Please Note: A list of commonly used abbreviations is attached

Transcription

1 Sonoma County Mental Health Board Minutes June 21, :00 PM Norton West Wing, Santa Rosa (Minutes are posted in draft form and after approval) Please Note: A list of commonly used abbreviations is attached CALL TO ORDER Meeting called to order at 5:15 PM by Doug Stephens, Chair ROLL CALL Present: Absent: Public: Ivan Anderson, Lyndal-Marie Armstrong, Doug Stephens, Rochelle Torre, Sherry Weyers Maureen Casey, Ron Miller, Kathy Smith, Mary Ann Swanson, Jenny Webley (Harry Martin, Leave of Absence) Theresa Bruton, Russell Naylor (CCAN); David France (NAMI); Dee Schweitzer (Buckelew); Laurie Petta (Goodwill); Kalia Mussetter, Floramor Board of Supervisors Liaison to the MHB: Sonoma County Mental Health: Michael Lucid, ASO II; Gary Bravo, Medical Director; Denise Hunt, Section Manager; Marty Marcus, QI; Hank Hallowell, Patient Rights Advocate; Virginia Meyer, clerk to the MHB ANNOUNCEMENTS /PUBLIC INTRODUCTIONS & COMMENTS 1) Eli Lindberg has resigned as a representative from the 5 th District. 2) The next MHB meeting will be held in Guerneville on July 19 th at the Redwood Lodge/Odd Fellows Hall. 3) Currently there are vacancies in Districts 2 (South County - 2 vacancies), 4 (North County), and 5 (Roseland and West County). If you live in one of these districts and are interested in serving on the Board, please contact Hank Hallowell at or hhallowe@sonoma-county.org. 4) You may submit agenda items for consideration, prior to the Executive Board meeting scheduled for the first Wednesday of each month the next one is July 6 th. Please or call MHB clerk Virginia Meyer at or vmeyer@sonoma-county.org. APPROVAL OF MINUTES Minutes of May 17 th 2011 could not be approved in the absence of a quorum. SPECIAL PRESENTATION The Quality Improvement Process with Marty Marcus, QI Program Coordinator; and Dr. Gary Bravo, Medical Director The QI program covers all MH programs and contractors, and all report to Dr. Bravo. Wendy Sanders is also a QI Coordinator, and Carlos Mariscal is the Admin Aide assigned to them. Together they translate information, track data, write policies and procedures, and design and implement processes to improve delivery of services. They also create forms to collect relevant and useful data that will be analyzed with an eye toward improving the system. They need in-depth knowledge of State regulations to prevent loss of dollars by being out of compliance. The State Department of Mental Health audits us every three years, for four days most recently in April. Charts are reviewed for compliance with 68 pages of requirements listed in our contract with DMH, and our Policies and Procedures are scrutinized for compliance, also. The results of the recent audit are expected soon. In addition to the DMH triennial audit, a contractor for the State conducts an annual review. This is called the External Quality Review Organization (EQRO) review, and is done by APS Healthcare. Their issues are access to services, timeliness, quality of services, and outcomes. They don t do chart reviews, but they do conduct focus groups of consumers, line staff, supervisors, and sometimes include MHB members. Dr. Bravo said last year s reviewers could easily see how the QI committees were interrelated in an easy-to-follow structure. The next EQRO review is scheduled for August 10 and 11. The QI program also prepares for other audits and reviews, including for Therapeutic Behavioral Services (TBS). There are three Quality Improvement (QI) committees. The weekly QI Policy (QIP) Committee consists of senior managers, the County s compliance officer, the MHSA coordinator, and the QI coordinators (Marty Marcus and Wendy Sanders). Their 1

