because of these important
linkages that we are able to effectively examine and respond to issues around substance abuse, violence
prevention and healthy lifestyles in Deschutes County.
AD 70 Budget 2009-2011
Personnel $39,500
Community coalitions 16,500 See details below.
Evidence cased curricula for MS/HS and/or families 10,000
Gender specific curricula 10,000
Youth Conference and youth team 8,500
Retailer training/Reward Reminder Program 2,000
Professional development 1,000
Total $87,500
Page 26 of 32
Page 27 of 32
Provider Name Approval/
License ID
Number
Service
Element
AMH Funds
in Subcontract
Specialty Service
BestCare Treatment
Services
93-1269087 AD 70 $ 5,500 On-going implementation
of direct services programs
for community coalitions
La Pine Park and
Recreation
93-1314045 AD 70 $ 5,500 On-going implementation
of direct services programs
for community coalitions
Sisters Organization
for Activities and
Recreation
93-1214147 AD 70 $ 5,500 On-going implementation
of direct services programs
for community coalitions
Total $16,500
2009-2011 Prevention Funding Plan Baseline Budget Narrative:
The following explanation is based on an annual budget. Budget numbers for 2009-2010 and 2010-2011
will remain the same.
Personnel/Staff ($39,500 annually) will cover the project coordination for the Youth Conference,
oversight of evidence-based curricula throughout Deschutes County, school alcohol and drug assessment
services. Personnel dollars will fund a portion of the salaries of the County Prevention Coordinator,
Robin Marshall, and the AD 70 Program Contact, Julie Spackman.
Community Coalitions ($16,500 annually) will be divided equally among and used to support three
separate rural coalitions in the communities of La Pine, Sisters and Redmond. These funds will be used
to advocate for and implement research-based prevention programming at the community level.
Evidence-Based Curricula ($10,000 annually) will be used to purchase curricula, provide trainings and
supplies for middle and high school evidence-based practices for all participating sites.
Gender-Specific Curricula ($10,000 annually) will be used to purchase curricula, provide trainings and
supplies for middle and high school evidence-based practices for all participating sites.
Annual Youth Conference and Activities ($8,500 annually) will be used for Youth Conference and
team activities to contract for alcohol, tobacco and other drug prevention speakers; youth team projects
and other general costs necessary for an effective prevention event for youth.
Accessibility to Alcohol ($2,000) will be used annually to offer, in partnership with OLCC and Tobacco
Free Alliance, at least one training to retailers in Deschutes County.
Professional Development/Training ($1,000 annually) will be used to allow attendance at two AMH
sponsored prevention meetings, web access training, and other inexpensive workshops throughout the
fiscal year.
Pa
g
e
2
8
o
f
3
2
Ad
d
i
c
t
i
o
n
s
a
n
d
M
e
n
t
a
l
H
e
a
lt
h
D
i
v
i
s
i
o
n
–
A
t
t
a
c
h
m
e
n
t
1
0
20
0
9
-
2
0
1
1
C
o
u
n
t
y
B
i
e
n
n
i
a
l
Im
p
l
e
m
e
n
t
a
t
i
o
n
P
l
a
n
PR
E
V
E
N
T
I
O
N
S
T
R
A
T
E
G
Y
S
H
E
E
T
Co
u
n
t
y
D
e
s
c
h
u
t
e
s
C
o
u
n
t
y
P
r
e
v
e
n
t
i
o
n
C
o
o
r
d
i
n
a
t
o
r
R
o
b
i
n
L
.
M
a
r
s
h
a
l
l
Us
i
n
g
t
h
e
g
r
i
d
b
e
l
o
w
,
l
i
s
t
a
l
l
t
h
e
p
r
o
p
o
s
ed
p
r
o
g
r
a
m
s
f
o
r
w
h
i
c
h
t
h
e
C
o
u
n
t
y
i
s
r
e
q
u
e
s
ti
n
g
f
u
n
d
i
n
g
.
