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Home My WebLink AboutAgenda - 09-03-2002 - 6a r ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 3, 2002 Action Agen Item No. SUBJECT: Update on Mental Health Reform Planning Process DEPARTMENT: OPC Mental Health PUBLIC HEARING: (YIN) No ATTACHMENT(S): INFORMATION CONTACT: Tom Maynard, 913-4000 Powerpoint handouts (used in Gwen Harvey, 245-2307 presentations to local groups) TELEPHONE NUMBERS: summarizing current status of planning Hillsborough 732-8181 content Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To update the Board of County Commissioners on the status of the State- mandated planning process and to advise the Board concerning key choices ahead. BACKGROUND: As the Board is aware; the State mental health reform effort directs that Orange County produce a local business plan by January 2003 describing how the County will carry out its responsibilities under the State Plan 2001 Blueprint for Change as revised. The Board of County Commissioners must choose a governance model, assess the status quo, and propose a plan for improving services. One major feature of the State Plan is the mandate that area authorities (or equivalent), such as the OPC Area Program, may no longer provide direct services and must propose a divestiture plan. The local planning process as originally conceived is on schedule. Under the guidance of the OPC Steering Committee, much work has been done over the past several months to include various stakeholders in assessing the current system and in devising responses to be included within the proposed plan. Public forums will be held in Orange, Person, and Chatham counties this fall to solicit community input. The Orange County forum is set for October 8, 2002 from 7- 9 p.m. at Southern Human Services Center on Homestead Road in Chapel Hill. The Steering Committee will review and recommend a governance structure from among several options for inclusion in the proposed plan. (The initial governance structure can be revised if necessary in the future). A finished draft of the proposed plan will be presented to the BOCC by November 1, 2002 and will include analysis and recommendations on issues posing serious financial risk or public controversy for Orange County, should any arise. FINANCIAL IMPACT: To be determined as part of the overall planning process and development of recommendations that come forward to the Board. OPC intends to present a 2 plan that can realistically improve client service delivery without increasing the net cost to the County. The extent to which services might be improved will depend in part on state funding. No state funding has been provided for transition planning. RECOMMENDATION(S): The Manager recommends that the Board receive the update as information in preparation for the public forum and subsequent stages of decision making. System Reform Choices Setting the Direction The Mission • Working in partnership with individuals and far assist individuals with disabilities to live norms in the community • To manage public resources wisely, efficiently effectively General Feedback • Where will funds come from for d ei nstitutional ization? • What will happen to non-priority popula • Can we avoid fragmentation of local services? • What will happen to OPC staff? • Not enough private providers to do all ji • Need better cultural competence in pro network Feedback on DD Systei • Movement toward ideals has been goo( • Most services are good • Not quite enough. of most things--waitini • More respite needed • Self Determination principles need strengthening • Start work with Murdoch residents to ply community placement Feedback on SA Service • Women's services , Criminal Justic connection is better, now a strengi • What will happen to non-priority populations? • No case management • Need more Intensive Outpatient Feedback on Child Mental HE • System of care is a strength • Work with Criminal Justice system strength • Medicaid access is better than witf adults • Home based supports hard to get . • Need more respite Feedback on Adult MH sy • ACT Teams and clubhouses are a strei • Not enough family support • Not enough client choice • Crisis services too hard to access • Affordable Housing , affordable housing • Need better access to affordable medic • Jobs needed • Services in short supply Services to SPM1 CY2000-2001 ACT TEAM $447,948.00 5 ADMINISTRATIVE $33,823.30 0 CASE MANAGEMENT $968,729.80 12 COMMUNITY SUPPORT $1 ,568,931 .94 19 COURT RELATED SERVICES $6,234.00 0 CRISIS SERVICES $10,606.65 0 DAY SERVICES $2,645.00 0 DETOX $3.550.00 0 DWI SERVICES $107828.00 0 EVALUATION $23,161 . 