2 focus is to review policies and set the direction for devising the means to measure our processes, to see if we re doing what we re trying to do. The monthly QI Steering (QIS) Committee is comprised of all Behavioral Health program managers, the Medical Director, a section manager, the Patient Rights Advocate, and the two QI coordinators. Finally, the monthly QI Committee (QIC) consists of BH line staff and program managers, the Patient Rights Advocate, the Medical Director, the QI coordinators, contract providers, consumers, family members, and a MHB member. They recently produced a survey for consumers, after consumers of the Corinne Camp Consumer Network (CCAN) held focus groups all around the County attended by 60 people, to help come up with pertinent questions. This resulted in a 25% response rate (10% is considered good), and its results are being digested now. Changes to the system will be prompted by the input received. Marty said a lot of counties have trouble filling slots on their committees. Napa County visited a meeting to see how we do it, and ironically it was a day when most members were able to be present. One Quality Improvement activity is the Performance Improvement Projects (PIPs). The Hospitalization PIP was designed to see if providing a home visit within seven days of a person s discharge from an inpatient unit would result in decreased subsequent hospitalizations or lengths of stay. The result of the visits was a 13% decrease in re-hospitalizations. Now the program is looking at why re-hospitalization occurs in the first place. If it s due to lack of medication compliance, how can compliance be encouraged. Another PIP is a state-wide project begun to see if the amount of day treatment for kids used was necessary and costeffective. Lacking measurement tools, the program started using the Child and Adolescent Needs and Services (CANS) assessment tool. Because Sonoma County had the highest rate of conservatorship among California s counties, the PIP group has accomplished a 40% reduction over the last two years, plus a reduction in hospitalization. Complaints and grievances from consumers and family members go to Marty Marcus and Patient Rights Advocate Hank Hallowell. Marty said that when something not good happens, a report is made. These Incident Reports are studied to see if any patterns are revealed. Someone remarked that Sixty per cent of Jail inmates have mental health issues, but Marty said MH has been keeping statistics since 1999, so he s very familiar with the facts. He said 220 of the 800-1,000 inmates have mental health issues, for which many are getting medications such as antidepressants, anti-anxiety drugs, and sleep aids from their Primary Care doctors. Of that 220, 27% are on psychiatric meds; 6-8% have serious mental illness, and 6-8% are on outpatient teams. All inmates are screened by Correctional Officers at booking, and if further screening is necessary, mental health staff evaluate them. Inmates can get their prescriptions filled during their incarceration. Dr. Bravo said that QIC represents lots of hard work. The 911 brochure was their first project, and, along with the Family Survey, represents collaborations with Wendy Wheelwright of Progress Foundation s Crisis Residential Unit, Erika Klohe, Buckelew s Family Services Coordinator, and the dedicated consumers of the Corinne Camp Advocacy Network (CCAN). Marty said that we have many champions now, within the QI framework. Dr. Bravo remarked that, previously, compliance was the focus of QI, and MediCal was always looking for fraud. Now the focus is on Recovery, and measurement of outcomes using CANS and ANSA tools, not just on compliance. Every contractor that provides MediCal-reimbursed services is part of the QI process, and MH provides trainings to help them increase the effectiveness of their programs. ACTION ITEM The election of officers could not be held, owing to the absence of a quorum. It will be rescheduled for the July 19 th meeting in Guerneville. BOARD PLANNING 1) The slate of candidates for next month s elections is as follows: Chair - Doug Stephens; Vice Chair Maureen Casey; Secretary Ivan Anderson, with Lyndal-Marie Armstrong as Alternate; Treasurer To be nominated; CALMHB Liaison Sherry Weyers [nominations for all offices can also be made from the floor at the meeting]; 2) the Ethics Webinars will be held in the MH Annex on June 29 th at 10-Noon and 3-5 PM; 3) members are asked to review meeting materials prior to the Retreat scheduled for this Saturday, June 25 th. 2