I
n
c
l
u
d
e
a
l
l
t
h
e
P
r
o
g
r
a
m
O
u
t
c
o
mes
(p
r
o
c
e
s
s
o
b
j
e
c
t
i
v
e
s
)
a
n
d
I
n
t
e
r
m
e
d
i
a
t
e
-
L
e
v
e
l
O
u
tc
o
m
e
s
(
e
d
u
c
a
t
i
o
n
a
l
,
a
t
t
i
t
u
d
i
n
a
l
a
n
d
b
e
h
a
v
i
o
ra
l
o
b
j
e
c
t
i
v
e
s
)
f
o
r
e
a
c
h
o
f
t
h
e
p
r
o
p
o
sed
pr
o
g
r
a
m
s
.
A
l
l
o
u
t
p
u
t
s
a
n
d
o
u
t
c
o
m
e
s
m
u
s
t
b
e
m
e
a
s
u
r
a
b
l
e
.
Pr
o
p
o
s
e
d
Pr
o
g
r
a
m
s
Pr
o
p
o
s
e
d
Ou
t
p
u
t
s
Pr
o
p
o
s
e
d
Ou
t
c
o
m
e
s
Ev
i
d
e
n
c
e
-
B
a
s
e
d
C
u
r
r
i
c
u
l
a
A
m
i
n
i
m
u
m
o
f
1
0
0
y
o
u
t
h
a
n
d
/
o
r
t
h
e
i
r
f
a
m
i
l
i
e
s
wi
l
l
p
a
r
t
i
c
i
p
a
t
e
i
n
e
v
i
d
e
n
c
e
b
a
s
e
d
p
r
a
c
t
i
c
e
s
th
r
o
u
g
h
m
i
d
d
l
e
a
n
d
h
i
g
h
s
c
h
o
o
l
c
u
r
r
i
c
u
l
a
.
65
%
o
f
p
a
r
t
i
c
i
p
a
n
t
s
w
i
l
l
r
e
p
o
r
t
i
n
c
r
e
a
s
e
d
li
k
e
l
i
h
o
o
d
o
f
u
s
i
n
g
n
e
w
r
e
f
u
s
a
l
a
n
d
/
o
r
d
e
c
i
s
i
o
n
ma
k
i
n
g
s
k
i
l
l
s
.
Ge
n
d
e
r
S
p
e
c
i
f
i
c
C
u
r
r
i
c
u
l
a
A
m
i
n
i
m
u
m
o
f
1
0
0
g
i
r
l
s
a
n
d
/
o
r
b
o
y
s
w
i
l
l
pa
r
t
i
c
i
p
a
t
e
a
n
n
u
a
l
l
y
i
n
g
e
n
d
e
r
-
s
p
e
c
i
f
i
c
s
c
h
o
o
l
cu
r
r
i
c
u
l
a
i
n
m
i
d
d
l
e
s
c
h
o
o
l
s
.
70
%
o
f
p
a
r
t
i
c
i
p
a
n
t
s
w
i
l
l
r
e
p
o
r
t
a
n
i
n
c
r
e
a
s
e
d
kn
o
w
l
e
d
g
e
o
f
c
o
n
f
i
d
e
n
c
e
,
c
o
m
p
e
t
e
n
c
e
a
n
d
/
o
r
ca
p
a
b
i
l
i
t
y
.
Co
m
m
u
n
i
t
y
C
o
a
l
i
t
i
o
n
S
u
p
p
o
r
t
A
m
i
n
i
m
u
m
o
f
t
h
r
e
e
r
e
s
e
a
r
c
h
b
a
s
e
d
p
r
o
j
e
c
t
s
(
1
pe
r
c
o
a
l
i
t
i
o
n
)
w
i
l
l
b
e
i
m
p
l
e
m
e
n
t
e
d
i
n
e
a
c
h
o
f
t
h
e
th
r
e
e
r
u
r
a
l
c
o
m
m
u
n
i
t
i
e
s
.
