Agenda Item Discussion Action/Assigned --Call to Order -Introductions 10:00 -Review of Meeting Minutes 10:15 Announcements 10:25

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1 [Member Names in Bold Font = Present] Multnomah County Mental Health and Addiction Services Division Adult Mental Health & Substance Abuse Advisory Council Meeting October 7, 2015 Public Service Representatives Guests Amy Anderson Carolyn Anderson Stephen Arnold Kenneth Biggs Kevin Fitts Ryan Hamit Debra Tess Hubbard June Howard Johnson Community Representatives Cheryl Lewis Rai McKenzie Michelle Moore Essie Mae Morphis Colleen Orr Shon Pruitt Wendy Shumway Victoria Taylor Tam An Tran Donna Anderson (LifeWorks NW) Katelyn Bessette (Volunteers of America) Julie Ibrahim (Luke-Dorf) Nancy Griffith (Corrections Health) Tashia Hager (Portland Police Bureau) David Kohler (Cascadia MH Crisis Response System) Tressa Kovachevich (Multnomah County Sheriff s Office) Kathleen Roy (Central City Concern) Brad Taylor (City of Portland) Bill Waters (NorthStar) Patty Arvizu Robert Fentress Samm McCrary Rai McKenzie Colleen Orr Jeff Woodward Kelsey Perkins Jeff Kerr (Name Undetermined) Nelson LaKeesha Dumas Staff: Dr. Nimisha Gokaldas, Ebony Clarke, Joan Rice, Susan Montgomery, Charmaine Kinney, Kay Marshall, Alice Mai, Neal Rotman, Andrea Quicksall, Julie Oyemaja. Agenda Item Discussion Action/Assigned --Call to Order -Introductions 10:00 -Review of Meeting Minutes 10:15 Announcements 10:25 Amy Anderson welcomed the group. Minutes from the September 2, 2015, AMHSAAC Meeting were corrected. Page two is corrected to Oregon Health Plan Ombudsman (OR OHP Ombudsman). (LTC Ombudsman is incorrect.) State of Emergency on housing and homelessness in Portland: Today, October 7, 2015, at 2:00, the public is encouraged to give testimony at Portland City Hall on the housing crisis. The Community Alliance of Tenants is participating in the forum to provide information to the mayor for the basis of a State of Emergency initiative on housing and homelessness in Portland. Page 1 of 10 Participants introduced themselves. Minutes approved with correction.

2 Announcements Mental Health Behavioral Collaborative Meeting canceled this month: This group met last month. A SurveyMonkey will be issued to facilitate common meeting dates and times so that everyone can participate. The discussion will be around Mental Health Court, with a desired outcome of a manual/model that can be added to the peer wellness training specific to the justice system. AMHSAAC will receive notice of meetings. Peer Support Advocacy Meeting sponsored by Mental Health America of Oregon: Kevin Fitts, Oregon Mental Health Consumers Association, gave the meeting schedule as the last Thursday each month at East Portland Community Center, 740 SE 106 th Ave. The next meeting is on Thursday, October 29, from 1:00 to 3:00 pm. Kevin will forward meeting minutes and agenda to AMHSAAC facilitator, who can distribute to this group. Division Updates 10:35 Neal Rotman, Community Mental Health Program Manager: Update on older adult behavioral health investment. This is a legislative award to fund care coordinators across Aging and People with Disabilities systems, and behavioral health systems and mental health and addictions. The program goals are prevention, health promotion, access to information and knowledge related to older adults and people with disabilities, to coordinate leader service delivery programs, primary care, improve standardized care in each community and across the state. Further goals are to implement a plan to eliminate system barriers for older adults, to promote evidence-based prevention, screening and treatment approaches to high need populations, to identify gaps in service provision, system coordination, provide urgent placement services and maintain a current database on all these resources. Funding for Multnomah County allowed hire of three clinical services positions, and a shared Regional coordinator position with Washington and Clackamas counties. All four positions have been filled and working actively. The clinical services staff are Melanie Rixford with Mental Health Services, Valerie Warden with Addictions Services, Jill Williams with Aging, Disability & Veterans Services, and Lauren Fontal LaRosa (sp) is the tri-county coordinator. In the first phase stakeholders identified predominant gaps across populations as 1) lack of client resources, Medicare restrictions, and low income, 2) isolation of older adults in the community, and 3) transportation. Between Aging, Disability & Veterans Services Division and Mental Health & Addiction Services Division, there are communication silos with inability to share information across systems, a gap about other services existing across systems, and funding issues with a lack of money for aging-specific care, which limits client activities and opportunities for quality of life enhancement. Another gap is a lack of housing Page 2 of 10