3 REPORT OF BEHAVIORAL HEALTH DIVISION DIRECTOR Michael Lucid, Administrative Services Officer II, for the vacationing Mike Kennedy The legislature passed the budget on time, but the governor vetoed it. We don t know how bad things will actually be, but we re cautiously optimistic. The $862 million diversion of MHSA money is going ahead, to cover managed care, AB3632, and the child MediCal match (EPSDT). We re unsure whether Realignment 2.0 will ever occur, since the ballot tax extension is up in the air. If the MHSA diversion is legally challenged, things could be bad. There s considerable re-organization at the state level. MediCal oversight is going from DMH to the State s Department of Health Care Services (DHCS). Technical assistance and MHSA are unclear, but the designers of change appear to be listening, and there is value in having their administration and support. The community planning process has been a great change and has improved MH s relationship with the community. The Governor repealed AB3632 and has given the responsibility to the schools. We re working with local education agencies for a smooth transition over the next six months. The County s proposed budget is close to adoption, and Supervisors have restored some funds. We can fill several administrative positions, along with the Jail discharge planner; and Sierra Youth Center funding continues, after all. We re talking about bringing Nurse Practitioners into the Jail, as they have been proven effective in working with psychiatrists to extend medication services. The MHB has hosted a public hearing on the MHSA 10/11 Plan Update and on the 11/12 MHSA Plan. We re editing the report to include input from the hearing, prior to sending it to the State in a couple of weeks. This report no longer drives whether MHSA funds will be released to us, as the method of distribution is being streamlined. The Workforce Education and Training (WET) RFP has been released. It emphasizes three parts: Independent Living Skills, Consumer Relations, and Post-graduate Internships. Responses are due by July 19 at 5:00 PM. The next step is Innovation, emphasizing creative funding, and mobile consumer support services to geographically outlying areas. SCMH is part of a Joint Powers Authority, named CalMHSA, for state-wide MHSA-funded projects. CalMHSA has recently awarded contracts for stigma reduction to State NAMH and the state consumer network. The award to the consumer network of $1 million is thought to be the largest ever in California The National Association of County Organizations (NACO) has recognized our CAPE (Crisis Assessment, Prevention, & Education) Team for their work in schools with school staff and families to identify early signs of mental illness, thereby enhancing recovery. Signature/Aurora Healthcare said they ll have the new psychiatric inpatient unit on Fulton Road up and running in October or November of this year. The eighth session of Crisis Intervention Training (CIT) takes place Monday through Thursday next week. For the first time, Dr. Emily Keram will be missing, as she has to testify in court. MH s relationship with law enforcement has been much improved since these trainings began four years ago. A MHB member mentioned that a CIT-trained officer at the Rosenberg Building is doing a wonderful job, carrying with him what he has learned. This new fiscal year [July 1 st ] will bring many significant changes. We ve had many retirements and are now scrambling to fill 34 vacancies with qualified people; and we ll have new programs starting. The positions included licensed clinicians and non-licensed senior client support specialists. We are currently hiring extra help to get us through until we can recruit and hire regular full and part-time employees. We ve also hired a number of interns with MHSA dollars, including bilingual/bicultural staff and one African American woman. Through the MHSA Workforce Education and Training RFP process, we will be adding more family member and consumer positions to the system. Someone asked for another nurse at the Intensive Recovery Team (IRT), and Denise Hunt said RN hires are prioritized. MH SYSTEMS TRANSFORMATION Sonoma County s Mental Health Services Act [MHSA] page is at The State s MHSA page is at Michael Lucid, Administrative Services Officer/Contract/Fiscal Unit The biggest issue is the transferring of AB3632 responsibility to the schools. We re finally on the same page and working together. The budget is driving changes in the Jail setting. We re pulling resources out of the North County; we re down to only two half-days, which means that some clients will have to come to Santa Rosa for appointments. Denise Hunt, Acute/Forensic Section Manager Our liaison to the Courts, psychologist Steve Ranish, is retiring after the funding for his position went away. We invited ourselves to District Attorney and Public Defender staff meetings to educate 3

4 them about our crisis and intervention services, and to encourage the DA to drop minor charges to get clients out of jail. We re constantly educating court officers and judges. Dr. Gary Bravo, Medical Director, Community MH Centers (CMHC), Community Intervention Program (CIP) See Special Presentation notes. REPORT FROM THE CHAIR Doug Stephens said he was happy to hear about all the good things being done with MHSA funding, from folks at the Public Hearing OTHER REPORTS BOARD DISCUSSION / PUBLIC COMMENTS David France announced that the 6 th of NAMI s Family to Family classes starts next week and will train another 20 people. The Peer to Peer class and the In Our Own Voice training still have openings. All classes are held at the NAMI offices at 1300 North Dutton, Santa Rosa. Goodwill s Laurie Petta said the MH Co-Op has hired Don Ross as Consumer Liaison. Meeting adjourned at 6:28 PM Respectfully submitted, Virginia Meyer, Mental Health Board Clerk vmeyer@sonoma-county.org 4

5 SONOMA COUNTY QUALITY IMPROVEMENT PROGRAM The Quality Improvement Program covers ALL of Mental Health (adults, older adults, youth, SonomaWORKS, Jail, and Juvenile Hall) WHO WE ARE: Quality Improvement Coordinators: Wendy Sanders, LCSW, Marty Marcus, LCSW Administrative Aide: Carlos Mariscal WHAT WE DO: 1. Translate information: between clinical, fiscal, information technology, legal, compliance people 2. Track data: within and across systems 3. Write policies and procedures 4. Create and implement processes to improve delivery of services 5. Create forms 6. Support managers and programs 7. Prepare for State Department of Mental Health audits every 3 years a. DMH reviews all compliance issues in Title 9 and in MH contract (68 pages of compliance issues) b. They review 20 adult charts. c. Last review was 4/18 4/21/11. Results have not come in yet. 8. Prepare for External Quality Review Organization (EQRO) review every year a. APS Healthcare is the contractor for the State who does this. b. They review for Access, Timeliness, Quality, Outcomes c. NO chart reviews, but they do focus groups of consumers, line staff, supervisors. 9. Prepare for other audits/reviews QUALITY IMPROVEMENT PROGRAM CONSISTS OF: (see attached sheets) 1. Q.I. Policy Committee Senior Management, Compliance Officer, MHSA Coordinator, and Quality Improvement Coordinators. 2. Q.I. Steering Committee all County Program Managers, Medical Director, Section Manager, Patients Rights Advocate, Quality Improvement Coordinators 3. Q.I. Committee line staff, managers, Patients Rights Advocate, providers, consumers, family members, Medical Director The QI program consists of two pieces: 1. Compliance with State and Federal regulations a. Chart reviews b. Site-certification c. Claiming issues d. Provider issues 5

