“Defining the Box” Meeting Notes 5 Feb 2009

Notes – Mental Health Services Work Group – February 5, 2009

Attendees: Natalie Ammarell, Thava M. Michelle Turner, Linda Foxworth, Andrew Pham Staff

Our Work: Describe the system as it relates to Chapel Hill Orange County. What it looks like and how it works

General Agreements re Work:

§  Visual Depiction (best, but complex)

§  Glossary

§  Walk some clients through the system, Poverty Simulation-type map

§  Different entry points for each demographic

§  Extensive Key

§  Funding and Regulatory maps as well.

§  Look through lens of age groups –  Birth -5; 5-12; 13-17; 18-21; 21-65; 65+  ($ to each age group, where states put to their money 13-17, high end group homes, small group of people get the most amount of money).

“Mapping”: 0-3 Age Group (Some of the things said…)

§  Pediatrician not the point of entry.

§  Fed mandate to find and assess children (IDEA, Individuals with disabilities education act)

§  OSEP>DPH>CDSH>ITSC>Provider

§  TEACH is important, people move to Chapel Hill just for it. Autistic is a special program and area demographic

“Mapping”: 21-65 Age Group (Some of the things said…)

§  OPC gets money from state IPRS integrated payment and reimbursement system; HUD; Substance abuse; direct funding from the counties. STAR Triage and referral phone tree.

§  Providers can bill Medicaid but many clients are not eligible for Medicaid. Reapply based on other diagnosis after initial entry. Takes time to follow the client.

§  Lack of preventive care

§  Need to be extremely ill for services without Medicaid. Acuity based system, crisis intervention system.

§  Local dollars, where are the gaps, plug up holes and use for preventive work. What is qualifies as preventive work? Different for each person.

ü  Parenting education

ü  Earlier Identification

ü  Access to Medication and services

ü  Filling out forms and red tape is hard

ü  Parents don’t have their own medications.

ü  From prescription to having it filled has obstacles for clients

ü  Housing,

ü  Club Nova.

ü  Drop in Center as a safe place, partial hospitalization programs

ü  Durham, Drop in center

ü  Peer specialists

ü  Units with supportive services.

ü  Social Worker available prior to cris

ü  Peer Bridger, NAMI type activities

§  The system is fragmented – no one knows where to go.

§  Can’t provide services and case management at the same time.  Current case management is ineffective. Referring yourself clients. No money and then they leave. Cherrypicking clients who have billable hours.  Case management disappeared – there needs to be an access team who knows about local providers and resources and processes

§  Need for Inter agency coordinating council to help (IAC). Case review at an agency level. Mandated by IDEA at the preschool level. Child Find, identification of Children. Public relations/awareness, transition from 2-3 service -5- school age services. Have to have it based on law. Local agency responsibility and reports, IAC. http://www.nccarelink.gov/ list of agencies.

§  Mental Health Court – Community Resource Court, Joe Buckner. (Hillsborough has closed, cutting the court dates in half.). Only three or four of them in the state. Requires coordination and time that isn’t billable. Sentences people to treatment instead of prison. Funding from state for the court system, you have to bill to get services. Can’t get sustained services for treatment. Provider has no power to enforce it.

§  No information system for provider information HIPPA. Client has to approve of privacy information. Value Options, authorizes services. HIPPA problem, stops the flow of information, no access to the system of the provider. How do they get around this problem.

§  Two groups: people who set fires and sex offenders. Hard to find providers for these groups. Borderline personality disorders. DBT Dialectical treatment areas.

§  Major constituent service. Verla Insko is the last resort. Doesn’t always work. Sign of a broken system.

§  Solutions?

ü  Case Management

ü  Inter agency Council group

ü  Reimbursement fee for referral, to cover costs and incentive for working together

ü  Look at the high users and evaluate them and actually try to help. Cost saving message.

ü  Maybe suggestions can be integrated into other town services.

ü  CIT crisis intervention Teams/training.

ü  ER is a source of clients. Try to keep people out of the ER and prevent it.

ü  Clinical home, 30 min reachability, and depends on the services.

ü  Carolina access for Adults? (Physicians work with clients and manage them – provider collaborative made the care for kids a lot better).

Concerns in this environment of State and local funding cuts:

§  How do we keep safety nets in place. How to hunker down?

§  Look at existing funds and reposition ourselves to maximize impact. Every year a needs assessment, to make sure the money is going to the right place. Zero-sum evaluation, how can the money be best distributed.

§  We are in a much better situation than other counties -d how to make best use of  resources?

Next Steps

Invite Lisa Lackmann and Bebe Smith to join group.

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