80
%
o
f
c
o
a
l
i
t
i
o
n
m
e
m
b
e
r
s
w
i
l
l
e
x
h
i
b
i
t
a
n
in
c
r
e
a
s
e
i
n
t
h
e
k
n
o
w
l
e
d
g
e
a
n
d
i
m
p
o
r
t
a
n
c
e
o
f
us
i
n
g
a
n
d
s
u
p
p
o
r
t
i
n
g
r
e
c
o
g
n
i
z
e
d
r
e
s
e
a
r
c
h
b
a
s
e
d
st
r
a
t
e
g
i
e
s
f
o
r
c
o
m
m
u
n
i
t
y
p
r
o
j
e
c
t
s
(
c
o
m
m
u
n
i
t
y
su
r
v
e
y
r
e
s
u
l
t
s
)
.
An
n
u
a
l
Y
o
u
t
h
C
o
n
f
e
r
e
n
c
e
A
m
i
n
i
m
u
m
o
f
3
0
0
y
o
u
t
h
a
n
d
a
d
v
i
s
o
r
s
w
i
l
l
at
t
e
n
d
.
75
%
o
f
a
t
t
e
n
d
e
e
s
w
i
l
l
r
e
p
o
r
t
i
n
c
r
e
a
s
e
d
kn
o
w
l
e
d
g
e
o
f
c
o
n
f
i
d
e
n
c
e
,
c
o
m
p
e
t
e
n
c
e
a
n
d
/
o
r
ca
p
a
b
i
l
i
t
y
.
Re
t
a
i
l
e
r
T
r
a
i
n
i
n
g
/
R
e
w
a
r
d
a
n
d
R
e
m
i
n
d
e
r
P
r
o
g
r
a
m
A
m
i
n
i
m
u
m
o
f
2
0
r
e
t
a
i
l
e
r
s
w
i
l
l
p
a
r
t
i
c
i
p
a
t
e
an
n
u
a
l
l
y
i
n
a
m
e
r
c
h
a
n
t
t
r
a
i
n
i
n
g
i
n
v
o
l
v
i
n
g
ed
u
c
a
t
i
o
n
o
n
p
r
o
p
e
r
i
d
e
n
ti
f
i
c
a
t
i
o
n
f
o
r
s
a
l
e
s
a
n
d
pu
r
c
h
a
s
e
s
o
f
a
l
c
o
ho
l
a
n
d
t
o
b
a
c
c
o
.
75
%
o
f
p
a
r
t
i
c
i
p
a
t
i
n
g
r
e
t
a
i
l
e
r
s
w
i
l
l
r
e
p
o
r
t
a
n
in
c
r
e
a
s
e
d
k
n
o
w
l
e
d
g
e
o
f
p
r
o
p
e
r
i
d
e
n
t
i
f
i
c
a
t
i
o
n
a
n
d
lo
c
a
l
d
a
t
a
o
n
y
o
u
t
h
a
l
c
o
h
o
l
a
n
d
t
o
b
a
c
c
o
u
s
e
.
PROBLEM GAMBLING SERVICES PLAN
Deschutes County Mental Health will continue to provide gambling treatment and prevention services to
residents of Deschutes, Crook and Jefferson counties in the next biennium.
While treatment services historically were provided primarily in Bend, we have been able to increase and
improve access by providing services in Madras and in Prineville as well. It is clear that on-site services
in those communities improves the accessibility of our gambling services in those outlying areas. The
plan is to continue this in the 2009-2011 biennium.
Minimal revisions are expected in our existing gambling prevention plan. The focus will continue to be
on targeted media campaigns, both radio and television, to reach a large segment of the Central Oregon
community. In addition, we will continue to provide regular education to a variety of agencies and
groups in the community to increase awareness of problem gambling and treatment referrals.
One particular focus will be on expanding and improving our targeted focus of gambling prevention
education to adolescents within Deschutes County. We will also continue to request that a small amount
of prevention dollars be designated for treatment enhancement (currently 10%) to assist with special
needs, primarily focused on case management and dual diagnosis (e.g., medication management) services
when needed.
