January 2002 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
The Unexpected Beneficiaries of California's Right to Drug Treatment Law: Hard Core Users with Multiple Convictions; Many with Mental Illness
When California's Right to Drug Treatment law, better known as Proposition 36, went into effect July 1st, planners were predicting that most offenders choosing the treatment option would be low-level users in need of short-term outpatient therapy. Instead in the first several months, counties have been seeing a population that is far more addicted than expected: older and in need of a range of services, including mental health treatment.
Sixty-one percent of CA voters approved the constitutional amendment in November 2000 attracted by its promises to reduce drug addiction, the prison population and state expense. The measure requires that non-violent drug offenders be given the option to choose probation and treatment rather than serve prison time.
Although it is too early to draw any conclusions about Prop 36, the Urban Counties Caucus reports responses to a November questionnaire reveal the rollout has gone "fairly smoothly" despite the need to coordinate across multiple county departments. The Caucus says caseloads under the new law are in line with projections. In large and medium counties the average projection was an increase of about 42 percent. Smaller counties projected much greater increases, an average of 984 percent, with nine counties projecting increase of over 100 percent and two counties projecting 7,000 per cent. Taking away those 11 counties, smaller county projections fall into line with large and medium counties.
But, says the Caucus, counties are concerned about funding. The ballot measure provided a set $120 million a year for five years to run the program. Any additional funding will have to come from the CA legislature at a time when money is tight. Counties report sufficient funding for this fiscal year, largely because of rollover planning and start-up money from the year before. However, because of the need to treat an unexpectedly severely addicted population, several counties are already experiencing shortages of residential beds. The rest are worried about residential needs in the future. One county reported insufficient funding to treat Prop 36 clients also suffering from mental illness. The mental health funds available under the proposition can only be used for the profoundly mentally ill and not all Prop 36 clients meet this description. In addition many county respondents had concerns about insufficient funding for drug testing, which was allocated in a separate, after-the-fact measure from Prop 36.
On a state level, Prop 36 costs may eventually be offset to some extent by savings in the penal system. At a legislative hearing in mid-November it was reported that in the first four months of the program the CA prison population fell by 2,400 inmates, a drop attributed primarily, although not entirely, to Prop 36. The state spends about $25,000 annually on each prisoner.
Because each of CA's 58 counties, has developed its own response to Prop 36 models vary. Following are interviews with three county alcohol and substance abuse directors:
Los Angeles County: In the long run Prop 36 is going to be a test of the drug treatment community's ability to market itself, says Patrick L. Ogawa, LA County Alcohol and Drug program Department of Health Services Administrator. Ogawa predicts that the system is going to run out of capacity and that will mean more residential and outpatient programs are needed. He says it will be important to gain the understanding of "the common citizen who voted for Prop 36" both because of the need for more funding and because of a not-in-my-backyard (NIMBY) attitude about the location of drug facilities. He also thinks staffing is going to be a major problem.
LA accounts for one fourth of all CA drug arrests so much of its continuum of care was already in place July first. However 26 monitoring courts had to added to the system. These make referrals to 11 community assessment centers, where the addictions severity index (ASI) is used to make referrals to over 250 community-based organizations that provide a range of services.
LA already had 13 drug courts, which integrate substance abuse treatment, sanctions, and incentives with case processing to place nonviolent drug-involved defendants in judicially supervised habilitation programs. Drug courts are an alternative to standard law courts chosen by defendants before making a plea while Prop 36 is a choice made after a guilty plea. A third option offered CA drug offenders is a diversion program called PC1000 in which non-violent, drug offenders with only minor drug charges may choose treatment and if they complete it successfully, their charges are dropped.
Ogawa says it is hard to say it if Prop 36 is taking business away the drug courts. In fact, unlike most other CA counties, LA hasn't seen the increase it expected in people seeking drug treatment. So far only about 1200 drug offenders have sought treatment. The projection for the first year of Prop 36 was 15,000. Ogawa predicts the numbers will come in by the end of year and in the meantime he has been glad to have to the time "to ramp the program up."
He says at least some misdemeanor cases are opting for jail time over more lengthy treatment and like other counties, LA is getting a higher volume of felony cases than expected and drug users who are more addicted. In addition more males than females are opting for treatment and they average in age from 25 to 44. "They're tired," says Ogawa. "The treatment providers are telling me that the people who are coming in are wanting to stay." That says a lot about those offenders who choose treatment and, in Ogawa's opinion is also "a good reflection on our system of care."