6 e. Compliance issues (JoAnn Borri is the Compliance Officer) 2. Quality Improvement Activities a. Performance Improvement Projects (PIPs) i. Hospitalization PIP designed to see if providing a home visit within 7 days of a person s discharge from an inpatient unit would result in decreased subsequent hospitalizations or lengths of stay. ii. EPSDT PIP (for Day Treatment for kids). State-wide project started out to see if the amount of day treatment used was necessary and cost-effective. We had no measurement tools, so we started using the Child and Adolescent Needs and Services (CANS) assessment tool. b. County Treatment Planning Coalition: i. 28 county collaboration to create a Treatment Plan library to use with an electronic health record. 1. To make Client Plans (treatment plans) appropriately address Client Recovery Principles, and yet be compliant with Medi-Cal requirements for Medi-Cal Necessity. c. Quality Review program audits reviewing for Access, Timeliness, Quality and Outcomes d. Electronic Health Record development to create auditing tools for both compliance issues and quality issues. e. Complaints and Grievances from consumers and family members f. Sentinel Events 6

7 ABBREVIATIONS & ACRONYMS 5150 Declared to be a danger to self and/or others AB3632 Assembly Bill - State-mandated MH services for seriously emotionally disturbed youth ACT Assertive Community Treatment (run by Telecare) ANSA Adult Needs and Strengths Assessment CANS Child, Adolescent Needs and Strengths Assessment CAPE Crisis Assessment, Prevention, and Education Team CIP Community Intervention Program CIT Crisis Intervention Training (for law enforcement) CMHC Community Mental Health Centers (SCMH)) ConREP Conditional Release Program (State-funded) CR Crisis Residential (aka Progress Sonoma-temporary home for clients in crisis, run by Progress Foundation ) CS Crisis Stabilization within PES - see PES (up to 23 hours) CSN Community Support Network (contract Provider) CSS Community Services and Support (part of Mental Health Services Act-MHSA) DAAC Drug Abuse Alternatives Center DHCS (State) Department of Health Care Services (replacing DMH July 1, 2011) DHS Department of Health Services (Sonoma County) DMH State Department of Mental Health in Sacramento EPSDT Early Periodic Screening, Diagnosis & Treatment (Children s MediCal) FACT Forensic Assertive Community Treatment FASST Family Advocacy Stabilization, Support, and Treatment (kids 8-12) FQHC Federally Qualified Health Center HSD Human Services Department IHT Integrated Health Team (medical and MH services for adults) IPU Inpatient Psychiatric Unit IRT Integrated Recovery Team (for those with mental illness + substance abuse issues) IMDs Institutes for Mental Disease (residential facilities for those unable to live on their own) INN Innovation (part of MHSA) LG Los Guilucos-Juvenile Hall LGBQQTI Lesbian/Gay/Bisexual/Queer/Questioning/Transgender/Intersexed (also LGBT) MADF Main Adult Detention Facility (Jail) MHB Mental Health Board MHD Mental Health Division (Sonoma County) MHSA Mental Health Services Act MIT Mobile Intensive Team NAMI National Alliance on Mental Illness PC1370 Penal Code 1370 (Incompetent to Stand Trial) PES Psychiatric Emergency Services PEI Prevention and Early Intervention (part of Mental Health Services Act-MHSA) PPSC Petaluma People Services Center QI Quality Improvement QIP Quality Improvement Policy (meeting) QIS Quality Improvement Steering (meeting) QIC Quality Improvement Committee (meeting) RCC Redwood Children s Center RCL Rate Classification Level (12, 13, 14 - group home designations) RFP Request For Proposals (released when new programs are planned and contractors are solicited) SCMH Sonoma County Mental Health SCOE Sonoma County Office of Education SELPA Special Education Local Plan Area SPMI Serious Persistent Mental Illness (or Seriously Persistently Mentally Ill) SYC Sierra Youth Center TAY Transition Age Youth (18-25) VOMCH Valley of the Moon Children s Home WET Workforce Education and Training (part of MHSA) WRAP Working to Recognize Alternative Possibilities YS/Y&F Youth Services/Youth & Family (Sonoma County Mental Health) 7