In the most recent County Health Rankings & Roadmaps, Red Lake County Ranked 14 th out of 87 Minnesota Counties in overall Health Outcome.

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1 Red Lake County: County Administration: Agency Name: Red Lake County Social Services Director s Name: Kristi Nelson Address: 125 Edward Ave. PO Box 356 Red Lake Falls, MN Telephone Number: FAX Number: County Agency Contacts: Area of Responsibility Name Title Telephone Number Social Services Kristi Nelson Director Public Health Anita Cardinal Director Mental Health - Adults Kristi Nelson Director Mental Health - Children Kristi Nelson Director Chemical Dependency Kristi Nelson Director Transportation Kristi Nelson Director County Demographics: Population 4087 Persons under 18 yrs. of age 24.2% Persons 65 and older 17.6% White persons 96.2% Black persons 0.3% American Indian 1.7% Asian persons 0.2% Persons of Hispanic/Latino 2.5% Language other than English 4.4% Median Household Income (2011) $47,719 Persons below poverty level 10.4% Mean travel time to work, 16 y/o minutes In the most recent County Health Rankings & Roadmaps, Red Lake County Ranked 14 th out of 87 Minnesota Counties in overall Health Outcome.

2 General County Service Delivery and Access Issues: Concerns that should be addressed in a proposal include: Lack of service providers within the Red Lake County geographical boundaries, in general. Meeting the needs for outpatient chemically dependent services. Lack of psychiatric services for adolescents. Lack of volunteer drivers to serve the need of both medical and non-medical transportation. Lack of residential services for MI-D and difficult to serve SPMI populations, especially those with previous legal issues. Lack of adequate choice among health care providers Improving prevention and early intervention services Lack of supportive employment services and transportation. Lack of services targeted toward addressing the needs of the aging population; lack of appropriate family supports. Lack of technology resources to support elderly/disabled to remain at home. Health care services currently unavailable or of limited availability to the county's MA recipients include: Transportation is an issue since Red Lake County has three satellite clinics but no primary clinic within its boundaries, these satellite clinics provide minimal care. Residents of Red Lake County are left with few choices except to access primary clinics located in neighboring communities. They either drive themselves, if they own a vehicle, or are dependent upon a neighbor or family member (family member reimbursement is $.20 per mile inadequate with the current fuel prices) or they can contact Tri-Valley community action program Rural Transportation Collaborative program in Crookston, MN for a volunteer driver (volunteer drivers are mostly seniors future possibilities of replacement drivers is not good). Primary clinics accessed by most Red Lake county residents are located in Thief River Falls, Crookston, and Grand Forks, ND. Specialized services may be available at Grand forks or residents are referred to areas such as Fargo, ND or Minneapolis, MN. Transportation is an issue for low income or those without a vehicle to access these services. Dental: Overall, Red Lake County has a dental provider to population ratio of 1:4115 which is significantly worse than the state ratio of 1:1660. There is a lack of dental providers who will see MA clients in Red Lake County. One dentist does not accept MA as a payment source. The MCO(s) should support this effort or any effort to bring dental care to MA and low income individuals in Red Lake County. Paying higher reimbursement rates and making billing more consistent across payer sources to attract local providers makes more sense in our rural area than paying the transportation costs to travel up to three hours away for the nearest dental provider accepting MA.

3 Current providers that county recipients use: Dr. Patrick Alcorn Park Place Mall, Red Lake Falls, MN - Phone This provider is not taking new MA clients. Northern Valley Dental Alliance for services and any other provider within reasonable distance from Red Lake County. Chemical Dependency: There are no chemical dependency service providers in Red Lake County. Red Lake County MA recipients have access to the consolidated chemical dependency funds which allows them to participate in most treatment programs in Minnesota. County recipients have to travel to our-of-county inpatient or outpatient providers. The issue with chemical dependency treatment for MA residents is whether or not the treatment program has a residential component or not. For those needing outpatient services, they may not have access to transportation to attend sessions in neighboring communities. There are no direct care providers or specialists in Red Lake County. Current chemical dependency treatment provider(s): Chemical dependency treatment provider Rule 25: Valerie Heffner contracted Rule 25 Assessor or Kathie Johanneck, Red Lake County Social Worker, chemical dependency case manager alternate Rule 25 assessor. Development of outpatient chemical dependency service within Red Lake County Development of residential assistance for mothers with children attending chemical dependency treatment or alternate programs within the region Evidence based methamphetamine treatment program in Northern Minnesota Reviewing and considering the use of psychotrophic medications along with the traditional CD treatment program Use of evidence based co-occurring disorder treatment programs within the region Provide for county care coordinator services for chemical dependency Mental Health Adults: Red Lake County is a participant in the NW8 Adult Mental Health Initiative. The initiative has been directly involved in the development of adult mental health services in NW Minnesota. Red Lake County has approximately.60 FTE adult mental health case managers. The emphasis is on community-based mental health services. Red Lake County contracts with the Northwest Mental Health Center located in Crookston, MN and Sanford Medical Center Psychiatric Unit in Thief River Falls, MN. Services provided by the Northwest Mental Health Center are: Day treatment Targeted case management ARMHS

