Marshall County: County Administration: Agency Name: Director s Name: Marshall County Social Services Chris Kujava Address: 208 E. Colvin Ave. Ste 14 Warren, MN 56762 Telephone Number: FAX Number: 218-745-5260 County Agency Contacts: Area of Responsibility Name Title Telephone Number Social Services Chris Kujava Director Public Health Gail Larson Public Health Director Mental Health - Adults Stacy Anderson Social Service Supervisor Mental Health - Children Stacy Anderson and Social Service Ruth Finseth Supervisors Chemical Dependency Ruth Finseth Social Service Supervisor Transportation Mary Jo Larson Administrative Assistant 218-745-5154 County Demographics: Marshall County encompasses 1,675 square miles and is located in the northwest corner of Minnesota. There are approximately 10,000 people that live in this county. It is a predominately agricultural county. Transportation is a major barrier to the residents of Marshall County. We need the MCO(s) to address the isolation of many of the county s residents: vast distances to travel, insufficient public transportation, needs of the non-english speaking persons to communicate with interpreter services, the increasing elderly population without extended family supports, and the many people who lack telephones for support and for scheduling activities. The county ethnic make up consists of 95.1% Caucasian, 3.8% Hispanic/Latino. Most of the county residents speak English, but there are some that speak Spanish.
General County Service Delivery and Access Issues: Some of the issues that the county deals with are: 1.) Lack of dentists taking new public assistance clients. 2.) Lack of public transportation. 3.) Lack of child and adult psychiatrists 4.) Lack of local adolescent chemical dependency (CD) treatment options 5.) Lack of adult daycare Dental: Many clients need to drive 100+ miles one-way to find a dentist that will see them. There is a lack of providers willing to take on more public assistance clients. Some clients may be seeing providers that the county does not know about and private paying for services or clients may be enrolled in a MCO and using their contracted providers. It is unknown if the MCO(s) can provide assistance in this area. Dentists in the area that want to contract with MCOs or DHS have already done so; they just are not taking any new clients. Perhaps there needs to be better reimbursement or carve out dental services from the MCO(s) and keep them fee-for-service. Another option is to provide financial incentives to the providers to take on more public assistance clients and to clients for keeping their appointments. The MCO(s) could contract with the county to provide care coordination to arrange dental services. Eliminating any dental co-pays may also increase dental usage. Chemical Dependency: Marshall County Social Services completes Rule 25 CD assessments and makes recommendations and referrals according to an individual s level of need and treatment considerations. Our Rule 25 Assessor works with the court system, service providers, individuals and families in various court proceedings, pre-petition screenings for commitments, commitment hearings and court ordered treatment as well as voluntary services. Individuals are referred to various providers for treatment as stated below, and case management is provided to assist in accessing and following through with treatment needs. As there are no treatment providers within our county, transportation can be an issue. Individuals who do not have their own transportation rely on family, friends, and at times utilize volunteer drivers. Marshall County currently has only one adolescent treatment provider within the area, and they provide outpatient only. Adolescents needing inpatient treatment need to go to treatment some distance away.
Marshall County employs a Rule 25 Assessor who completes chemical health assessments, makes treatment recommendations and refers for treatment based on the individual s needs. Marshall County also uses other counties Host County Contracts. The MCO(s) can contract with counties for completion of Rule 25 assessments and abide by Rule 25 criteria for funding level of care recommended. The MCO(s) can also contract with county Social Services for care coordination, similar to Minnesota Senior Health Option (MSHO) and Special Needs Basic Care (SNB). Mental Health Adults: Adult Mental Health services in Marshall County consist of case management, counseling, flex funding, pre-petition screenings, community-based services including Community Support Program (CSP), Adult Rehabilitative Mental Health Services (ARMHS), Intensive Residential Treatment Services (IRTS), vocational assistance, money management, transportation, waivered services, Personal Care Attendant (PCA) and Adult Mental Health Initiative (AMHI) staff and transitional services for youth 18-21. Marshall County Social Services provides case management services which can include Rule 79 Case Management. Services provided to adults with mental health needs are coordinated with providers serving our county. Due to our rural community, travel to appointments can sometimes be difficult. Currently we utilize volunteer drivers to assist with transporting to mental health/medical appointments. County, CSP, and AMHI staff as well as county care teams assist with assuring that the consumers mental health and medical needs are addressed through coordinating and communicating services needed. The shortage of available psychiatrists can sometimes result in long waits for appointments and/or result in emergency holds. There are crisis beds available in Thief River Falls and Crookston, MN. Currently we have one hospital available for 72-hour holds. This hospital serves the entire region; therefore the limited amount of beds makes accessing this service difficult at times. Current mental health provider(s) with which county contracts (including community mental health, Rule 79 case management, children's mental health collaborative providers): Marshall County Social Services Northwestern Mental Health Center Northwest Medical Center Marshall County also buys off of other counties Host County Contracts The MCO(s) will need to coordinate with county case managers in providing for diagnostic assessments, and in development of treatment plans. There needs to be
