RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES

Serving the Counties of Culpeper, Fauquier, Madison, Orange, and Rappahannock

Board of Directors Regular Meeting September 12, 2017 Programs that matter People who care NOTE: To navigate this document, click on items in the Table of Contents to be taken to supporting documents in the package.

Board Chair TABLE OF CONTENTS Robert Legge Madison County

Executive Director Board Meeting Information Page # Brian Duncan Board of Directors Meeting Agenda September 12, 2017 2 [email protected] Board of Directors Meeting Minutes July 11,2017 4 Executive Director Report September 12, 2017 10 Director, Aging and Transportation Services Board Meeting Informational Content Page # Ray Parks Fauquier County Behavioral Health Strategic Plan 16 [email protected] DBHDS Financial Realignment Plan 21

Director, Clinical Services Office-Based Opioid Treatment (OBOT) Services 52 Ryan Banks RRCS Annual Picnic 55 [email protected] Young Adult Coordinated Care (YACC) Letter 62 Fauquier Senior Center Article 64 Director, Community Support Paula Stone RRCS Revised Bylaws 66 [email protected] Golf Tournament Financial Report 80 Executive Director Recognition - RRRC 81 Director, Finance and Administration Anna McFalls Other Informational Content [email protected] • HPR-1 Emergency Services Report Summary 82 • Addressing the Opioid Crisis Workshop Flyer 83 Administrative Assistant • DMAS CAP Review Letter 84 Laura Wohlford • DMAS Opioid Crisis Memo 85 [email protected] • Genoa Pharmacy Flyer 91 • RRCS Community Partner Prevention Support Grant 93

• VACSB Conference 95 Other Meeting Minutes Page # Administrative Services Committee August 22, 2017 97

Aging Services Advisory Council July 18, 2017 100 P.O. Box 1568 Development Committee No Meeting -- Culpeper, VA 22701 Executive Committee August 1, 2017 104 (540) 825-3100 Executive Committee September 5, 2017 110 www.rrcsb.org Program Committee August 22, 2017 112 st Senior Management Team, 1 Bi-Monthly Meeting July 11, 2017 116 Senior Management Team, 2nd Bi-Monthly Meeting July 26, 2017 132 RRCS does not discriminate on Senior Management Team, 1st Bi-Monthly Meeting August 8, 2017 141 the basis of race, color, nd national origin, sex, religion, Senior Management Team, 2 Bi-Monthly Meeting August 23, 2017 147 age, disability, or any other Board Member Resources / Development Content Page # characteristic protected by law, Board Members and Terms 154 in employment matters and in its programs and services. Senior Management Team Roster and Useful Websites 155 Board & Administrator Newsletter (August and September Issues) 156

Acronyms used at RRCS 160

Rappahannock Rapidan Community Services

Regular Board Meeting September 12, 2017 at 1:00pm

AGENDA

1. Call to Order — Board Chair, Robert Legge

2. Moment of Silence

3. People Who Care Awards

4. Agenda Review — Board Chair, Robert Legge • Additions/Deletions • Adopt

5. Board Chair Remarks / Announcements: New Member representing Rappahannock County

6. Public Comment

7. Corrections / Review / Approval of Minutes • July 11, 2017 Board Meeting Minutes (page 4)

8. Executive Director Report (page 10)

9. Closed Session - Scheduled - Personnel

10. Committee Reports to the Board of Directors • Executive Committee: Chair’s report – August (page 104) & September (page 110) o Action: Executive Director Contract Extension to February 1, 2018 • Administrative Services Committee: Chair’s report (page 97) o Action: Policy #423 Contractors, Interns, and Volunteers o Action: Classification Review • Program Committee: Chair’s report (page 112)

11. Other Business

12. Announcements (members and staff)

13. Call to Adjourn RRCS Board Meeting Agenda – Page 2

September / October 2017 Meeting Schedule Date Time Committee Location September 5, 2017 1:00pm Executive Committee Conference Room B September 12, 2017 Noon Development Committee Board Room, 2nd Floor September 12, 2017 1:00pm Board Meeting Board Room, 2nd Floor September 26, 2017 1:00pm Program Committee Board Room, 2nd Floor September 26, 2017 2:30pm Admin Services Committee Board Room, 2nd Floor