3 options. Division Updates Question: Are there online resources for the group to get more information? Response: Neal would like to invite Lauren, the regional coordinator come to the next meeting and give a full presentation, and get materials to everyone. Question: What is the definition of older adult? Response: Older adults are identified as age 65 and above. The service delivery system contains many consumers with older adult issues, and people with disabilities issues, such as physical care and access issues, which are barriers to service from both Aging, Disability, and Veterans Services Division and the Mental Health & Addiction Services Division. Neal Rotman Update on Refugee Funding: This year an additional $200, (approximate) was received to fund refugee-specific services, and were awarded to current culturally-specific providers for six identified populations. The majority of funds went to Lutheran Community Services, who provide quality services for refugee populations in Oregon and Washington. Lutheran provides counseling services for refugee populations of Somalli, middle Eastern, eastern European and Burmese. Other funds went to Asian health community services, for outreach and engagement program for the growing Burmese community. Mental Health and Addiction Services (MHASD) is coordinating with Charlene McGee, the refugee health program coordinator for Health Department, and a first meeting was held involving representative for both physical and behavioral health. Question: For people 65 and older who have Medicare (not Medicaid), and apply for mental health (MH) services in our community, Medicare requires that a Medicare-qualified provider be on staff. That is one of the largest problems, along with Medicare not paying for MH, how are we going to show the financial concerns? Care equals access, and barriers prohibit access. How are we looking for solutions to bridge costs to senior populations? They can t get access/care. Response: The state is attempting to identify and map those areas and gaps. The process is to evaluate as a state-wide systems issue in both rural and urban areas. Clarification: If someone has Medicare and goes to a Medicare-enrolled provider, and if there is a psychiatrist available at the facility that is an enrolled Medicare provider, Medicare does pay for some MH services. Medicare pays for nurse practitioner, psychologist, and medical doctor appointments, and therapy appointments with licensed clinical social workers (LCSWs). There are many restrictions, everything else is covered under Medicaid. There are individuals who don t have Medicaid and don t fit into any priority population to Page 3 of 10

4 qualify for additional funds. Division Updates Question: If a client needs culturally specific care, which is available, but there is no qualified Medicare provider, that request is denied and the person is told they have to go somewhere else. Answer: If the client is working with one of our culturally-specific providers, that care is paid for. Efforts are underway to address this issue regionally across the tri-county area for continuity of care and response. People do need to go to the Medicare-enrolled provider if one exists, and providers are required to have Medicareenrolled providers that they contract with. We know that s not always possible. An answer will be coming, hopefully regionally. It was suggested that this specific issue be discussed separately with Charmaine Kinney. Health Department primary care clinics, safety net clinics, have behavioral health and mental health services provided in these clinics. Provide care to all our patients in terms of behavioral and mental health needs, and we need to consider the Medicare population and uninsured as primary target for our integrated services. In Health Department clinics, people with Medicare are seen as very important people to serve, because we understand this gap exists. Michelle Moore described her Medicare coverage experience as good in that most services are covered. Michelle doesn t quality for Oregon Health Plan, does receive assistance from state to pay Medicare premium, and incurs a $10.00 co-pay every time she goes. She sees her mental health provider, primary care doctor, and a therapist and counselor if she wants. She expressed that it would be good to have other options to provide coverage. Andrea Quicksall, Addiction Care Coordination, Pilot Project: The project provided treatment of consumers with dual diagnoses at DePaul treatments clinic. Since June 2015, 15 unique individuals were serviced, with a total of 20 authorizations, including a few individuals have continued in that level of care more than 30 days. Average number of service days is 27 at that level of care. Services outside of normal services such as extra medication management appointments with a psychiatric nurse practitioner, up to two mental health one-on-one sessions per week, increasing up to three sessions per week if needed. Schedules for group sessions are flexible and modified to meet the daily ability of individuals to attend. High level of needs have been accommodated, within a more therapeutic, wrap-around environment, helping participants to be successful while they are Page 4 of 10