That kind of motivation lessens worries that offenders who choose treatment will quit early or that amount of treatment allowed by Prop 36 will not be enough. Prop 36 mandates up to a year of drug treatment with six months of follow-up. "If we can tag on a structured after care," Ogawa says, "the time element may not be as critical."
Prop 36 was supported by the county department of health services but opposed by the board of supervisors. Since passage, however, there has been a strong collaborative effort among courts, probation office and treatment providers, "a gift for all of us," sighs Ogawa. Now, he says, LA is working on an automated information system to move reports across the system of care.
Sacramento County: The model developed by Sacramento County made probation the hub of the Prop 36 system funneling all reporting and communication through that department. That decision has been both criticized and to some extent justified by the first five months of Prop 36. Administrator of Sacramento County's Alcohol and Drug Services Division Toni Moore says Sacramento chose to model Prop 36 on the drug court system, which emphasizes frequent contact with courts, close monitoring and supervision. Because Prop 36 offenders are placed on probation, this decision meant beefing up the probation office and Sacramento elected to spend a third of its Prop 36 money doing that. "The reality is that most probation departments in our state are under staffed and the level of supervision people get for like (drug) offenses is pretty minimal, " says Moore. "We felt to have a quality program it needed to be balanced and particularly to get the support of courts…we needed a program that put an emphasis on the public safety side."
The decision earned Sacramento a `D' grade from Prop 36 advocates who thought all program funding should be spent on treatment and not criminal justice, which already has its own funding stream. But Moore thinks experience bears out the probation decision. In the first four months of the Prop 36 program two thirds of the individuals served in Sacramento have had prior felony convictions and a quarter had have three or more felony convictions.
In addition the county of 1.2 million people has added more treatment capacity. Fortunately says Moore, there was unpurchased capacity in both out patient and residential treatment to make that possible. "You really do need a pretty sophisticated array of treatment services, as well as supervision," she says, her statement again borne out by the numbers: a quarter of the people choosing Prop 36 have needed mental health services, two thirds are unemployed, almost a fifth require health care and more than a tenth are homeless. "I thought it would be more of a mix," admits Moore, who was also surprised that two thirds were male and over 35 years of age.
In the first four months 720 Sacramento drug offenders chose Prop 36, in line with a projected 2600 per year. Only a few of them have been parolees. Something that has surprised Moore is that drug court and drug diversion numbers have not been affected but she says the programs serve different populations. Offenders with multiple offenses, for instance, do not qualify for Prop 36 but are eligible for drug court. And those who qualify for diversion are apt to make that choice because charges will be dropped.
Almost a third of county offenders, eligible for Prop 36, are dropping out before they get to assessment. What this means Moore doesn't know: "I don't know how many are saying, yeah, I want Prop 36 and just failing to show up versus how many are saying I don't want to be bothered with treatment, I'll just do the jail time. The good news is that once they get to treatment a high percentage engages in treatment, over 90%."
Moore, who backed prop 36, has this advice for other counties that might be facing similar measures: "If you don't already work in a collaborative fashion (with criminal justice) then get going on it because you'll need to be well-organized and work out your philosophical issues, your organizational issues and your turf issues because this will challenge that," In her county a criminal justice cabinet was already in place, bringing together the presiding judge, district attorney, public defender, sheriff, police, drug and alcohol services on a regular basis for years. It allowed Sacramento to get an early start on Prop 36.
Butte County: Something Butte County Alcohol and Drug Programs Administrator Bradford Luz hadn't anticipated with Prop 36 was the difficulty of getting people from jail and court to treatment. "These folks are in jail, they go to court, they choose the option of treatment and so the idea is to move them very quickly right then to a treatment program so having a bed, an out patient slot available is critical," he says. What Butte County learned to do was make assessments before court hearings so that county officials were ready with a treatment recommendation and a person, choosing Prop 36, could be taken from court to the appropriate level of care. "It's very quick," says Luz.
With a population of 225,000 Butte County is a smaller medium-sized county by CA standards. It was a county that had a good experience with drug courts and when Prop 36 was approved, was reluctant to make changes that would affect the drug court system. Luz's department was seeing a whopping 40% success rate with drug court treatment, which he attributes to longer treatment times, long case management and long oversight by the court. Luz, who has done some drug treatment, believes the odds are against recovery in a short period of time: "Most people take about 90 days for brains to unscramble. Then it takes about 18 months for their physiology to adjust to the lack of substance and achieve a normal metabolism." Because of the good results, his clinicians liked working with the drug courts too. "Their patients were tractable, they were there, showing up, which is half the battle," says Luz.