flexibility in access to resources for both emergency crisis management and for ongoing stabilization and treatment. The MCO(s) need to coordinate with counties to provide and coordinate services involving the court system. The MCO(s) need to coordinate with county case managers, schools, mental health providers, Adult Mental Health Initiative and medical providers for provision of mental health services. The MCO(s) need to coordinate and collaborate with counties and all mental health providers to provide early intervention and prevention services to the consumers. The MCO(s) need to accommodate mental health services when consumers live outside of the county. The MCO(s) should contract with county Social Services for care coordination. Mental Health Children: Children s Mental Health services in Marshall County consist of Children s Mental Health Case Management, office based individual and family counseling, diagnostic assessments, in-home family community support services, school based mental health services, Children s Therapeutic Services and Support (CTSS), medication management, acute mental health care including hold orders, flex funding and residential treatment. Case management is provided by Marshall County Social Services, with the majority of other services being provided through Northwestern Mental Health Center, which is based in Crookston, MN, and Northwest Medical Center, which is in Thief River Falls, MN. Both are within 30 miles of our county seat. Marshall County Social Services is a member of the Northwest Council of Collaboratives. Also, through the Marshall County Family Service Collaborative, we are working with schools in our county and Northwestern Mental Health Center in provision of school linked mental health services including diagnostic assessments and CTSS. Other mental health providers used are private practitioners, Altru Health System, Center for Psychiatric Care, and Prairie St. John s. We have experienced a shortage of child psychiatrists in the area, which may result in long waits for appointments. Northwestern Mental Health Center has begun utilizing tele-mental health to assist in alleviating this shortage issue. Doctors and nurse practitioners/physicians assistants have been utilized for medication management. Transportation is also an issue, with families needing to travel for appointments. Current mental health provider(s) with which county contracts (including community mental health, Rule 79 case management, children's mental health collaborative providers): Rule 79 Case management is provided by Marshall County Social Services. Northwest Medical Center
Northwestern Mental Health Center Marshall County also uses other counties host county contracts The MCO(s) need to coordinate with county case managers in providing for diagnostic assessments and in development of treatment plans for children with SED. There needs to be flexibility in access to resources for both emergency crisis management and for ongoing stabilization and treatment. The MCO(s) need to coordinate with county case managers, schools, and other providers in for provision of school based services. The MCO(s) will need to accommodate mental health services when children are in out of home placements outside of the responsible county. The MCO(s) should contract with the county Social Services to provide care coordination. Transportation: Marshall County Social Services currently contracts their Volunteer Driver Program with the two MCOs that operate in this county. If the recipient has a car or another ride available with a family member or friend, they contact the county for prior authorization and are reimbursed by the county. If the recipient does not have access to transportation, they can call their MCO (if enrolled in managed care) or call the county (if fee-for-service) to arrange for a volunteer driver. Marshall County s Volunteer Driver Program is usually able to provide transportation for those who need the service. However, there are times (for example: emergencies, short notice, etc.) when a driver can not be arranged. List of current Transportation providers (including those with county contracts): Special medical transportation: Emergency: Common carrier (including bus, paratransit, taxi): Volunteer system: Each of the MCOs contract with the County s Volunteer Driver Program. Any new MCO(s) need to contract with the Marshall County Volunteer Driver Program. The MCO(s) should contract with the county Social Services to provide care coordination.
Public Health: Public health services are provided by North Valley Public Health. Services include home visits to pregnant women, newborns and moms, families with children, screenings for school children, PCA screenings, participation in Long Term Care Consultations with county Social Workers, Geriatric Care Coordination for Nursing Facility MSHO clients, facilitation of Interagency Early Intervention Committee, provider of Child & Teen Check Ups, provider of Outreach program for C&TC Program, tracking immunizations and developmental screenings for children, provide immunizations including flu shots for children and adults, facilitation of the Child Abuse Prevention committee, health screenings for adults, smoking prevention programs, public health preparedness coordination, correctional health services, and environmental health services. Current providers that county recipients use. North Valley Public Health Current home health care provider(s) with which county currently contracts (including PCA): Altru Home Health Good Samaritan Home Health Various PCA Choice Agencies