4 Homeless (PATH) Employability Outpatient Mental health screenings Psychological Community support program Adult foster care Supported apartment services Services provided by Sanford Medical Center are: Inpatient Inpatient crisis (12-hour holds) Psychological evaluation 24-hour crisis phone line There is a: Lack of in-patient psychiatric services Lack of transportation for seriously and persistent mentally ill the transportation program often does not meet their needs Lack of specialists knowledgeable about applying evidence based treatment for mental health disorders, especially co-occurring disorders. Lack of step down residential program in the area Lack of long term residential placements available in the area for those most difficult to serve. Current mental health provider(s): Northwest Mental Health Center, Crookston, MN Sanford Medical Center, Thief River Falls Red Lake County Social Services general case management and Rule 79 case management some rule 79 case management is co-case managed with staff from the Northwest Mental Health Center. Family service specialists at the Oklee/Plummer school district and Red Lake Falls school district project of the Red Lake County Child & Family Services Collaborative. *Due to funding cuts to the LTCS reimbursement rates, these positions cannot be funded after this FY. Developing psychiatric services Improving transportation for MA clients without a vehicle Developing services for those with co-occurring diagnosis Collaborating with the NW8 Adult Mental Health Initiative in regards to adult mental health services Maintaining existing adult mental health network Enhancing county care coordinator for mental health services

5 Mental Health Children: Red Lake County has approximately a.50 FTE children s mental health case manager. Inpatient crisis services are provided by the Sanford Medical Center in Thief River Falls. As stated above, case management services are provided by Red Lake County Social Services. Red Lake County contracts with the Northwest Mental Health Center for children s mental health services. Family Group Decision Making Family Community Support Services (Family Ties) Children s Mental Health Crisis Service Child outpatient Child outpatient medication management Occasionally, Red Lake County will utilize a Rule 5 residential facility or obtain a 30-day evaluation from a residential facility. Red Lake County Family and Children s Mental Health Collaborative has a family specialist (social worker) in the Red Lake Falls school district and one in the Oklee/Plummer school district. The emphasis of service delivery is home and community based. There is a: Lack of psychiatric services Lack of evidence-based programs for child perpetrators Lack of transportation for low and moderate income parents. No family choice of family based service providers Lack of providers who can provide evidence based practices for children with cooccurring disorders. Current mental health provider(s:: Northwest Mental Health Services Red Lake County Social Services Red Lake County Children and Family Services Collaborative Developing an improved child psychiatric service Developing an alternative family based service program so families can have a choice Developing a contract for an evidence based child sexual perpetrator treatment program Improving the transportation options for low and moderate income parents of emotionally disturbed children Improving respite care options for parents Providing enhanced county care coordination services for children s mental health Providing outcome based practices for co-occurring disorders Transportation: Red Lake County Social Services health, medical assistance care access plan states that we will use Tri-Valley s Community Action Program s Rural Transportation

6 Collaborative which is a volunteer driver program and also has a bus service. The volunteer rate for 2013 is $.565, to transport a relative the amount is $.20 per mile. These rates apply for social service clients as well. Special transportation is available through several small providers who are certified as special transportation providers: R & L Specialized Transportation, McIntosh, MN. Since we have a small number of service providers within the county s geographical boundaries, we are dependent upon services in surrounding counties. This creates a difficult situation for residents without vehicles or low income individuals who cannot afford transportation expenses. In summary, recipients are primarily either using their own vehicles and reimbursed at $.20 per mile or use RTC volunteer transportation from Tri-Valley Opportunity Council in Crookston, MN. Due to current restrictions in DHS policy, barriers are created for individuals who may have a working vehicle but lack insurance, driver s license or ability to purchase fuel prior to the appointment. This decreases the use of preventative care services that are a cost savings to the Medicaid system. Most volunteer drivers are seniors who may soon age out of volunteer driving. There does not seem to be replacements available for those who quit or age out of driving. This trend could have a severe impact on the pool of volunteer drivers and dramatically impact the availability of transportation services in the future. There is a lack of transportation services for recipients. Current transportation providers: Tri-Valley Opportunity Council Volunteer system Self, family, neighbors Special medical transportation: R & L Ride Service, McIntosh MN Emergency: Red Lake Falls Ambulance Oklee Ambulance Common carrier (including bus, paratransit, taxi): Occasionally Tri-Valley Transportation bus Volunteer system RTC Tri-Valley Allow transportation to be a part of reimbursed care coordination services Currently there are no resources for specialized transportation within Red Lake County. Arrange for specialized transportation provider to serve Red Lake County citizens Special Programs: Current community based planning organizations, advisory councils, and task forces and special initiatives involving health care for county MA recipients: Mental Health Local Advisory Committee Children s Mental Health Advisory Committee NW8 Adult Mental Health Initiative

7 Red Lake County Child Protection Team We are currently developing an Adult Protection Team at RLCSS. Additionally, we are in the process of developing Communities for a Lifetime Committee to focus on aging issues and planning needs for the local community. Public Health: Red Lake County contracts with Inter County Nursing Service. Currently Inter County Nursing Service has one nurse stationed in Red Lake County. Inter-county public health nurses stationed in Thief River Falls, MN are available upon request to Red Lake County residents. As previously mentioned, Red Lake County was ranked 14 th out of 87 counties on health outcomes. Some areas of improvement needs included adult obesity, clinical diabetic screenings, limited access to health foods and limited access to recreational facilities. In general, due to the lack of primary care clinics, we experience a lack of provider choice. We do not have specialty care providers within the county. Transportation is an additional barrier as we are at least 30 miles from the nearest primary care clinic. Urgent care clinics even in surrounding counties are limited. Red Lake County has no urgent care. The main recurring issue in Red Lake County as stated throughout is the lack of local providers. We are dependent on services available in surrounding counties. Current providers that county recipients use: Inter County Nursing Service Home Health Care Providers that Red Lake County holds host county contracts through other surrounding counties include: River View Home Health About U Inc. Home at Heart Care Independence Plus Inter County Nursing Service