Hence, in Butte County drug court jeopardy was "the bitter pill" of Prop 36, not only to clinicians, but also to justice officials, all of whom were against the measure. "(They) felt pretty much like their tremendous efforts and leadership had been ignored," Luz asserts, "That was definitely one of the barriers or boundaries we had to work with, not to lose what they had done."
Implementation was further impeded by the vagueness of Prop 36's language, "not insightful about the way government agencies, service delivery organizations work," says Luz, whose stance on Prop 36 was neutral. The gaps in the measure left him with a lot to work out. He did so by taking a "scientific approach", looking at the different factions "how do they do this, what does the document say, where are its shortcomings and what are we going to have to do as the lead agency to make it work." Another frustration was that the courts kept changing things along the way, adding to the population to be served and making it harder, Luz says, to be successful.
Like the counties above Butte was fortunate in the cooperation of its police, jail, court officials, who put aside their opposition to work towards making Prop 36 a success. Luz says all the various groups pooled their talents. "We had some strengths in terms of contracting, quality assurance, oversight contracts to make sure things are getting done, people are getting efficacious treatment, that was our strength in this," maintains Luz, "Probation actually does a much better job of case management of following them, finding them." Butte County Probation also does drug testing, now that additional money has been made available for that.
On the plus side Luz says Prop 36 funding has allowed him to develop and offer a range of services he did not have before. He was able to overhaul the system and create options. The overhaul will continue because he has also set up a review system, evaluating data every two months and making changes where necessary. "It allows us to move the money where we need the service," Luz says, "It's become a very interesting productive process."
Butte is on track with projections. As of mid-November prop 36 has led to 98 referrals; 350 were predicted for the first year. They fit the profile being seen in other counties, having been in the jail system and acquired longtime drug habits. But the biggest surprise to Luz is the number of parolees, as much as 15% of referrals, choosing Prop 36. "They are a different element from what we're used to working with," he says.
Luz believes another six months will really tell the Prop 36 story by giving a better idea of the shorter-term treatment efficacy and recidivism rates. He notes that drug court is still an option in Butte County but that the system is much diminished and he hopes that it will not be removed from the menu of treatment options for drug offenders.
Proposition 36 Moves on to Ohio and Florida
The November 2002 ballot in Ohio is likely to contain a Proposition 36 like constitutional amendment. Whether the Florida ballot will follow suit will be decided by the state's supreme court. Launching initiatives in these two states is of primary interest to the Campaign for New Drug Policies, which promoted California's ballot initiative. Campaign Executive Director Bill Zimmerman has been quoted as saying Ohio and Florida are of primary interest because in addition to being big initiative states, they are Republican states. The campaign is also targeting MI.
A coalition of policy reformers supported by the Lindesmith Center Drug Policy Foundation, the campaign is financed by wealthy businessman George Soros, Progessive Insurance Chairman Peter Lewis and University of Phoenix Founder John Spurling. It has sponsored 13 initiatives, most of them dealing with medical marijuana and most in Western states. To combat the perception that "drug reform is a Western phenomenon," Zimmerman has said that OH, FL and MI were chosen because they are east of the Mississippi.
Chief Executive Officer of the Hamilton County ADAS Board Sherry Knapp notes with wonder that the OH first lady has come out against the State's right to treatment amendment, although the governor is still making up his mind. Legislators and the entire criminal justice system in the state vehemently oppose the measure. But, Knapp says, the public strongly favors it.
She, like other treatment providers in the state, is leaning towards backing the measure because she believes in the efficacy of treatment but she worries about the future of drug courts in the state. The initiative would provide an additional $38 million a year for drug treatment through 2009 and that, she says, is "very appealing."
One drawback to the FL proposal is its lack of funding. "There is some incorrect notion that somehow there are enough publicly funded resources to meet the need (created by a right to treatment amendment)" says one FL treatment provider, who thinks the measure is aimed at eventual legalization of drugs: "My personal opinion is that this issue is legalization disguised as decriminalization disguised as a treatment alternative."
This view is echoed by the Director of FL's Alcohol and Drug Abuse Association John Daigle, who is surprised by his own opposition to a measure that favors drug treatment. But he believes that the amendment sends "a terrible message" by eliminating "offender accountability." He also says there is already a critical need for drug treatment resources in the state: "Currently only one in five individuals in need of treatment is able to access that treatment."