October 3, 2017 1:00pm Executive Committee Conference Room B October 10, 2017 1:00pm Board Meeting Board Room, 2nd Floor October 24, 2017 1:00pm Program Committee Board Room, 2nd Floor October 24, 2017 2:30pm Admin Services Committee Board Room, 2nd Floor

Committee Assignments for 2017 Administrative Executive Development Program Ad Hoc Search Services Committee Committee Committee Committee Committee Robert Legge(C) Bonita Burr Marcia Brose Donalda Lovelace Robert Legge (C) Elizabeth Davis Alan Anstine (VC) Marcia Brose (S) Pat Balasco-Barr

Robert Weigel / Marcia Brose Pat Balasco-Barr (alternate) All RRCS All RRCS Elizabeth Davis

Donalda Lovelace

Paula Howland Robert Weigel Joel Rothenberg (DBHDS) Rappahannock Rapidan Community Services

Regular Board Meeting July 11, 2017 at 1:00pm

MINUTES

Members Present: Alan Anstine, Pat Balasco-Barr, Marcia Brose, Elizabeth Davis, William Hepler, Paula Howland, Robert Legge, Donalda Lovelace, Matthew Parker, Robert Weigel

Members Excused: Bonita Burr, Dawn Klemann, Clare Lillard, Demaris Miller

Other Present: Joel Rothenberg, DBHDS

Staff Present: Brian Duncan, Katia Luna, Paula Stone, Laura Wohlford

1. Call to Order — Board Chair, Robert Legge Robert Legge, Chair, called the meeting to order at 1:03pm.

2. Moment of Silence Robert Legge, Chair, requested a moment of silence.

3. Service Awards Brian Duncan presented the service awards.

4. Agenda Review — Board Chair, Robert Legge • Additions/Deletions There were no additions or deletions to the agenda.

• Adopt ACTION: Marcia Brose moved to adopt the agenda as presented. Alan Anstine seconded the motion. There being no further discussion, the Board voted unanimously to approve the agenda as presented.

5. Board Chair Remarks / Announcements Moire Satre, CAYA Coalition, stated on Facebook that the McShinn Foundations has a building in Warrenton that will be used for a recovery center.

Madison County School Board will be stocking Naloxone at various schools in the county.

Robert also distributed the Visions Newsletter. 6. Public Comment There were no public comments.

7. Corrections / Review / Approval of Minutes • June 27, 2017 Called Board Meeting Minutes

ACTION: Alan Anstine moved to approve the meeting minutes as presented. Pat Balasco- Barr seconded the motion. There being no further discussion, the Board voted unanimously to approve the June 27, 2017 Called Board meeting minutes as presented.

8. Executive Director Report • Report Local Government Presentation for FY18 Program Plan Brian reviewed the schedule for the presentations. He is still trying to set up a confirmed date/time for Rappahannock.

RRCS Supported Housing Programs The supported housing program will be funded this month.

A grant application by Ray Parks is included in the packet to highlight the standards requirement for the apartments participating in the voucher program. If these standards aren’t met, the landlord can no longer accept vouchers. This requires the tenant to move, through no fault of their own. We have developed a grant to provide bridge funding to assist these individuals/families make this transition. We have had up to four such incidences per year of this in the past.

Questions: Is this on-going funding for the tenant? Response: No, it is considered one-time assistance.

Bowl for Seniors This was a very successful event. Don’t forget about our golf tournament next week.

Recruitment and critical agency positions This was discussed extensively with the Executive Committee. Our HR department and division heads are working on a proposal. This will include Crisis Services staff and may include other classifications.

Board Work Session Plan for July We will cover these topics, if time allows.

Bridges New Construction Project There will be a final walk-thru in a couple of weeks; then we will do a close out with the architect two days later. We will be holding an open house in early August; all board members will be invited.

Questions/Discussion: Does this increase our capacity? Response: Yes, the building has the capacity for around 125 people per day. We are not currently serving that many individuals now and we don’t anticipate rapid growth when we reopen. Our immediate goal is to successfully relocate and combine the two facilities into the new building and get everything stabilized.

