regional management group meeting date: september … · report • es managers presented...

REGIONAL MANAGEMENT GROUP MEETING

Date: September 28, 2018

Time: 9:00 a.m.

Attendees: Margaret Graham (LDN CSB), Daryl Washington (FFC-CSB), Carol Layer (ALX CSB), Lisa Madron (PW CSB), Deborah Warren (ARL CSB), Amy Smiley (NVMHI), LaVoyce Reid (ARL CSB), Jean Post (NVRPO), Randy Buckland (NVRPO), Tyler Carey (NVRPO), Wendy Rose (NVRPO), Heather Baxter (PWC ES), Roshontia Haas (LDN ES), Gabriel Duer (ALX ES), Jim Kelly (FFX CSB), Abbey May (FFX CSB), Alice Straker (RAFT)

Guests: Judith Korf (Parent), Aaron Rebuck (Birmingham Green), Debra Campbell (Birmingham Green), Joan Thomas (Birmingham Green), David Winter (North Spring), Hilton McDaniel (Piedmont)

Recorder: Xiuping Cheung (NVRPO)

Call to Order: Margaret Graham (LDN -CSB) called the meeting to order at 9:05 a.m. The group was welcomed and introductions were made.

Handouts: Agenda, RMG Meeting Notes (August 2018), The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization article, FY19 Regional State Hospital bed use Report, Adult/Older Adult Bed Days per 100k, Regional Utilization Management Report

TOPIC DISCUSSION REC/ACTIONS RESPON- SIBLE PARTY

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Introduction • Introductions were made; M. Graham welcomed our guests from Birmingham Green.

Birmingham Green • The leadership of Birmingham Green (BG) shared a power point with the RMG which addressed a regional partnership and the various services offered Birmingham Green.

• BG is regulated by CMS and Department of Health and offers Skilled Nursing, Auxiliary Grant Assisted Living and Private Pay Assisted Living.

• BG has partnerships with many different schools for internship training; provides a comprehensive training program to their employees. Andrew Heck's "H.E.A.R. - Health, Environment, Approach, Resident" approach is a central component of their training model. They also provide dementia training and currently have 31 certified dementia staff.

• BG Axillary Grant ALF is the result of a public/private partnership and each locality has a liaison as the main contact person for Birmingham Green; J. Thomas will share that list of liaisons with J. Post.

• BG has additional space available for expansion, currently working on strategic planning, looking at ways to expand resources.



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• BG programs: o The District Home Assisted Living: 36 private beds; offers

long and short-term care. Must have an updated physical and clearance of TB testing. District home does not need a referral, but most of the time, admissions are by referrals and ES. Currently have 2 beds available.

o Willow Oaks Assisted Living: Accepts Auxiliary grant; has 77 beds for over 62 yr.; under 62 yr. have 15 beds available. Currently at 100% capacity. Both categories have separate waiting list. 77 bed category wait list is from 6 months to 1 year wait time.

o Northern Virginia Health Care Center, Nursing and Rehabilitation: 180 beds; accepts Medicare/Medicaid. 30 beds with key code entrance for memory care.

• BG is able to provide services for those with DD, if the need for these services were to increase then staff training would increase as well.

• The RMG was invited to visit BG and BG offered to host a RMG on behalf of the group.

• They have an event coming up in October 5th for Geriatric Mental Health Partnership; website for more information: www.worldeventform.com/gmhp/

SUD diversion • 3. Post shared that currently Fairfax CSB has utilized the SUD funds for hospital diversion: 5 diversions completed, 1 pending case.

• Challenges in utilizing these funds include: lack of detox beds available, length of waitlist for some providers, inability for detox providers to accept TD0s, and contract limits within individual CSBs.

• Opportunities include: ride other CSB contracts - LDN & ARL working on riding FFX contract for IVOVA CATS program; and for hospitals to release before hearing, to detox stepdown when appropriate.

Regional Activity and Exception Report

• ES managers presented challenges related to TDO Activity and Exception report: defining TDO exception and new subjective data element of suspected intoxication at time of assessment resulted in TDO.

• It was agreed that the October 25th Involuntary Commitment Process training may address this.

North Springs • North Springs' CEO - David Winters joined RMG meeting and provided an general program overview, status update on the kids inpatient bed expansion, and reviewed efforts made by North



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Springs to ensure the safety of those served. • North Springs began providing acute care services in September

2015. They currently have a 15 bed inpatient program but are in the process of expanding to 40 total inpatient beds (December 20019/January 2020). No cap on TDO admissions. Have video conference capability.

• Current youth to staff ratio at North Springs residential program varies by age group: 1:4 for younger patients and 1:6 for older patients. The state staff to client required ratio for youth residential is 1:8.

• Due to a recent tragedy, North Springs has made some changes to increase staff training and enhance clinical services, such as:

o daily shift training and multiple staff trainings weekly to address various challenges as well as a cognitive behavioral training program based on demonstrated competencies (94% of staff are ranked at an intermediate level)

o enhanced clinical services based acuity of needs, such as: increased therapy sessions, behavioral plan development and implementation, and added flags/warning signs to alert staff to risks/challenges/individual needs. Have also added a physician on site daily to address and treat the physical needs of those without a PCP.

Community capacity enhancements to decrease hospitalization

ICRT+, Wendy Rose, NVRPO • Discussed adding an ICRT+ program to provide more intensive care

residential treatment than what our current ICRT provides. Current ICRT has 2 locations, each have 8 beds, it's the most intensive program in the community. There are adults in our state facility that require a more intensive program then what is currently available in the community. For example: one resident in the ICRT receives 1:1 support and supervision; and as a result has been out of the hospital for many months, longer than she has been able to remain in the community in her lifetime. This program would have a greater number of staff (such as 1:2 staff to client ratio) with an advanced skill level (MA, Licensed eligible) and fewer residents.

