Seneca County Community Services Board - Meeting Minutes December 19, 2017

Seneca County Community Services Board - Meeting Minutes December 19, 2017 Present - Dr. Theodore Papperman, Tom Premo, Pat Plyter, Lisa Heitmann, Stanley Hatch, Peter Same, Susan Ganser, Jennifer Mander, Todd Horton (acting Chair), Excused - Dr. Veronica Mittak Absent - Supervisor Greg Wadhams, Amy Elias Guests - Margaret Morse, Bob Dinan Jr., Tammy Orlopp, Kathleen Horton, Annie Mahoney, Carol Faivre Welcome - Meeting was called to order. Secretary minutes from November: Motion to accept initiated by Stanley Hatch and seconded by Dr. Theodore Papperman. No discussion. All in favor. None opposed. Motion carries. Public Announcement: None Consumer Report: None Committee Reports (Dr. Theodore Papperman): ASA Subcommittee meeting was held prior to CSB meeting. Administrative Remarks (provided in advance by DCS Margaret Morse): CSB Administrative Remarks December 2017 (Reflecting November data) Outpatient Services Mental Health Clinic Productivity Units of Service (Productivity Standard 1400 UOS/month) November 2016: 972 November 2017: 1170 Gross Revenue ($120,000/month standard) November 2016: $115,297 November 2017: $148,248 YTD Gross Revenue 2016: $1,368,941

2017: $1,436,426 (approximate 5% increase from 2016) Program Activity Program Census: 598 Admissions: 34 Discharges: 37 Intake visits: 53 Psychiatry visits: 269 Injections: 6 Family Therapy: 16 Individual Therapy Sessions: 781 Crisis Services: 5 Forensic Services: 5 Nursing: 6 Sex Offender Group 21 DBT Group 7 Psychological Testing - 1 Addiction Clinic Productivity Units of Service(Productivity Standard 483 UOS/month) November 2016: 476 November 2017: 530 Gross Revenue ($33,000/month standard) November 2016: $27,520 November 2017: $29,303 YTD Gross Revenue 2016: $342,475 2017: $412,533 (20% increase from 2016) Program Activity Clinic Census: 117 Admissions: 16 Discharges: 12 Evaluation visits: 49 Group visits: 218 Individual counseling services: 185 Addiction medication services (Suboxone or Vivitrol): 35 Work Assessments: 5 Vocational: 11 Brief Interventions: 1 Brief no charge: 10 Psychiatric Services: 16

Accumedic Implementation Reboot Billing work plan in place to finalize successful billing module implementation Appointment reminder system implementation in process. Lab module interface in process. Seneca County Community Counseling Compliance Program Bonadio audit in process. Initial findings were reported. Additional 100 dates of service for Medicaid Managed Care charts to be audited in the end of November. Plan to make full report to the CSB and BOS in December. Bonadio is reviewing our current compliance plan for recommendations. Proactive Spreadsheet and Agenda structure is in place on the MH side. Staff is aware of expectations surrounding timely documentation. Zero tolerance policy all paperwork must be completed within regulatory time frames. Fully electronic at this time. All treatment plans and other documentation are in the electronic health record. Next steps setting up billing rules. DCS reinforced in most recent management meeting: expectation of compliance with Medicaid and OMH documentation. Staff, including management will be held accountable for lack of compliance. Managers are responsible for oversight and monitoring functions. New Quality Auditing Policy implemented. Staffing Dr. Roemer is now a Full Time Staff Psychiatrist as of 11/6/17 Evening hours implemented at Cady Stanton Elementary to better serve families. Romulus Central Schools has requested a satellite office in their building. EZ PAR in process. Open Positions: a. Natalee Carroll, Community Educator (del Lago MOU), started on November 13 th. b. 2 Psychiatric Social Workers (1 Ovid, 1Waterloo) In order to meet school based service needs, we need to fill these positions. c. Peer Advocate position has been filled by Amberlynn Jones. Her start date is December 11 th. d. Full time RN position for Addictions Clinic has been filled by Meredith Beckley, RN. Her start date is December 18 th. Crisis Intervention Training (CIT)