New Clinical position with Central Virginal Regional Jail (CVRJ) All approvals are in place and we are developing the memorandum of agreement with CVRJ. We are recruiting for the clinician. This will reduce our need to send crisis services employees to CVRJ for assessments and crisis intervention. CVRJ will fully fund the position.

RRCS development of two six-bed group homes for Department of Behavioral Health and Disability Services (DBHDS) We will help facilitate the development of these two homes in our area. We will be meeting with a planning architect soon. We will not be the operator of the buildings; we only handle the construction management. The board will make final approvals regarding locations, contracts, etc. We would own the buildings and receive on-going rental payments.

Executive Director Retirement Brian introduced Joel Rothenberg from the Department of Behavioral Health and Disability Services (DBHDS). Joel is with the Support Services department; monitoring and assisting us with our performance contract with DBHDS. Joel will be a member of the search committee to help guide the process.

Executive Director Goals Not discussed.

Other: We will be doing one or two REVIVE trainings this summer. The training will last about 90 minutes; we are doing this in conjunction with the Culpeper Department of Health. They will also provide Narcan auto-injectors to participants. We will let everyone know when these trainings are scheduled.

9. Appointment of Executive Director Search Committee The search committee is comprised of Alan Anstine, Pat Balasco-Barr, Marcia Brose, Elizabeth Davis, Robert Legge, Donalda Lovelace, and, Robert Weigel.

ACTION: Pat Balasco-Barr moved to approve the members of the search committee. William Hepler seconded the motion. There being no further discussion, the Board voted unanimously to approve the members of the search committee.

10. Committee Reports to the Board of Directors • Executive Committee: Chair’s report o Action: None The Chair referred to the minutes.

• Development Committee: Chair’s report o Action: None The Chair referred to the minutes.

• Program Committee: Chair’s report o Action: None The Chair referred to the minutes.

• Ad Hoc Building Committee Report The Chair referred to the minutes.

• Ad Hoc Bylaws Committee Report The Chair referred to the minutes.

11. Other Business Joel Rothenberg is the Director of the Office of Support Services Community Contracting. He highlighted that we need to appoint a search committee, which has been completed. The search committee needs to understand whether or not the board as a whole is expecting the search committee to handle the entire hiring process or if the search committee is expected to select a few candidates for the board as a whole to interview and make a determination.

Joel will be a voting member as well as a guide/consultant for the process. He encouraged the board to review the guidance document attached to the board package.

We need to craft an advertisement (both long (for website) and short (for newspapers, etc.) versions)

There also needs to be a budget for advertising, candidate travel, etc.

A job description also needs to be developed.

Both the advertisement and job description must be approved by DBHDS before they are distributed.

It is the board decision to select the new director; it is not DBHDS’ decision. DBHDS only makes sure the minimal qualifications are met.

The other thing to consider is salary; DBHDS has a salary range for a medium-budget agency (RRCS is in that category). There are requirements that need to be met before an individual can be hired at a rate above the minimum rate.

The board needs to schedule the development of the advertisement and job description.

What role do you want Brian to have in this, as well as the HR staff?

The search committee needs to decide if they want to screen of all the applications, versus having HR do the initial screening.

There are already reasonable funds in the FY18 budget to cover advertising and routine travel expenses.

Often boards will use Skype, etc. for initial interviews with candidates who do not live locally.

We also have to determine the best place to put ads: local papers, Richmond Times- Dispatch, maybe Charlottesville, Washington Post on-line? On-line is better than spending for print ads.

Katia will be a valuable resource for the search committee.

The process can be arduous; it should be a deliberate process and the most important decision the board will make.

The number of meetings depends upon who takes responsibility for writing the advertisement (HR could do this), the job description should be reviewed and approved by the entire board – parts of the current description can be added to the model description.

How many responses does the committee need to start their review?

Brian has provided a timeline that can help address how items can be prioritized.

Brian and Katia can develop the ad for the committee’s review. We will want to have the job description resolved before the ad is distributed.

The selection committee will meet on July 25 at 1:00pm in the 2nd floor board room for their organizational meeting. Katia will provide recommendations for where to place the ad.

Questions: Would Brian be available to overlap with the new director? Response: Maybe, there are pros and cons. This can be decided later.