In OH the Attorney General has sought some changes in the ballot initiative but is likely to pass on it. The FL Attorney General, however, has ruled the amendment doesn't meet the criteria to go on the ballot and has kicked it up to the Supreme Court.
Knapp, who is also the chairman of the NACBHD Substance Abuse Committee, says the group has not discussed right to drug treatment initiatives and has taken no position. However, she points out that by coincidence the NACBHD Board is in the process of drawing up a position paper generally favoring treatment over incarceration.
To date the Campaign for New Drug Polices has racked up an impressive list of wins, loosing only one ballot initiative that it backed.
1915B Waivers Benefit From "Culture of Responsiveness" at the Former HCFA
The agency, formerly known as HCFA, and now called the Centers for Medicaid and Medicare (CMS) is making a concerted effort to get Medicaid waivers out quickly.
Says Deputy Director of Disabled and Elderly Health Programs Glenn Stanton that means engaging states even before they get the paperwork in to address design issues up front. It also means acting promptly, well within ninety-day windows for questions to be raised or decisions made. "The old HCFA waited until the 89th day before coming back with questions," Stanton says. "What we heard from states was it's okay to tell us 'no' but don't drag your feet and then tell us 'no'."
In the beginning of the new administration in January HHS made a concerted effort to eliminate a backlog of waiver requests. At CMS, staff was put on 'and down', says Stanton, working intensively on various waiver requests while state representatives flew in or met by conference call. As a result 247 waivers and state plan amendments for Medicaid and other programs were approved between Jan. 20 and April 20, 2001. Now CMS is working only with current waiver applications.
"We realize we have a role that goes beyond giving permission," says Stanton, who welcomes states looking towards innovative solutions and will even supply those solutions on occasion. Stanton notes there is currently a pro-state bias at CMS and also at HHS where former Wisconsin Governor Tommy Thompson is now Secretary. Stanton has considerable experience in the state of Michigan both in state government and associations. Most recently he was a Bureau Director in the Michigan Health Department.
This pro-state stance is born out by designated national account representatives. Any state that feels it lacks access to CMS may call it's designated reps either in the regional office or nationally. The reps in the national office are all senior level managers. Stanton himself is the rep for WI.
Looking at 1915C waivers and in particular the IMD exclusion Stanton says that CMS policy is not likely to grant waivers for IMDs because department policy has been to avoid institutional care and look for community placement opportunities wherever possible. Stanton admits that substance abuse systems, the biggest proponents of an IMD rule change, are generally under funded. But he thinks organizations like NASADAD are on the right track when they suggest more creative solutions than just eliminating the rule. Stanton also admits the policy on IMD's might well be changed at a level higher than his. IMDs (institutes for mental diseases) are inpatient facilities with 16 or more beds whose patient census exceeds 51% with an admitting diagnosis of mental illness. Federal Medicaid matching payments are prohibited for IMDs with a population between the ages of 22 and 64).
Stanton thinks the soon-to-be released report to the President on Alternatives to Community Living, part of the White House's New Freedom Initiative, will have an impact on mental health. Commemorating the 11th anniversary of the Olmstead Act, six cabinet level agencies and four volunteer agencies undertook to identify barriers to community living. The investigation has included a national listening session and solicitation of comments. Stanton says many of the 800 or so comments received concerned mental health issues, like parity. The final "action-oriented" report was in draft form in mid-December and being revised, according to Stanton.
Wrapping up Year-End Mental Health Measures on Capitol Hill
By Sally McElroy, NACO Associate Legislative Director
Mental Health Parity - After failing to negotiate a compromise on parity language, House and Senate Conferees on the FY '02 Labor, Health and Human Services, and Education (Labor, HHS) Appropriations bill were planning to hold an up-or-down vote the week of December 17th on whether to include mental health parity language in the final bill. The parity language presented one of the last obstacles to final passage.
The Senate-passed version of the Labor, HHS bill contains S. 543, the Mental Health Equitable Treatment Act of 2001. S. 543 would require employer-provided group health insurance plans that offer mental health benefits to provide in-network benefits that are equal to or on par with benefits for physical health. No company would be mandated to offer mental health coverage under the bill. Businesses with less than 50 employees would not be subject to the parity requirements. Affected group health plans could not impose any treatment limitations or financial requirements and co-pays for mental health care that are different from physical health care.