Sheriff Luce and Margaret Morse to lead Kick off Training end of January. Need a Community Advocate to be part of the kick off team. o Crisis Intervention Training o Mental Health First Aid o Ongoing Community Forums Gambling Mitigation Tammy continues to collaborate with Del Lago on program development. Billboard draft was approved and invoice for 6 months was sent to Lamar. Suicide Prevention Coalition Next steps Strategic Planning Subcommittee Support Group Subcommittee Public Relations and Marketing Subcommittee DCS is working with Seneca County School District Social Workers and Guidance Counselors to develop a uniform approach to suicide prevention for Seneca County Schools. Seneca County Systems of Care United Way and LGU are taking the lead for Seneca County s Systems of Care (SOC). Family, driven, trauma informed, culturally competent, youth focused and strength based philosophy towards provision of services to families and children in Seneca County. We are in the process of developing a SOC training opportunity. We propose training human service providers throughout Seneca County (all new workers mandatory?) to help facilitate a common philosophy and language. This has had preliminary support from DHS. We will work with County HR dept. Twice yearly training focused on new workers but also seasoned workers are welcome to attend. New County Initiatives with DCS involvement Raise the Age Steering Committee continues. Counsel at First Appearance Steering Committee continues. Integrated Care Initiatives Rural Health Network to provide Chronic Disease Self-Management Group in our Mental Health Clinic and Chronic Disease Self- Management of Pain Group in Addictions Clinic. Still in the process of recruitment for the group. SBIRT Implementation Projects Still in Planning

Finger Lakes Community Health Seneca County Public Health Value Based Payment Medicaid Transformation BHCC s FLACRA and Genesee County Integrity Partners for Behavioral Health is now 15 County Providers. We added Cayuga and Cortland, Schuyler and Tioga. Application submitted 11/8/17. Seneca County Network participating affiliates include: o Finger Lakes Health o Finger Lakes Community Health o Seneca Cayuga ARC o Rural Health Network o Seneca County Public Health o Dick Van Dyke Treatment Center o Lakeview Mental Health o Rochester Regional Health Bonadio - Came in and started the Medicaid Manage Care audit on 12/18/17. The clinic is still going through the process. Bonadio will volunteer to speak with staff about the risks and how to put systems in place. The clinic is in the process of moving all of our medication only clients to clinicians. There will only be a small handful of clients that will remain as medication only clients. The nurses need to be doing Health Monitoring and seeing clients if issues arise from medications. Margaret discussed 2 handouts from the NYS Conference of local Mental Hygiene Directors, Inc. - Why Invest In Jail-Based Substance Use Disorder Services - Completing the Recovery Treatment Continuum: Jail-Based Substance Use Disorder Services There will be a training with Jed Wollenbreit, CLMHD council- an attorney about the New York State Mental Hygiene laws at the next CSB meeting January 16, 2018 @ 6:30. New Narcan kits will be distributed to CSB members with the new 2-4mg dose kits. Monthly Report Bob Ritter - Coordinator of Children s Services

Month: November 2017 I. Outreach Efforts: a. 11/15/17: Presentation to DHS staff on youth services available and referral process b. 11/28 and 11/29: NYS Coalition for Children s Behavioral Health Conference learned about changes in service delivery system and engaged in networking c. Participated in team meetings (Student Support Team, Effective Practices, COST) at schools as follows (number indicates # of meetings attended): i. South Seneca Elementary: 3 ii. South Seneca HS/MS: 3 iii. Frank Knight School: 1 iv. Romulus School District: 1 v. Waterloo HS: 1 vi. Waterloo MS: 1 vii. Lafayette School: 1 The name of the meeting and the number of meetings held per month varies per school. Cady Stanton canceled its meeting for this month. Skoi Yase, Mynderse Academy, and Seneca Falls Middle Schools do not hold these meetings. II. Referral & Linkage: a. Number of Referrals Received: 10 b. Number of Referrals Made for Waiver Services: 4 i. Pathways: 4 ii. Hillside: 0 c. Number of Referrals Made for Health Home Care Management: 5 (Specify Providers to Whom Referrals were Made) i. EPC 1 ii. Glove House: 2 iii. FLACRA 1 iv. Hillside 1 d. Number of Referrals Made for non-medicaid Care Management: 2 i. Glove House: 2 e. Number of Referrals Made for HIFI Services: 4 f. Number of Referrals Made to FLPN: 3 g. Number of Referrals Made for Other Services: 0 (Specify Providers to Whom Referrals Were Made) h. Number of Families that Declined Services: 1 Some families were referred for more than one service so referrals made exceeds referrals received. III. Health Homes Care Management: a. Agency Number of Cases i. EPC 9 ii. Glove House 12 iii. FLACRA 4 iv. Hillside 1