5 in that level of individualized care. While there are a low number of individuals service, there have been really good outcomes, and look forward to expanding the program. Division Updates Election of New Members 11:20 Addition of Four Addictions Benefits Care Coordinators: A joint effort between Care Oregon and Multnomah MH to be able to look at full addictions benefits across those two systems. These positions will add capacity to track individuals from hospital admits, into detox, into treatment, follow for 90 days to assure they are connected to continuing levels of care, peer mentorship or other needs. Recruitment will include two culturally-specific positions, one as a bilingual Spanish-English speaking recruitment, and the other African- American. Two positions will be stationed at Hooper Detox to engage that community, one will be a community person, and the other position will be associated with primary care. Shon Pruitt invited elected AMHSAAC members to vote on the provided ballots for three open positions. Rai McKenzie, Colleen Orr, and Kevin Fitts were elected to membership effective today. To become an elected member of AMHSAAC, a candidate attends two of the AMHSAAC general meetings, and submits an application. The Executive Committee reviews applications an election is scheduled for the general meeting if there are vacant positions. The categories of membership are consumer, advocates, family advocates, and public service representatives. A consumer has participated in MH services. An advocate may be an individual who may not have received MH services, and acts as an advocate, such as a family member, or professional advocate who belongs to an advocacy group. Also, an individual may choose to represent themselves as an advocate, vs. as a current consumer of services, and that is and has been historically allowed. Corrections Health There are positions that may need to be filled next month. Also, the Executive Committee will discuss potentially increasing the number of elected members after review and amendment to Bylaws. Amy Anderson thanked everyone for attending and participating in meetings and Subcommittee meetings. Nancy Griffith on Role of Corrections Health and Mental Health and Addictions: Corrections Health (CH), within the Health Department, delivers medical, MH and dental care inside Multnomah County jails, and includes the juvenile detention facility. Of the 38,000 individuals who are arrested and booked annually, CH delivers services to about 5,000. About 40% of people are released shortly after booking. Many people in jail have conditions of mental illness (MI), substance abuse (SA), and chronic diseases. CH staff Page 5 of 10

6 identifies those people at intake and tracks their care throughout their elease. CH works very closely with primary care clinics as well as mental health and addiction services, to transition their care to clinics or resources in the community (about 200 referrals a month). Corrections Health Question: How are medications assured to continue? Response: Individuals who indicate they are on medications sign a release of information (ROI), which is sent to their pharmacy. Information is more readily available and more quickly from a pharmacy vs. a treatment facility. If the individual is part of the primary care system, records are available as part of one big record. If the person doesn t know where their pharmacy is, CH staff have to dig for the information and contact their agencies. Delays occur if medication has not been recently filled, usually for a good reason. CH staff meet with a person to ask about what medication has worked in the past, their comfort level, and about side-effects. A lot of effort is put forth to determine medication history from possible sources. CH staff want a person to be assessed in order to assist to get a medication they are going to stay on. If an individual is supervised by the State of Oregon Psychiatric Security Review Board (PSRB) and has come into the jail, CH staff will work directly with parole/probation office (PO), not PSRB, because someone is tracking the individual in the community. Question: How does it benefit the county, state and individual when medication coverage is suspended while someone is in jail? How does that contribute to continuity and quality of care? Response: It does not. That is a federal decision around the lawsuit occurred that allows healthcare in jails and was written in, and called an inmate exception, and cannot bill Medicare or Medicaid for services. It is state or county money depending on the institution. Question: When a person is released from jail, how do they know where to go to get medications? Response: CH staff have a form which is given to every inmate who is on medication upon their release, given into their property. CH staff are very conscious that nothing is in the cell that someone else can see. Individuals are given a sheet of paper that has every primary care pharmacy, and directs them to the pharmacy on SW Stark St., usually with a prescription to take and get filled. Question: If the person is confused and hasn t had their medications, why not take them to the pharmacy? Response: Close to 100 people a day would need assistance. After court happens, they leave, often during the evening hours. There is work done within county and MH leadership to have resources after 5:00 pm, and use of the triage center. We do need more resources. Information can be obtained through 211. Anyone needing MH services, whether coming out of jail or not, should be directed to urgent care clinic at Cascadia, open 7:00 am to 10:30 pm, 7 days per Page 6 of 10