The House version of the Labor, HHS bill did not include similar language and House appropriators were opposed to including any "legislative riders" - provisions not specific to appropriations - in the bill. In addition, the leading members of the House authorizing committees of jurisdiction for parity was opposed to including the language, as they had not acted upon the issue in committee. Many House members would prefer to reauthorize a more narrow parity measure that was passed in 1996 and expired on September 30, 2001.
NACo has supported S. 543. However by mid-December the chief sponsors of S. 543, Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM) were growing less optimistic that the language would be included in the final bill.
HIPAA Compliance Delay - The HIPAA compliance delay is one step away from law. The Senate passed H.R. 3323, the House version of the Health Insurance Portability and Accountability Act (HIPAA) one-year compliance delay, under unanimous consent on December 12th. With identical bills passed in the House and Senate, the need for a conference committee is eliminated and the legislation will be forwarded to the President for his signature.
The new compliance date for the HIPAA transaction and code set regulation will be October 16, 2003. All covered entities and programs that wanted to take advantage of the one-year delay will have to submit an explanation of why the deadline in current law cannot be met, a plan for reaching compliance by the new 2003 deadline, and a budget for doing so. NACo supports the delay.
Post Terrorism Mental Health Improvement Act - On December 12, the Senate passed by voice vote, S. 1729, the Post Terrorism Mental Health Improvement Act. The legislation would authorize unspecified funds for grants to improve the ability of state and local governments and mental health professionals to address mental health needs arising directly from the September 11th attacks and from future disasters. Grant monies could be used for activities such as training of mental health professionals to treat victims of disaster using evidence-based practices and the development of coordinated response plans that include public and private organizations for responding to the mental health needs that arise from a disaster. Applications for assistance under this program by state and/or local entities must be made in coordination with the state's governor, the state office of emergency preparedness, and the state mental health office.
NACo supports S. 1729. The bill has now been referred to the House Energy and Commerce Committee.
2002 Legislative Conference - Mark Your Calendar
By Lauren Wolfe, MS, NACBHD Deputy Executive Director
NACBHD's 7th Legislative Conference will be held February 27 - March 1st at The Madison Hotel in Washington, DC. This year is especially meaningful for us to come together and acknowledge the spirit and strength that lies in our unity.
We have invited Congressman Patrick Kennedy (D-RI) to speak to us about his efforts on mental health issues. Charles Curie, the new SAMHSA Administrator will address the group and moderate the panel of SAMHSA agency directors at our traditional and well received Federal Update.
We welcome Mr. Glenn Stanton, the new Deputy Director of Disabled and Elderly Health Programs, Center for Medicaid and State Operations, CMS (formerly HCFA). Hear about the current position on Medicaid waivers and plans to change the Medicaid program in the future (see story above).
We will take time to digest the impact of the September 11th attacks on county systems by engaging in a discussion on the status of emergency services and crisis response systems at the local levels. John Russotto, the behavioral health director of Arlington County, VA and Gary Weiskopf of the New York Conference of Mental Hygiene Directors join Beth Nelson, Chief of Emergency Services at SAMHSA to share their insights and facilitate discussion.
The Congressional Updates are new and improved this year with a NEW UPDATE on children's behavioral health added to raise the level of awareness of critical policy issues affecting children and adolescents. They join updates by our policy partners and advocacy organizations. Substance abuse policy plays a more active role this year as does developmental disabilities.
The Deputy Surgeon General, Dr. Kenneth Moritsugu has been invited to speak about the Surgeon General's Reports on children's mental health and race, culture and ethnicity in behavioral health services.
NACBHD's Medicaid Survey and its results will be the focus of a session facilitated by the county directors who developed and analyzed it. From here we will define NACBHD's position on Medicaid and the areas that require more concerted advocacy.
We have a full and important policy program for you this year. As always, no other conference is geared to the policy information that county authority behavioral health directors need to hear. Register today online at www.nacbhd.org/registration.html and by calling the NACBHD office at (202) 234-7543. For hotel reservations call The Madison Hotel at 1-800-424-8577 or (202) 862-1740 by February 5th. Use the code NACB22Y to get the conference rate of $130/night (single/double).
New Commissioner Aims to Fit Developmental Disabilities into a Seamless System
Money is limited, admits Patricia Morrissey, who has been on the job as Commissioner of the Administration on Developmental Disabilities since late August. Therefore, she says, the challenge is to make established community services in the public and private sector work for the developmentally disabled population. She sees her agency as a catalyst to make all the different gears in the support system turn together. "We're trying to make it so people don't have to spend half their coordinating stuff," she says.