v. Lakeview 1 IV. Waiver Services Summary and Analysis: a. Pathways: i. Number of Youth Served: 6 ii. Number of Cases Opened: 2 iii. Number of Cases Closed: 0 iv. Number of Cases in Start-up: 2 v. Number of Cases Planned for Discharge w/in 30 Days: 0 vi. Number of Openings Currently Available: 3 (transfer planned for 12/1 will leave 2) Narrative/Analysis: County to county transfer paperwork will be completed once it is confirmed by family that they have moved from Canandaigua to Seneca Falls (see I.a.vi. above). Same ICC and service providers will continue in Seneca County with this youth skill builder, parent advocate and intensive in home worker. b. Hillside: i. Number of Youth Served: 3 ii. Number of Cases Opened: 1 iii. Number of Cases Closed: 0 iv. Number of Cases in Start-up: 1 v. Number of Cases Planned for Discharge w/in 30 Days: 0 vi. Number of Openings Currently Available: 0 Narrative/Analysis: A slot could be borrowed from Monroe County to avoid formation of a waiting list. V. FLPN: Services: a. General Family Support: i. Number of Families Served: 15 ii. Number of Cases Opened: 0 iii. Number of Cases Closed: 0 iv. Units of Service (Total Staff Hours): 55 b. Support Groups: i. Number of Groups Held: 2 ii. Number of People Served: 8 iii. Units of Service (Total Staff Hours): 4 c. Child Care at Support Groups: d. Respite: i. Units of Service (Total Staff Hours): Unavailable (UA)

i. Number of Families Served: UA ii. Number of Cases Opened: UA iii. Number of Cases Closed: UA iv. Units of Service (Total Staff Hours): UA e. Teen Group: i. Number of Groups Held: UA ii. Number of Youth Served: UA iii. Units of Service (Total Staff Hours): UA f. Family Education: i. Number of Events Held: 0 ii. Number of People Served: 0 iii. Units of Service (Total Staff Hours): 0 Narrative (Highlights, Comments, etc.): None reported by provider Analysis (Performance per Contract): FLPN does not currently have the data keeping system in place to provide the requested statistics on a monthly basis. Much of the data is tabulated manually. The statistics provided above are a month behind. Other requested categories have no data reported at all. Peer Services Director Arlene Francis reports that the agency is in the process of acquiring a computer based system for data tracking. I will monitor the agency s progress in this regard as reliable data reporting is integral for measuring their performance per contract. VI. Glove House: I. Services: a. HIFI: i. Number of youth served: 5 ii. Number of cases opened: 1 iii. Number of cases closed: 0 iv. Openings Available: 5 v. Units of Service (Total Staff Hours):150 b. Respite: i. Number of youth served: 2 ii. Number of active cases: 14 iii. Number of cases closed: 0 iv. Openings Available: No limit v. Units of Service (Total Staff Hours): 230 c. Mental Health Support Groups: i. Number of youth served: 5 ii. Number of cases opened: 2 iii. Number of cases closed: 0 iv. Openings Available: 5

v. Units of Service (Total Staff Hours): 25 d. Non-Medicaid Care Management: i. Number of youth served: 1 ii. Number of cases opened: 0 iii. Number of cases closed: 0 iv. Openings Available: 19 v. Units of Service (Total Staff Hours): 3 e. Health Homes Care Management: i. Number of youth served: 13 ii. Number of cases opened: 5 iii. Number of cases closed: 1 iv. Openings Available: No limit v. Units of Service (Total Staff Hours): 270 Submit Roster as Addendum f. HHCM Service Dollars: Number of recipients utilizing funds: 0 Narrative (Highlights, Comments, etc.): The Me, Myself and I Teen Support Group met 3 out of 4 weeks with an average of 5 teens in attendance. The topics covered were: Feelings, emotional regulation,and the SELF module and the group completed a community service activity. Groups will begin at Cady Stanton on December 4, 2017. The Mental Health staff is working with Romulus and South Seneca School Districts to provide groups in their schools as well. The Parent Support Group, What About Me? will begin in January and will occur once per month in the evening to accommodate parents work schedules. Child care will be available. Emily Wesoloski has been hired as the HIFI staff person and has helped to revive the HIFI program. She is expecting to have a full caseload by next month. Fourteen youth currently are eligible to utilize the respite program but 2 utilized this service in November. Analysis (Performance per Contract): Glove House is performing well and meeting the terms of its contract. I reviewed the contract with Program Manager Jennie Darling. The contract appears to include non-direct service time (paperwork, travel, etc.) in determining units of services and that is reflected in the numbers above. Referrals to HIFI through SPOA are rising and it is anticipated that this service will be fully utilized by early 2018. VII. Seneca Cares: a. 11/16: Care Team Facilitator Training b. Serving on Web Site Committee actively working to create a site for Seneca County. VIII. Identified Unmet Service Needs: One youth was identified in need of mentoring services such as Big Brothers/Big Sisters. I was unable to secure services from BBBS of Rochester and Ithaca. I will monitor the number of youth who are identified as in need of mentoring services. IX. Narrative: The statistics in this report represent November 2017. Much more referral activity has continued into December. Waiver slots will be filled by mid-december and a waiting list