CHILDREN’S MENTAL HEALTH SERVICES PLAN
Families and youth are engaged in planning and service development in a variety of ways. Clients are
active participants in collaborating with the provider in their own treatment planning. Clients also
participate by completing the Oregon Change Index (OCI) questionnaire, which encourages consumer
feedback about services received. In addition, our clinicians offer a Devereux Assessment Tool (DSMD)
with child, parent and teacher input to assess mental health concerns and to determine the efficacy of our
interventions. As part of the Children’s System of Change Initiative (CSCI), all children and families
involved in Intensive Children’s Treatment Services (ICTS) are involved in determining treatment
services with a community involvement focus. All services are consumer driven. We also encourage
input from the Deschutes County Addictions and Mental Health Advisory Board as well as the Central
Oregon Regional Advisory Board (for the CSCI).
We emphasize the strengths inherent in all cultures and examine how our system of care can more
effectively deal with cultural differences and related treatment issues. We view cultural competence as a
developmental process. We are sensitive and strive to adapt services in response to cultural mores,
appropriateness and efficacy of interventions. We try to include the minority family and community in
developing resources, setting goals, and outlining action steps. Additionally, a certain percentage of staff
attends cultural competency classes on an ongoing basis. We have adjunct on-call staff available that are
fluent in a variety of foreign languages, and interpreters are provided at no charge to the consumer.
Clients give us feedback on where their needs are not being met; and we try, depending on budget
constraints, to assess and meet those needs. We stay current with new evidence based practices and have
an agency committee who looks at new developments and how we may implement them into best
practices. We provide significant staff training throughout the year with an emphasis and focus on child
development in the context of family. We look at grant and other funding opportunities. We have just
begun a new eighteen month pre-psychosis program providing comprehensive education and direct
services to youth and their families.
Page 29 of 32
Community collaboration and engagement is a primary focus of the Child and Family Program. As part
of the CSCI, we collaborate strongly with other community partners. We collaborate for ICTS with
Cascade Child Center, the Bend-La Pine and Redmond school districts as well as Maple Star and DHS for
foster placement services. We coordinate our alcohol and drug prevention services with the Commission
on Children & Families. We coordinate our work frequently with law enforcement, Juvenile Justice and
other County departments, and other providers such as Cascade Healthcare Community. We strive for
area involvement, not only in Deschutes County, but for the entire Central Oregon region. We work
closely and collaboratively with Jefferson County and BestCare Treatment Services, as well as with
Lutheran Community Services in Crook County, all with the goal of ensuring services and supports are
comprehensive and well coordinated.
Coordination and continuity of care is achieved through the following services to ensure that children and
youth remain at home, in school, and out of trouble.
1. Alcohol and Other Drug: Provide evaluations of youth to determine need and level of services
through comprehensive assessment including the use of American Society of Addiction Medicine
Patient Placement Criteria (ASAM-PPC). Contract with community providers to offer intensive
outpatient services. In conjunction with Deschutes County Commission on Children and Families,
provide intensive prevention outreach services through Towards No Drug Abuse (TNDA) program in
school settings.
2. School Based Services: Currently provide on-site therapy and alcohol/drug counseling services in
twenty-seven public schools (15 elementary, 6 middle and 6 high schools) in the community.
Sufficient funding is necessary to assure mental health and addiction services are available in
Deschutes County schools at least one day per week. Availability is declining, and the number of
public schools services requested continues to increase due to population growth. Safe School
Assessments have been provided as follows: 74 referrals and 299 service hours in the 2005-2006
school year; 86 school referrals and 436 hours in the 2006-2007 school year. We project at least a
10% to 15 % increase in Safe School Assessment referrals in upcoming years.
3. Clinic Based Services: We have continued the effort to assure community-based outpatient services
at a level that will limit a wait list and assure we meet a growing community need. These services
mitigate the need for higher cost residential and hospital placements in the coming years. We offer
individual, family and group therapy. Sufficient funding to assure mental health and addiction
services are available in Deschutes County is of great importance as current staffing is stretched
between school based services and covering clinic needs. We provided 303 new intake screenings in
2007 in addition to clients we already were serving. This does not include new intake screenings for
children we see in the school settings. We also provide mediation services for families in transition.