Emphasis on collaboration will definitely be reflected in new regulations, Morrissey's agency is writing to reflect the 2000 legislation. She says the new rules will require any prospective grantee to pick one or several of seven areas of emphasis and an optional category, including employment, housing, health, childcare, early intervention, transportation, recreation and quality assurance. "Any one who gets a grant has to focus on one or more of these areas, set the goals that they want and at the end will have to show either impact or benefit," she says.
Grantees will also have to collaborate with protection advocacy agencies, state councils or university centers for excellence. This can be done in three different ways: Several grantees may pick an area to collaborate on, a single grantee might pick an area of interest and then work with someone else on it or, uncertain about a specific goal, a grantee might meet annually with other grantees. "The road map is going to change," says Morrissey about the regulations, "but we're especially interested in 3 things: information about consumers, collaboration among other partners and whole issue of working in a way that works for you." Morrissey is perhaps well suited to writing the regulations because she knows the legislation very well. "I rewrote it," she says, during a stint with the Senate. "The old law was not interpretable."
An unabashed Washington insider, Morrissey has been employed in the city since 1976, working for former Presidents Reagan and Bush, as well as both the House and Senate. Most recently she has been a senior associate with the international management consulting firm, Booz.Allan&Hamilton. She's bringing all that experience into play now: "If you know how Washington works, you can get a lot accomplished. I'm not into wasting anybody's time; I am interested in doing concrete things that benefit people and focus on the person at the end of the chain."
Her timing in some sense couldn't be better. She has observed a new "powerful" attitude in Washington since the September 11th terrorist attacks. "At the federal level we're removed from real people. The New York situation brought us in touch with real people," she maintains. "A lot of bureaucratic excuses have been put aside." Morrissey was part of a federal emergency response team that met every day for three weeks after the attacks. It gave her access, resources and an ability to coordinate.
"The system, thank God, works," she says about the emergency response to 9/11. But what didn't work was that there was no way to account for and take care of the developmentally disabled, who might have been stuck in their apartments in need of help. Now that problem, too, has been addressed. Morrissey's former employer, Booz, Allen, has developed a web based registry for people with disabilities in New York City.
With the web based data base, "we will be able to identify you, locate you and assist you and inform people that you are on the registry automatically via e mail," says Morrissey. The system, which is likely to be duplicated all over the country, uses GPS technology to pinpoint registrants.
While Morrissey's agency has no control over Medicaid policy decisions she thinks that participation in the White House's special nationwide assessment of barriers to living faced by disabled Americans (see CMS story above) will have an impact on Medicaid spending. "This issue, making sure more resources go to people with disabilities, is the substance of that report," says Morrissey, "whether it will affect the HIFA waiver, granted earlier in the year, I don't know." She thinks the report may deem some things mandatory that are now optional and that these might mitigate concern about the HIFA waiver. And she is definite about the effect of the report on the developmentally disabled: "It has an incredible number of things in it that will have a positive effect on people with disabilities.
NACBHD Committees
NACBHD president Jim Stewart is placing new emphasis on the work of committees, expecting important work to emerge from these groups. Here's what they're up to:
Bill Harper, Membership and Services Committee: The Membership and Services Committee has been doing some great work. With the able support of Lauren Wolfe and the addition of Fred Hutchinson from Plexus Consulting Group, we have become more sophisticated in our approach to membership development. The Membership Survey completed in September has given our committee lots of useful data that will help us tailor NACBHD services to meet the emerging needs in county-based behavioral health. For example, 69% of respondents rated this newsletter as valuable or extremely valuable. We have also learned that 69% of those completing the survey, prefer e-mail for regular communications and 84% prefer it for time-sensitive communications.
We have a compelling message to take to the 1,000+ county directors in this country. NACBHD provides a lot of value for very low cost. It is our intention to continue our steady increase in total membership while remaining a member-driven organization. We will continually assess our services and products for quality, relevance and usefulness.
Sherrie Knapp, Substance Abuse Committee: This past year the Substance Abuse Committee accomplished the following: 1) We were successful in advancing a policy statement regarding the Medicaid IMD exclusion. As a result of committee work, a policy statement was prepared, approved by the NACBHD board and adopted by NACo's board. It is now part of both organizations' lobbying efforts on Capitol Hill. 2) Our committee advocated to add a workshop entitled "Treatment not Condemnation" on alcohol/drug services as alternatives to incarceration to the NACo Conference and alcohol/drug services workshops to NACBHD's annual conference in July. 3) We provided feedback to the Office of National Drug Control Policy regarding their progress in implementing the National Drug Control Strategy.