will begin. Hillside can borrow a slot from Monroe County. Any other youth in need of Waiver services will be referred for HHCM until a slot becomes available. Bob Dinan - DBT group has 6 members and is 5 weeks in. The group cannot have more than 15 people per group per Medicaid regulations. This class teaches skill building is done to help manage emotions, Fight/Flight/Freeze. Severe trauma people are always ready to fight. This class also teaches disstress tolerance. There are 5 or 6 applicants that have applied for the open positions for 1/2 school base, 1/2 clinic for the open position for the one - Ovid and one - Waterloo clinics. These were advertised in Ithaca and Trumansburg newspapers. Tammy Orlopp - A report for Addiction Treatment Program, Prevention Program, and Problem Gambling Program was presented during the ASA Subcommittee meeting prior to the CSB meeting. A survey has been conducted to adolescents, adults, parent groups, church members and community. The data collected will be broke down by group. Findings will be presented at a later date. Old Business - Public Health and Enviromental Health will be moving to the new health building in January 2018. Mental Health and Addictions programs is looking to transition to DiPronio Dr. in 2019. $1.3 million is the estimated cost to renovate the office space. Margaret meets with the all the dr. s every month. DIC - The bathrooms of the Drop In Center have made a lot of progress. This was slated to be finished before the Holidays. Due to unforeseen circumstances this will not be possible. All four walls needed to be tiled. Work had to be stopped. There were issues with the porta potties. The porta potties were not maintained like they should have been. They will now be serviced twice a week. Forward motion - a nice job is being done. An RFI will be written up for interest in the Drop In Center to possibly be a free standing unit. After the RFI, then a RFP will be written. Becoming independent will not be written in the RFI or RFP. Kirstin Muckstadt - peer services - has interest in DIC and their independence. Would like to work with CSB behind the scenes to assist and work with the employees on a budget and governing board. Ms. Muckstadt would assist with anything she can. She would come to the county. Ted Papperman showed that we need not to be paternalistic, but to let them make decisions, not for them.

This DIC is different than the other DIC is surrounding counties. Some of them are peer run, while others have state involvement. More to follow. There is additional funding in 2018 budget for DIC repairs. We are not rushing this and taking time to do it right. Money will still come from the county until further information is presented. New Business - Thank you to the Sub Committee chairs for stepping up and taking on 2018. CSB went into Executive Session. During Executive Sessions There was a vote for Peter Same and Dr. Theodore Papperman to another 4 years on the CSB committee. Nominations for and voted in Lisa Heitmann for Vice Chairwoman, and Todd Horton for chairman positions. We also voted to bring into resolution the addition of attendance regulations for CSB as written by Carol Faivre. Executive Session: Executive session moved and seconded At 8:20 by Tom Premo, Lisa Heitmann. Peter Same was re-nominated to CSB moved and seconded by Tom Premo, Dr. Ted Papperman Dr. Ted Papperman was re-nominated to CSB Moved and seconded by Stanley Hatch, Pat Plyter. Also as a voting board we elected to amend the bylaws to Attendance requirements as spelled out by Carol Faivre. Moved and seconded by Tom Prim, Stan Hatch. Also discussed was hiring policy for Drop in center. We will discuss the findings at our next CSB meeting. Motion to adjourn the meeting was made by Pat Plyter and seconded by Lisa Heitmann. Next meeting: Tuesday January 16, 2018 at 6:30. OPDWW will be prior to CSB at 5:30.