17 0 GROUP TREATMENT $413,892.33 5 INDIVIDUAL THERAPY $1,344,626.07 16 INTAKE $72,349.38 0 MEDICAL SERVICES $579,578.99 7 PSYCHOSOCIAL REHAB $1,185,096. 17 14 RESIDENTIAL $475,443.0' 5 RESPITE $4,658.75 0 SPECIAL THERAPIES- $535.85 0 TRAVEL $1211762.25 1 VOCATIONAL SERVICES $681 ,261 .79 8 Total: $7,955,665.441 100 SERVICE DISTRIBUTION to SPMI Consumers CY200t Service Distribution to SPMI $180,00U.00 $180.000,00 $140.000.00 y� $120,000.00 J $100,000.00 qja W W $80 000.00 $e0.0w.00 $40.0$0.00 $20,000.00 $0.00 0 Soo 1000 15W 2000 CLIENTS Service Distribution to SPMI CY200C • 2080 different people served • Average expenditure/person/year $1 • Receiving more than $5000/year ; • Receiving less than $500/year 1 • Receiving less than $100/year Services to People with Schizophrenia--F • Total of 477 served • Individual Therapy-. • Pattern of services ' Medication------------ • Case Management- linked to program of , vocational Service.c entry • Psycho social--------- • Average of 3 • ACTT------------------ services per person CBIIHRI--------------- • Residential------------ • Average of about Group Therapy------ $5000/person Case Support-------- Philosophical Principle: • Self Determination • Client choice • Person centered purchase of ser • Full community participation • Best Practice • Recovery Model • Outcome oriented Choices--General • Governance model--Area Authority for • Consolidation--Not now, but funding wil later consolidation • Privatization of Services--State is adarr Will evolve over several years • OPC will have to assist with service transitions--private sector alone will not enough Choices--Structure of Consumer. Input and Influe • Governance Structure of LME-- Consumer/family participation • Consumer/Family Advisory Committ .term structure • Client rights procedures • Outcomes measures--Who decides will it work? Choices--Adult MH • Need better crisis services--easier access • Better tracking and support for people who are fret, admitted to hospitals • More affordable Housing • More Jobs • More case management • Easier access to affordable medication • Need "ACT Lite" - Outreach — Community based support - intensive support on demand • Need Case Finding--Schizophrenia Choices--SA • Need prompt access to detox from rur areas • Jobs • Housing • Increase Intensive Outpatient Pro capacity • More Case Management Choices--Child MH • Need more local wrap-around sere • Need more respite • Focus on Age 0-3 Early Interventic Choices-- DD • Need more respite • Need to reduce wait list • More training for staff in Self-determinat • Cannot implement needed change with new money, new Medicaid plan • Need to get moving on Murdoch downsi need help with funding Pilot Proposal • Simplified funding model--alternatil Fee-for-service • Reward good Outcomes • Pilot consumer/family involvement How might new plan make things bE • Resource shift to high priority consumers/acti • Focus on Outcomes--Reward good outcome: through contract incentives • More choice • Competition could improve quality, cost • LME focuses on system development, result! • Cultural Diversity and competence may be e; arrange • State can clear up its funding model and Medicaid How might state plan ma things worse ? • More provider agencies could mean me duplicated administrative expense • Coordination will be more challenging • Non-priority consumers unserved • Deinstitutionalization could overwhelm existing services The plan to mitigate hart • Contract conditions to discourage "chE picking," reward coordination . • Contracting will eliminate low producti, • County Funds can be used for state rn priority consumers • State Medicaid changes could fund deinstitutionalization with federal fund: Some help needed from s • Medicaid plan--not rehab orient • Payment structure--mixed mod • Rules too complex, burdensom • Oversight duties duplicative • Clear authority, accountability Next , Steps • Public Forums — Chatham--September 9 — Person--September 12 — Orange--October 8 • Local Business Plan Draft Novei Each County will review, hear pub comment • Local Business Plan goes to Sty — Jan 2 , 2003