Our goals for the coming year include: Increase attention to alcohol and other drug issues by NACBHD and NACo; provide input to NACBHD's upcoming membership campaign to assure outreach to directors of county agencies which address alcohol/other drug services; provide input on substance workshop topics for NACBHD's and NACo's conferences; influence the legislative agenda of both organizations; facilitate the development of a strong NACBHD and NASADAD; and survey membership regarding the extent of services for persons with co-occurring disorders.
The Substance Abuse Committee would welcome any new members.
Kathie Eilers, Program Committee: The goal of the program committee is to monitor, develop and improve the program of NACBHD's Legislative and Annual Conferences. Our objectives are to: review the Legislative Conference to ensure appropriate, timely informative sessions and speakers; to make sure that the opportunity for congressional visits is well organized and formulated; to establish a theme for the annual conference that encompasses critical concerns of county behavioral health directors; to review the responses to the annual conference call-for-proposals; to identify those that are most likely to be developed as an effective relevant conference session; to identify speakers and general session topics; and to assist with the identification of promotional opportunities and social events.
Planning is well under way for the Legislative Conference. We hope to have a mini-leadership institute as part of the annual conference and would welcome any ideas anyone has to share.
David Wiebe, Medicaid Committee: NACBHD's newest committee, the Medicaid Committee was formed at the July annual conference and will hold its first face-to-face meeting at the NACBHD board retreat in December.
The committee plans to survey NACBHD members to identify key issues pertaining to Medicaid coverage for behavioral health care in their states, especially with respect to managed care. From that the committee will develop strategies to address the issues. The committee also hopes to co-ordinate its efforts with NASHMHD.
A draft of the survey has already been circulated to committee members and the committee hopes to submit it to board members in December.
Mike Chambers, MR/DD Committee: The MR/DD Committee advises NACBHD's board on issues related to mental retardation and developmental disabilities; analyzes policy and law as requested; drafts policies and positions for board consideration; makes recommendations regarding association training, membership development and priorities; advocates for county MR/DD programs and persons with developmental disabilities through relationships with governmental entities and other national organizations; and supports NACBHD's mission.
The committee has been discussing issues of concern to the MR/DD field, which also have national significance. Among them are implementation of person-centered processes and self determination initiatives; resources for persons with co-occurring mental illness and mental retardation disorders; wailing lists for services and supports; human resource shortages; impact of the Olmstead decision; medical necessity criteria versus flexible services and supports provided for in Medicaid waivers; diversion from the justice system; and transition to managed care models.
A committee near-term goal is to establish initial relationships with the National Association of State Developmental Disabilities and the National Alliance of Local Developmental Disabilities Administrative Authorities. Based on these relationships the committee will determine potential future objectives and make recommendations to the NACBHD board.
Nominations For The Robert Egnew Excellence In Advocacy Award
Nominations are being accepted for the Robert Egnew Policy Award. This new NACBHD award recognizes an individual county behavioral health director for outstanding achievement at the state and/or federal level advocating for an issue that has relevance to his/her community, consumers and local systems of care. An Application Form is posted on NACBHD's web site at www.nacbhd.org/egnew_award.html, or call the NACBHD office to receive a form (202) 234-7543. This $2,500 award will be made at the Awards Luncheon during NACBHD's annual conference in San Diego, CA in July, 2002.
Job Announcements
Director of Mental Health
COMCARE of Sedgwick County is the largest Community Mental Health Center in the state of Kansas, located in Wichita, KS, a regional center for business, education and culture. COMCARE seeks a Director of Mental Health to lead an organization that offers a full range of behavioral health services to children and adults including substance abuse, outpatient services, community support services and community based services.
A successful candidate will hold an advanced degree in psychology, social work, business or public administration or other related field. They will possess leadership and communication skills, fiscal and human resource management experience, experience in board and government relations and a comprehensive knowledge of innovative and effective care and treatment models.
For more information contact Deborah Donaldson, Director of Human Services, 635 N. Main, Wichita, KS 67203; telephone 316 383-8251.