ILPPP request for concept proposal, Jean Post, NVRPO • ILPPP requested a concept proposal to increase community capacity

and decrease hospitalization; ICRT+ is one of the programs that will be submitted to ILPPP for review. Others are ALF and Psychiatric Emergency Crisis Center. This is due to ILPPP October 1st.



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Psychiatric ED, Abbey May, FX-FC ES • Discussed a Psychiatric Emergency Department that FX visited in

San Antonio, Texas and that such a facility in Region 2 would help increase community capacity and decrease last resort TDOs to our state facilities. A. May and J. Post participated in a conference call with Henrico to discuss their visit to a similar Psychiatric Emergency Department in Delaware, Recovery International - https://riinternational.com/. RI currently has 10 Psychiatric EDs located in 5 different states. Region 4 is considering a consultation with RI for additional information. Services are reimbursable through Medicaid. J. Kelly will share additional information with J. Post to be distributed to the RMG.

Peer Recovery CSU, Jean Post, NVRPO • An article regarding "The Effectiveness of a Peer-Staffed Crisis

Respite Program as an Alternative to Hospitalization" was share with the group

Robust MOT program, Gabriel Duer, Alex ES • Discussed the effectiveness of MOT as established under Code of

VA. Trend use of MOT is declining in region 2. Current requirements are that the client must agree to the treatment which few do. D. Warren share that CSB Board member is raising this issue with Legislative liaisons and suggested that the VACSB ES Counsel bring this to the attention of the VACSB. Group agreed this should start with what's best for the people we serve.

ES workload enhancement, Roshontia Hass, Lou ES • ES workload greatest challenge is bed finding, on an average ES

spends 5-7 hours completing a bed search. This results in long shift for clinicians and law enforcement waiting with the individual and remaining pulled from their duties of policing the community.

• FFX and ARL have positions of "bed finders", which appear to be having a positive impact on ES clinicians workload management.

• ES Managers proposed regional bed finding staff to streamline the process and create workload efficiencies. Executives ask for cost analysis to show how this is helpful. D. Warren suggested ES review the current bed finders' position description, volume of calls and trend of call as well as cost. ES Directors agreed will pull the



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information together and present the case to the RMG next quarter.

SJ47 Subcommittee, TDO Taskforce, Roshontia Hass, Lou ES • Stakeholders are holding a meeting to understand the TDO crisis,

they are interested in Psych ED and ECO extensions but no formal update has been shared. Next panel meeting is scheduled for October 29th. 5J47 is scheduled to tour the institute on Monday Oct 1st and will be meeting with D. Washington on Monday as well.

Gun Right Post Commitment, Gabriel Duer, Alex ES • Discussed gun right post commitment, Alexandria has developed a

draft talking point document which is currently with the Alexandria City Attorney, for review. It will be shared with the Region following the Attorney review. D. Washington suggested that this issue may be better addressed by Law Enforcement, rather than the CSBs.

Regional Office Budget

• T. Carey presented highlights of the current Regional budget. • D. Washington expressed concerns regarding inadequate base

LIPOS funding. • Subsequent funding historically has been provided by DBHDS as

base funding is depleted; however, it is not consistently received in a timely manner. As a result, Fairfax-Falls Church CSB assumes increase risk secondary to covering the funding until funding is received and processed and the contractual obligation.

UM Report • Monthly state hospital bed use report was shared with the group • The Regional UM Report was distributed and highlights reviewed.

Round Robin • D. Washington shared that commissioner will be visiting FFX CSB on October 18th. He suggested that consistent talking points be developed for regional needs and that they be shared when the commissioner visits each individual CSB. Talk points suggested include ICRT+, Increase PACT team, the disbursement of funds for DBHDS community capacity enhancement efforts, and increase intensive community support. J. Post will work on talking points and share draft. D. Washington will share outcome with the group after the meeting with the commissioner.

• H. McDaniel shared that 30% of piedmont clients are from Region 2. He requested to be included in the RMG meeting distribution list and will attend meetings as he is able to do so.

• ALX CSB is hiring for an opioid coordinator

air



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• ARL CSB is meeting with the director of DMAS, Dr. Lee. D. Warren will share the lack of DBHDS funding alignment related to community capacity enhancements and reductions to the CSB General Funds as a result of Medicaid expansion. Arlington BOS had a public hearing on Saturday. The land swap proposal was a primary focus. There were 78 speakers addressing VHC proposed expansion and psych service points of agreement. There's an article in the Washington Post addressing the expansion. Advocates requested that VHC provide funding to increase capacity CR2 as VHC's expansion plan does not address the BH needs of Arlington Youth. ARL and the CR2 program are working on an improvement plan to better meet the BH needs of youth. Arlington is also reviewing and editing the draft MOU for RAFT and will share it in the next week to two weeks. Beth Macy will be at the Library to discuss her book on November 13th. ARL celebrating their 50th anniversary. Arlington CSB Budget has been reduced 8.5%, which is roughly $8.5 million reduction.

• LDN CSB shared that Rita Romano retired and Elise Madison will be her successor. Heather Baxter is the ES program manager. Also, PW CSB celebrates their 50th anniversary. A recovery plan meeting is being held in Manassas from 12 - 5.

• NVMHI is celebrating their 50t1 anniversary as well.

Adjournment: The meeting was adjourned at 11:40 a.m. The next meeting will be on October 26, 2018, at 9:00 a.m. in Merrifield, 8221 Willow Oaks Cooperate Drive, Room 3-409A

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regional management group meeting date: september … · report • es managers presented...

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