Could you cover the ongoing construction projects after retirement? Response: This is something that can be decided later. Brian doesn’t want to leave the agency in the lurch, but there are always things going on. No one leaves a position in a static condition.

Can we see a breakdown of various salary levels? Response: The range is from $110,600 to $169,900. These are the ranges from CSBs only, but the calculations are based upon the size of the overall budget.

12. Announcements (members and staff) Robert Legge read the following tribute he had written:

As I was driving home after Brian told me of his plans to retire, I was thinking about our committee meeting an hour before, working on revising the bylaws. Even though he knew he was only going to be director for a few more months (unbeknownst to us), he was making suggestions and thinking deeply about things that had long term implications for the agency and the people it serves. That made me feel very confident that we will be getting exactly the same Brian these next 6 and a half months as we have seen during his many years of service.

Another thought I had was, who has had a more profound impact in our region the past quarter century, especially in the lives of some of our most vulnerable citizens. If it's not Brian Duncan, he's on the really short list.

One final thought. When I looked over the long list of qualifications the next Executive Director is supposed to have. I laughed to myself and said: "We're not going to find anyone like that or who knows all the stuff Brian knows." But after he retires, a part of him will still be here for years to come. By that I mean, the senior staff, workforce and systems he has left behind. And that will help the next director grow into his or her new position.

13. Call to Adjourn The board decided to postpone work session until the next meeting.

The meeting adjourned at 2:45pm. Rappahannock Rapidan Community Services Executive Director Report September 2017

1. Introduction of Ann Baumgardner, new appointee from Rappahannock County

Please join me in welcoming Ann to our Board representing Rappahannock County. I have had the opportunity to meet with Ann and go through our standard orientation. Robert joined us for the meeting. Ann is a professional in the behavioral health field and brings considerable experience to the Board including working in the CSB system and in private practice as a therapist.

Notes: ______

2. Local Government Presentations - Updates

I have completed presentations to all local governments related to our Fiscal 2018 program plans and overview of priorities. All of these meetings have gone well and lead to meaningful discussions with Board of Supervisor members. Even in Madison County, who did not fund our increase, I spent almost an hour talking to the Board and getting their feedback and perceptions of our services. This amount of time allowed me to convey more information about some of the more complex issues that affect our services and relationships with other community partners. Thank you for your support through these presentations.

Notes: ______

3. Grant award from Northern Piedmont Community Foundation – Housing

I am pleased to report that we have been awarded $10,000 from the Northern Piedmont Community Foundation to assist individuals and families who are being displaced due to landlord noncompliance with VHDA housing standards. This is a creative approach to helping families deal with these issues that arise from time to time through no fault of the individual. Ray Parks developed this proposal with support from his housing staff in the Aging and Transportation Division.

Notes: ______Rappahannock Rapidan Community Services Executive Director Report September 2017

4. Fauquier County: Behavioral Health Strategic Plan / MH Collaborative

On page 16, you will find the PATH Foundation’s Behavioral Health Strategic Plan. I worked with the community group and the Foundation in putting this together - you will note the plan identifies RRCS as a major player in local strategic priorities. The PATH Foundation Board is using this plan to help guide its decisions over the coming years in terms of their allocations for behavioral health services. As you will remember, the Foundation is funding a portion of our current feasibility study for replacing our facility in Warrenton and is committed to helping pay for its eventual replacement in partnership with RRCS and Fauquier County.

Notes: ______

5. Department of Behavioral Health / Financial Realignment Plan

This lengthy report is provided as information for interested members (page 21). Later this year, the Department of Behavioral Health and Developmental Services will present a report to the General Assembly with recommendations influenced by these issues. A new funding model for State psychiatric hospital beds is being discussed that would put CSBs in control of some of the funding.

The concept is built upon the assumption that if CSBs are more directly accountable for their use of State psychiatric beds and have the funding to purchase those beds, they are also then more likely to develop improved community capacity to serve these same individuals thereby reducing the likelihood of needed hospitalization. This is an overly simplified description, but does make the point being presented.

You can also review slides two and three that provides the basis for the report from the General Assembly.

