Ocean County Joint PAC/PACADA Meeting Summary July 20, 2010

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1 Ocean County Joint PAC/PACADA Meeting Summary July 20, 2010 CALL TO ORDER Dave Roden, PACADA Chair, called the Joint PAC/PACADA meeting to order at 2:00pm. Attendance was taken by sign-in sheet and introductions were made. ATTENDANCE (Sign in sheet attached) MEETING INTRODUCTION Brunilda Price, OCHD Community Health Service Coordinator and Tracy Maksel, OCDHS Assistant Mental Health Administrator provided the group with an overview of the agenda, which reflects guided focus group topics. The purpose of the meeting is to bring local DAS and DMHS stakeholders, including funded providers and consumer advocates, to the table to provide input into the merger of DAS and DMHS under the New Jersey Department of Human Services. Specifically, correspondence was received by the New Jersey Association of County Mental Health Administrators (NJACMHA) regarding the establishment of an ad hoc workgroup comprised of County Mental Health Administrators to develop recommendations concerning the merger of DAS & DMHS and to advocate aggressively for those recommendations to be considered, and hopefully implemented. The workgroup outreached County Mental Health Administrators encouraging all counties to hold a Joint PAC/PACADA meeting to discuss key areas of concern identified by the workgroup. Those key areas of concern will be used as the topics of discussion for today s breakout groups. In addition, it was noted that Kevin Martone, Assistant Commissioner under the New Jersey Department of Human Services had outreached Jill Perez, New Jersey Association of County Human Service Directors President, to identify a liaison for a DAS/DMHS merger workgroup under development within the State Department of Human Services. The information uncovered at today s meeting will inform, then, both the NJACMHA workgroup and the NJDHS workgroup. All attendees were asked to break out into small groups of 6-7, and focus group topics were assigned. A good faith effort was made to include both mental health and substance abuse representatives in each break out group, though a greater number of substance abuse representatives were present. BREAKOUT GROUPS A. State Contracting Discussion focused on questions. Specifically, the following questions were asked: Will both DAS and DMHS components be treated equal in funding? Will there be a blending of contracts? Will there be a blending of licensure? Will DAS vs DMHS credentials affect access to funds? Will there be a blending of diagnosis and funding? If so, how will admissions to treatment be affected?

2 Will a fee for service model be pursued, or will funding be granted based on static beds/slots? The group suggests that administrative functions be merged, but that programs remain independent as they exist now. The group suggests that an electronic contracting/budget system that is universal and user friendly be adopted. It is expected that any new contracting/budget system will not serve to overwhelm providers. B. State Licensure The group identified issues, and inconsistencies, that currently exist within the licensure of DAS and DMHS. Ultimately, the group focused on wholeness in licensing and credentialing. It is recommended that conflicting licensing requirements be resolved to produce mutually beneficial licensing that is streamlined to meet DAS and DMHS requirements. The group raised concern regarding credentialing. The group suggests that if a blending of funding/service scope is expected, that credentialing requirements should not change mid-stream for already contracted providers. Ideally, a grandfathering period for credentialing should be implemented to ease the transition for providers existing independently prior to the merger. In addition, it was noted that supervisory issues occur due to licensing constraints and lack of co-occurring programs. The requirements for supervision of staff should be reevaluated as part of the merger. The group also tackled financial issues specific to licensure/credentialing. The group raised specific concerns regarding the expectation of unrealistic staff to client ratios and the potential for increasing mandates for small facilities, which will cause harm and potential closure as smaller programs struggle to provide increasing levels of service with reduced funds. In addition, it was noted that as programs encounter increasingly difficult contracting and accounting requirements and mechanisms, additional staff time is required, though not available. The group recommends a more realistic fee for services model for both DAS and DMHS, uniform credentialing for DAS and DMHS and uniform computer programs for DAS and DMHS. The group also recommends a streamlined contracting mechanism that is user friendly, technologically driven, and not unnecessarily overwhelming.