7 week, and located at SE Division and 43 rd. CH arranges to cab people where they need to go if they don t have the resources, including back to their apartments. Corrections Health Appreciation was expressed to CH for the hard work that has been done, the database, the big improvement in services over time, and people being able to get their medications. An area for further improvement is in the connection between the individual parole officers, treatment and housing services in the community, and what happens when individuals leave the facility. Each independent parole/probation officer has a different methodology, and there is a need for standardization and dissemination of information upon inmate release. Question: In terms of Americans with Disabilities Act (ADA) compliance, what specifically is done in jail to accommodate mobility, hearing and vision? Response: Individuals who require mobility accommodation are housed in the downtown jail where there is more space, in a single cell and on the 10-person medical unit. The intake form asks about sight and hearing function. Many have figured out how to get along and don t disclose issues. When indicated, CH works very closely with the Sheriff s Office to share that information through a special form. People can be assisted with eyeglasses. All clients printed forms are large print and are reviewed by the health literacy department. Question: Is the whole MH pod still located at Inverness Jail as in the past? Response: They are not. Individuals with the most acute mental illness will stay in the downtown jail where the most MH resources are. Question: Do the jails use the same Multnomah County patient bill of rights? How closely does CH work with Portland Police Behavioral Health Unit as far as screening out people who could use their services? Response: CH works closely with the Behavioral Health Unit, who do a lot of diverting from jail. CH can make recommendations, and the courts have to release them. CH staff notice people who repeatedly come back into the system, and then notify the behavioral health staff about tracking this person. The CH bill of rights is the Inmate s Bill of Rights used by the Sheriff s Office. The booking area is not a good place to read or take in a lot of information. Medical rights are talked about during the process in which they are being seen. Question: Michelle Moore asked about rare, complicated situations, such as medications that are being given to a person with mental illness, free from a doctor, or on a grant basis, Page 7 of 10

8 Corrections Health and the person is not able to relate that information. Maybe it is a Friday, late at night, and released without medications and get really sick. Response: Friday night arrests are really hard. If critical medications are indicated and the person is clearly not doing well, and the individual s medical records or provider are not able to be reached, on-call physicians are available who can give orders for medications. Medical complexities can be just shy of Trauma 1 level. CH has to be really careful as they don t want to give anyone a medication to make whatever s happening worse. Epic, an electronic health record, is a wonderful resource, and can show if a person had hospital visit. Access to confirming medical and medication treatment status from the community is an ongoing issue for us Question: Is there withdrawal treatment at the detention center? Response: On any given day about 40 people are on withdrawal protocol. Heroin withdrawal symptoms take about hours, so some individuals who believe they will be released, will not disclose heroin usage. When they start to feel to feel bad and request medical services, withdrawal protocol is started. With alcohol usage, the withdrawal protocol is started for everyone as withdrawal can be fatal. Integrated Clinical Services Governing Board for the Health Department Healthy Columbia- Willamette Survey Amy Anderson is a member of the Integrated Clinical Services Governing Board for the Health Department and the Justice System is part of their purview. Meetings are open to the public, the second Monday of every month at the McCoy Building on the 10 th Floor, located at 426 SW Stark St. For those people who are interested in the Corrections Health concerns, please come to these meetings. Dinner is served, and discussion is about the Health Department with Corrections Health, and which now includes Mental Health and Addiction Services. The Healthy Columbia-Willamette Work Group is conducting a needs assessment for our tri-county area, and has created a survey. The survey wants to know what your healthy community would look like. The link has been ed and will be ed out again. The survey is being offered in five languages on the web. Take a printed flyer and make sure they get collected. Everybody is target population, so please distribute to your community. The survey ends at the end of December with the research team compiling results to be issued in July This effort is inclusive of Health Share, 16 organizations and four counties. The Healthy Columbia-Willamette Work Group will be hosting some small focus groups, and looking for organizations which may want to help host a group of individuals, one Page 8 of 10