4. Children’s System of Change Initiative: There is a need for Intensive Children's Treatment Services
resources sufficient for service needs of Levels 4, 5, and 6. We have developed a comprehensive
wrap-around model and care coordinator roles given limited resources. Resources for care
coordination as currently practiced are inadequate to be sustainable. As no local Psychiatric
Residential Treatment Services (PRTS) is available since Trillium's local services ended, there is an
increased demand in this area and focus on keeping children in the community. Currently, we are
contracting with Cascade Child Center for day treatment services. We remain active in partnership
with Cascade Child Center and with Crook and Jefferson counties and ABHA in trying to sustain a
small PRTS program in Central Oregon. We are working more collaboratively with a local foster
home placement agency, Maple Star, to assure needed services are available. More support is needed
to continue these vital services.
Page 30 of 32
5. Services to victims of abuse and neglect: Continuation of treatment services at the KIDS Center at a
level that will limit wait list and assure help for victims of abuse. Sustainability and expansion of
services is dependent upon sufficient funding. Currently working on JDS grant focusing on youth
suicide prevention.
OLDER ADULT MENTAL HEALTH SERVICES
The Seniors Mental Health Treatment Program receives less than $9,000 annually to serve people 65 and
older who have mental health issues. Our managed care organization and our County general fund dollars
add to that amount so that we can have 2.5 FTE serving this population. There are currently 450 clients
opened in this program. Due to the staffing shortage, we can serve only the most acute situations which
leave many others seniors to deal with depression, anxiety, substance abuse and other mental health issues
without services. Those families who try to help out with their family members in need of help often end
up needing help themselves.
Senator Gordly’s report on Senate Bill 1075 states that seniors experience a higher rate of mental illness
and addiction than the general population. National figures indicate 15%-25% of those over 65 have
mental health problems requiring intervention. For Deschutes County that would mean between 4,000-
5,000 seniors would be expected to be in need, and we are able to serve less than 10% of them. The
population of those over 65 is expected to grow at almost three times the rate of the general population.
With no additional funding, the gap between the available service and the need for that service continues
to grow. Although today seniors represent 13.7% of the population, they account for 25%-30% of all
successful suicides. Suicide is often the consequence of failing to provide services to this population. As
the number of those unable to access services grows, so will the number of people who end their lives in
isolation and desperation.
In addition to needing more staff service hours there is also a need to provide targeted training to the staff
who work with older adults. The combination of medical and mental health issues presented by this
population requires specialized training that is becoming increasingly difficult to access. The State is no
longer providing these training opportunities, and with limited funding it is difficult to access this training
through the private sector.
In an attempt to provide additional service we have looked to using volunteers and interns to provide
some services to the seniors in less acute situations. This can provide additional service hours but
requires staff time to train, monitor and support the volunteers and interns. We would like to add a
position that could provide these needs and increase our ability to connect with people living in isolated
situations.
We need to find a way to double our current staffing and look to triple it by the 2009-2011 biennium in
order to keep pace with the anticipated growth. If we can better meet the needs of this population, we can
expect lower costs for medical interventions, reduction in the number of suicides among the senior
population and improved quality of life for those at the end of their lives.
Our Enhanced Care Outreach Services (ECOS) program has been very successful in dealing with a small
number of high needs seniors who are very difficult to serve in the residential programs. Unmet mental
health needs have meant seniors in residential care were often in almost constant transition. Through
these targeted services we have been able to break the cycle of multiple placements and difficult
relationships with providers and other residents that often lead to the need for stays at Oregon State
Hospital (OSH). We have been able to bring home Central Oregonians who were placed at the State
Hospital and have not had to make new placements there. Preventing that first placement at OSH keeps
Page 31 of 32
clients much more successful in their residential programs. This is a very cost effective program as the
cost for one individual in the ECOS program is about $1,200 per month while a stay at the State Hospital
is over $15,000 per month. The success of this program relies on the ability to provide intensive
treatment (low staff-to-client ratio) and a good working relationship with our local SPD program. The
ECOS program needs to be able to grow and maintain the staffing ratios as the population grows.
Page 32 of 32