3 C. State Required protocols for client assessment The group targeted integrated, comprehensive client assessments that are more universal, less repetitive, consumer driven, and inclusive of additional wellness and recovery indicators. The rate per assessment ($48) was noted as too little for the time involved in completing a comprehensive assessment. Recommendations include: the development of common domains for assessment with ability for providers to customize the format, but with the intent to avoid repetitive gathering of information. Assessments should be streamlined so as not to interfere with consumer engagement. Assessments must include components that promote a person centered recovery plan. Assessments should include input from the consumer, families, TX providers, non-traditional supports (e.g. AA, self-help.) and finally, assessments should consider entitlements and all resources that may address consumer needs so that a comprehensive, integrated recovery plan can be developed and agreed upon. D. State Standards of Care - The group provided input regarding standards of care. Recommendations call for a DAS/DMHS standardized assessment instrument; a standardized income and program eligibility mechanism. The group also assessed the value of evaluating best practices on both the DAS and DMHS spectrums to identify what innovations are necessary and how to achieve advancement in the areas of prevention, early intervention, treatment and support services. Recommendations call for an analysis of best/innovative practices and areas of improvement so that if a re-engineering is needed, positive change and development can be achieved. The group discussed outcome measures and how those are different between disciplines. The group recommends that universal (whole) measurements of success be adopted. The group discussed the differing roles of mentor/peers and families in the process of wellness and recovery. The group recommends that both disciplines understand the role of peers/mentors in the unique treatment milieus and then analyze how they may better integrate peers/mentors into the service spectrum. The group expects the merger will be completed with high standards, through local input, and will not ultimately present as a Quick Fix to State budgetary constraints. The group expects that decisions will be made through an open, inclusive process, with mechanisms seeking input from local providers, consumers and county coordinators.

4 E. Cross Training for State, County and Provider Staff The group identified DAS and DMHS differences in perceptions, services and culture. The group believes that a zero based knowledge approach must be embraced. More specifically, the group sees the benefit of both DAS and DMHS staff, providers and consumers engaging in crosstraining, but with the expectation that there is little knowledge of each other s systems of care, ideologies, and approaches. By beginning with a clean slate, knowledge and competence can be gained in a mutually beneficial environment lending toward better integration. The group also sees the benefit of engaging in the purposeful identification of similarities and differences between the DAS and DMHS systems/milieus, so that a concept map of how to proceed in developing knowledge in a merged environment can be achieved. It is the expectation of the group that the State will focus upon cross-training DAS and DMHS together to: understand differences; identify similarities; build competence in systems of care; and develop strategies to create a true continuum of care. It is the expectation of the group that the State will focus upon cross-training DAS and DMHS together on: healthcare reform; prevention; resources and continuum of care; best practices; entitlements; stigma within systems; language within service milieus. It is the expectation of the group that the County will focus upon cross-training DAS and DMHS together to: understand differences; identify similarities; build competence in systems of care; and develop strategies to create a true continuum of care. The group discussed resources available and how to better approach a system/continuum of care. Again, the issue of recognizing best practices, areas of improvement, and innovations was discussed. It is a recommendation that a DAS/DMHS transition team engages in the mapping of the current system/continuum of care, the identification of best practices and areas of improvement, and then address innovations necessary. F. Future Ocean County planning and the Role of County Government It was discussed that the perceived role of county coordinators/administrators is to ensure that the outcomes and messages emerging from local planning and oversight activities are communicated to the State. It therefore is essential that the county coordinators/administrators continue to participate in State and County meetings, and continue their advocacy efforts to inform decision making at the State level. In addition, it was discussed that the county coordinators/administrators are in a position to utilize existing mechanisms (PAC, PACADA, Committees, Surveys, Planning Activities) to continue to focus upon mutually beneficial cross training, information sharing, communication, etc. for DAS/DMHS providers and consumers. It is the expectation of the group that the county coordinators/administrators will continue to encourage joint DAS/DMHS venues of information sharing and training.

5 It is the expectation of the group that the county coordinators/administrator will continue to communicate with one another regarding DAS/DMHS issues, concerns, and activities. It is the expectation of the group that the county coordinators/administrators will represent the local systems of care, their voice, concerns, and messages to inform all decision making processes that will impact the county system of care, providers and consumers alike.

6 Special Joint PAC/PACADA Meeting Agenda To: Professional Advisory Committee on Alcoholism and Drug Abuse Ocean County Mental Health Board From: Brunilda Price, Acting County Alcoholism & Drug Abuse Coord. / Tracy Maksel, Assistant Director, Ocean County Department of Human Services Date: July 20, 2010 Time: 2:00 PM Location: Agriculture Building, 2 nd Floor Meeting Room (building is in the rear of the OCHD parking lot) RSVP to Bridget Albers at ext or balbers@ochd.org 1. Call to Order Dave Roden, PACADA Chair 2. Special Joint Meeting Merger of the State s Division of Addiction Services and the Division of Mental Health Services-B.Price/T. Maksel 3. Topics for discussion: (All Present) A. Future County Planning and Role of County Government B. State Contracting C. State Licensure D. State-Required Protocols for Client Assessment E. State Standards of Care F. Cross-Training for State and County Staff and Provider Staff G. Conceptual and Philosophical Perspective, Framework, and Vision 4. Adjournment Your attendance and input is important concerning the re-structuring and re-organizing plan for the new Division of DAS/DHMS

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