Apply on-line with Sedgwick County, Kansas at www.hrepartners.com
Behavioral Health Director
$91,494 - $113,273 annually + excellent benefits
Closing date has been extended until January 25, 2002.
The Monterey County Health Department is seeking a highly qualified professional to be Behavioral Health Director. This challenging position plans, organizes and directs programs for diagnosis, treatment and prevention of mental illness and substance abuse; provides leadership and management to the Behavioral Health Program Managers in developing and maintaining programs; motivates and empowers staff, captures funds, and ensures quality service delivery. The Behavioral Health Division provides comprehensive treatment and service to people with mental illness and alcohol and drug dependency. The Division has developed a progressive, multi-focused social rehabilitation program for preventing or reducing demand for acute inpatient and state hospital care.
Qualifications: Per California Administrative Code, the successful candidate must meet one of the following qualifications:
To apply: Send a Monterey County Employment Application form, resume and responses to the Supplemental Questions to: Human Resources Division, Health Department, 1270 Natividad Rd., Salinas, CA 93906. For more information or to receive application materials, see our website: www.co.monterey.ca.us or call 831/755-4527. Applications must be received in the Human Resources Office by January 25, 2002. Equal Opportunity Employer.
New Program Helps Screen for Alcohol Problems and At-Risk Drinking; Provides Education About How Alcohol Can Affect Overall Health
Now there is a free and easy way to screen for at-risk drinking and alcohol problems. National Alcohol Screening Day, the country's only nationwide alcohol screening program, is being held this April. Aimed at educating people about alcohol use and its health effects, NASD materials help clinicians screen patients, inform them about the effects of their drinking habits, and refer those in need to treatment resources. The program addresses at-risk drinking as well as alcohol abuse and alcoholism in an effort to help prevent problems and promote early intervention. NASD is a program of the nonprofit organization Screening for Mental Health and is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Center for Substance Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention (CSAP).
Registered sites receive:
In addition, supplemental Spanish-language materials are available, including a new Spanish-language videotape and an ample supply of brochures and posters in Spanish. This unique videotape, being produced by the NASD office, features native Spanish speakers from a variety of backgrounds discussing alcohol's effect on work, relationships, overall health, and the challenges and rewards of recovery.
Sites can use the screening materials to reach out the general community as a public education event, or, can screen existing clients and patients by incorporating the screening into regular daily procedures on April 11, National Alcohol Screening Day, (or another day during April, Alcohol Awareness Month). Sites interested in registering can contact the NASD office at 781-239-0071 or download the registration form at www.mentalhealthscreening.org/nasd/nacbhd.
Since its inception in 1999, NASD has provided thousands of community health care facilities, treatment centers, mental health clinics, colleges, and primary and specialty care providers with a ready-made, easy-to-use program for conducting free, voluntary alcohol screenings with referrals for individual evaluation and treatment. NASD addresses a range of alcohol problems, from at-risk drinking to alcohol dependence, and seeks to educate the public about signs and symptoms of alcohol problems, decrease stigma and promote intervention, early recognition, and treatment. Materials include the latest information about alcohol's effects on medical conditions, and drug interactions. Over the last three year, NASD has attracted nearly 100,000 people to the event, screening some 60,000 individuals and educating friends and family about signs, symptoms, available treatments, and where to seek counseling and help.
Conference Announcement
July 10 - 14, 2002: Washington, DC. "Developing Local Systems of Care for Children and Adolescents with Emotional Disturbances and their Families: Family Involvement and Cultural Competence". National Technical Assistance Center for Children's Mental Health at Georgetown University. Contact: (202) 687-5000.
2002 Membership Campaign Underway
NACBHD's 2002 membership campaign is in full swing. Look for your renewal notice in the mail and respond quickly. Our work over the past year and our plans for the coming year, increase and expand our commitment to serving you the best way we can. Our influence in Washington is substantial and increasingly visible. Membership services are improving all the time. In difficult times such as these, it is imperative that we maintain our position in the public sector arena. County authorities cannot be overlooked. NACBHD works to ensure that your voice is always heard and your perspective is always considered. Return your renewal notice with payment or renew online at www.nacbhd.org/join_us.html. Make the investment in your future, today!
Taking You in New Directions
Since 1987, Brown & Associates has assisted hundreds of community-based behavioral health organizations in successfully reaching their goals.
A Full Range of Consulting Services.
Specialists in Accreditation.
Brown & Associates, Ltd.
Behavioral Services Consultants
1-800-495-6786
www.danbrownconsulting.com