9 Convention on Homelessness 2016 Transition Projects, Inc. meeting of about two hours. The input is requested from target populations of seniors, people with disabilities, mental health, addictions, homeless, and communities of color. Participants may receive gift cards. Please let Amy Anderson know if you and/or your organization would like to participate in this process. National convention on homelessness will be held in Portland in Shon Pruitt is a member of Transition Projects, Inc. (TPI). TPI has a class on post traumatic stress disorder (PTSD) on Wednesdays. People who are homeless suffer from PTSD and could benefit from the class, as well as Veterans who may not trust the Veterans Administration (VA). There is a free PTSD app to download for free. TPI helped sponsor the last Veterans Stand Down with Veterans court representation. Judge Bergstrom in Appeals has court on Thursdays, and there is a web site if someone you know needs legal advice, such as Veterans with mental illness and criminal activity, to have their records expunged. Expunged records help eliminate barriers to housing. TPI provides information on other organizations such as Clean Slate, which can assist those people with criminal history. There is a cost, and TPI can offer financial assistance. TPI will be invited to present to AMHSAAC. Another Veterans Stand Down for Veterans, especially for homeless Veterans, is scheduled for October 17. There will be an array of information including VA benefits, and health care, surplus free clothing, and contacts for VA benefits. Please see the flyer, or see Shon after the meeting. Subcommittee Report on Rights and Responsibilities The AMHSAAC Subcommittee has been working on the project of MH rights and responsibilities. The group did a SWOT analysis. SWOT stands for Strengths, Weaknesses, Threats, Opportunities. Charmaine Kinney is requesting feedback on the initial draft synthesis that was done by the Subcommittee. Through discussion and building on this draft, AMHSAAC will provide input with the outcome as a strong, formal set of recommendations and the possibility for action and improvements (handout). Please note that peers in this discussion are defined as clients, or individuals, or participants receiving the care. The Subcommittee recommended that the rights and responsibilities as well as the grievance procedure to be available in paper format as well as electronic format. It is an expectation that these rights and responsibilities will be posted. Cascadia has an excellent electronic system with electronic signatures. Dave Kohler of Cascadia noted that hard Page 9 of 10

10 copies are always available to be printed out and given. These hard copies are often left in the trash or in the lobby with the client names for anyone to see which are HIPAA concerns (Health Insurance Portability and Accountability Act). Cascadia keeps hard copies of the grievance procedure in the lobbies so they can be picked up without having to ask staff, and verbal grievances by phone are always taken by staff. Subcommittee Report on Rights and Responsibilities Volunteers of America give every client a handbook that has both the rights and responsibilities with grievance procedure. The grievance policy is posted in the lobby in English and Spanish. Shon Pruit requested a copy. It was expressed that the rights and responsibilities were posted in the lobbies, whether as part of an audit or not (which needs verification). This posting process was clarified as a past volunteer activity by Ann Kasper, who has since taken on different responsibilities, and that the posting may not be ongoing. The rights and responsibilities will be brought back to the Subcommittee and to the main AMHSAAC group for further discussion and finalization. Charmaine Kinney if you have any specific feedback. Please clarify your processes for the next meeting, we ll check and see what we re doing. The individual site audit piece has not been happening, every three years not frequent enough. Public or Invited Guest Comments October 12 Indigenous Peoples Day, also Native American Day Adjourn Tam An Tran went to City Hall to hear Mayor Hales and the City Commissioners announce that October 12 will be Indigenous Peoples Day, a historic day in history specifically to honor Native Americans. A proclamation will be forthcoming. Andulia White Elk, also noted that next Monday, October 12, 2015, there will be many celebrations in our communities that every is invited to celebrate with the Native American communities. Andulia requested that we all share that information with everyone and to recognize this as a major steppingstone in the community Meeting ended at 12:00 PM. Page 10 of 10