Service Management and Evaluation Sub-Committee

Of the Local Business Planning Committee

 December 2, 2002

MINUTES

MEMBERS     Bert Bleakley, NAMI

PRESENT:      Louis Gloston, Peterkin & Associates/IPA

                        Lena Klumper, Partnership for Children

                        Daniel Muldrow, Main Focus

                        Alfred Spriggs, L.I.F.E. Concepts

STAFF           Debbie Jenkins, Child and Family Services

PRESENT:    Director, CCMHC

                        Densie Lucas, Assistant Area Director, CCMHC

William H. McDougal, Substance Abuse

Services Director, CCMHC

Stacy Martin, Clerk to the Area Board,

CCMHC (Recorder)

 I.          Welcome/Introductions

            Mrs. Jenkins thanked everyone for coming.

 II.        Agenda Adjustments

            Minutes from 11-25-02 were adopted.

 III.       Continued Discussion of Service Management Section

·        Redistributed the Grid (ATTACHMENT A) as well as pages 17-19 of the State Plan (ATTACHMENT B) and discussed the elements with the following highlights:

-     management of core services;

-     ensuring the management plan is supported by the CFAC;

-     oversight of delivery of services to the target populations; and

-     best practices.

·        Ms. Lucas discussed the availability of a 24/7 crisis team in collaboration with CONTACT, DSS, law enforcement, BHC, Cape Fear Valley, Health Department, and housing resources.  The team would meet with clients at location other than the emergency room as this is at an expensive of at least $600.00 for the medical clearance in the Emergency Room. 

-     Discussed the possibility of utilizing space at Roxie Avenue Center for this purpose.

·        Mrs. Jenkins re-distributed the following documents to members who did not have:

-     Values and Principles For the Mental Health Center’s System of Care (ATTACHMENT C)

-     Utilization Statistics of Dorothea Dix Hospital (ATTACHMENT D).

·        Mr. Bleakley pointed out that when the new jail opens, they are supposed to have mental health services available. Currently there is the availability of a psychiatrist one day per week (Mondays) and with a Public Health Department Nurse assigned as staff to the jail.  (The Health Department expends a large amount of money on psychotropic medications for the inmates).

·        There was discussion regarding MOA reflecting a mental health assessment being conducted within one hour for children.  In some areas this is a requirement for all age groups.

·        Item 2 if grid:  have had several committees at CCMHC addressing issues with the following recommendations:

-     single access for adults and one for children’s services with the most skilled staff performing the assessments.  Mrs. Jenkins commented that there are six events/occurrences available prior to identifying a client as a member of a target population.  Following the process appropriately and completely is critical as it determines payment/billing eligibility to Medicaid and the State.  All pilot programs, with the exception of VGFW are or have experienced problems with this.

-     need too look at authorizations.  Mr. Gloston reported that IPA/Peterkin currently track authorizations on paper.

·        Discussed points of entry into the system.  It is unknown at this time what the multiple points of entry will be.  VGFW uses every public agency along with the school system. 

-     Would be cleaner for Cumberland County to utilize public agencies (schools, court, DSS, etc.) and use the crisis response team of the LME for after hours.

-     Access Subcommittee will begin meeting soon to address this issue.

-     Mrs. Jenkins reported that she hopes to have the geographic mapping complete within two weeks to identify where access points need to be based on current providers and consumers.

-     Mrs. Jenkins shared what disability-specific assessments need to be completed and informed members they are listed/discussed in the Service Monitoring section of the State Plan.

·        Mrs. Jenkins reported that the LME will handle item three of the grid. 

-     Discussed step-down services currently available and the need to develop mid-range services such as respite.

-     Ms. Lucas shared that there is a push in the Triangle area to not close Dix Hospital as it will have a huge impact on care and the economy of that area.  There was discussion that sending clients to Butner will significantly increase commute time and have a significant impact on law enforcement as they are primary transporters for clients to state hospitals.

·        In response to item four of the grid, there was discussion regarding inadequate resources for crisis services. 

-     People are currently sitting in the emergency room for hours.

-     Mr. Spriggs shared with the committee that BHC is shutting down some of its inpatient beds and that this will increase the bottleneck in ER.

-     It is the hoped that the crisis team will help bypass the lengthy and exhaustive process of going through ER assessment.

-     Mrs. Jenkins shared that CCMHC has been in discussion with Mr. Sprouse of BHC about alternatives to accessing the ER.

-     Mr. Spriggs shared an idea that he has for transitional housing. The proposal will offer intensive case management supports for 5-6 people.  He suggested that this could also serve as a triage site.  Ms. Lucas cautioned him about mixing crisis assessment with step-down.  Mr. McDougal offered the name of Mr. Bert Bennett, Capacity Coordinator at the Division who could help with grants. Mr. Spriggs has already talked with Mr. Bennett and has also communicated with NIDA about funding opportunities.

-     Ms. Lucas suggested that there is a need to look at training/education regarding co-occurring issues across the spectrum of MI/DD/SAS/HIV and health issues in general.

·        Regarding item #5, Mrs. Jenkins reported that she is still waiting for the State to clarify their concept of one case manager per family as there is some differences of opinion on whether this is true in human services specific areas or if it is across all human service agencies.  She did share that at-risk case management for DSS has been differentiated by the State from clinical case management for mental health.  Once more clarification is received from the State, CCMHC will better be able to determine direction for case management and care coordination.

·        In response to item #6, Mrs. Jenkins commented that the State is still debating a standardized contract.  This will be handled by the QPN subcommittee.

·        Regarding Item #7, a policy has been written in the QPN committee stating that individuals will be given choice.  Fair competition for referrals will require additional discussion to ensure fair distribution and equity. 

·        With respect to item #8, Mrs. Jenkins shared Medicaid appeals process regarding denials, suspensions, terminations, or reductions in services as this will be the similar appeals process for target populations.

 IV.       Next Steps

             Mrs. Jenkins will bring to next meeting written documentation including Executive Summary that will be submitted to State, narratives, and the Strategic Plan.

 V.        Adjournment

            Next meeting will be in two weeks on Monday, 12/16/02 at 8:30 a.m.