Notes: ______

6. Board Work Session Plans for remainder of 2017

At your meeting, we will discuss our schedule for wrapping up our work session goals for 2017. The topics remaining are below:

• Opportunities and challenges related to being both the Community Services Board and the Area Agency on Aging Rappahannock Rapidan Community Services Executive Director Report September 2017

• Fundraising – what does the Board want in the future related to organizational level fundraising

Notes: ______

7. Bridges Opening

Many of you attended the opening for Bridges and observed what a positive event this was for the organization. Services officially opened on September 4 and we have closed out our lease relationships in Orange and Warrenton. The coming year is significant for our Bridges program as they adapt to this new facility and location and incorporate major changes in the regulatory environment and payment system for these types of services.

Notes: ______

8. Start-up of Office-based Opioid Treatment (OBOT) Services and related support programs

I have provided a copy of our OBOT license in your package (page 52) and we have started providing services - typically referred to as medication-assisted treatment. These services are being provided through our Culpeper Behavioral Health office in collaboration with our other clinical providers and the on-site Genoa pharmacy. This is a comprehensive initiative that includes physician services (Dr. Alta DeRoo), outpatient services in the form of individual and group therapy, and access to medications through the Genoa pharmacy.

Notes: ______Rappahannock Rapidan Community Services Executive Director Report September 2017

9. RRCS development of two, six-bed group homes for the Department of Behavioral Health and Developmental Services

I am actively identifying properties for these developments to study and purchase. Once identified and contracted, I will bring them through the Board for review and approval.

Notes: ______

10. RRCS Annual Picnic – September 29

I hope a number of our members can join us on September 29 for our Annual Staff Picnic. Our staff planning team has done an excellent job preparing for this event, which is enjoyed by all staff and members. Information about the picnic has been provided in your report on page 55.

Notes: ______

11. Young Adult Coordinated Care Letter

A parent from Fauquier County took the time to write a letter thanking our staff for support provided through our YACC program (see page 62). The letter really captures the unique nature of this all-inclusive program and the difference these services can make in a young person’s life.

There are many stories like this in our organization reflecting the positive impact our services have on the community. As members of the Board, you are often learning about our challenges and struggles so I like to share these when they are received.

Notes: ______Rappahannock Rapidan Community Services Executive Director Report September 2017

12. The role of the local Senior Center (article)

Carol Simpson, Executive Director for Aging Together, wrote an excellent article about the services provided by the Fauquier Senior Center (page 64). The article also addresses the core value of the Senior Center service that we consistently hear from participants regardless of locality. Our five Senior Centers form a solid base for community presence and activity in our localities unlike any other service we provide.

Notes: ______

13. Revision to bylaws – activities of September and October meetings

Your ad hoc bylaws committee has completed their work and the revised bylaws are in your Board report for information and review this month (page 66). After your review (unless other modifications are made), a vote can be taken to approve the updated bylaws at the October meeting. The changes are primarily focused on updates to current practices and the Virginia Code.

Notes: ______

14. Golf Tournament – Future Event

At your meeting, we will have a brief discussion about board interest in supporting another golf tournament in 2018. If interested, additional help is needed from the board with a designated point person from each locality who would serve on the planning committee and promote the event. A summary of income and expenses from the 2017 tournament is on page 80.

Notes: ______

15. Executive Director Goals –

a. Lead advocacy and education efforts for board of directors and other interested parties during first quarter of 2017 (January – March) for proposed local funding increase. This goal will be measured by the amount of increase in local funding achieved over current levels. Rappahannock Rapidan Community Services Executive Director Report September 2017

• September: Local budgets have been approved resulting in $144,000 in new local funding for FY 2018. Growth in all localities except Madison.

b. Utilizing best practice principles for nonprofit boards design and facilitate a program to review, discuss and develop board practices around applicable principles during 2018. This review will include all aspects of board operations from program, fiscal, governance, transition planning and fundraising. The success of this goal will be measured by individual ratings by each participating member in November as to their experience and what has been learned. • September: In process

c. Successful completion of capital projects and program transitions for Bridges consolidation and Culpeper Behavioral Health. This goal will be measured by evaluating the successful close out of construction activities on budget and the timely start-up of services in the new locations. • September: Completed

16. Executive Director Recognition – Regional Distinguished Leadership Citizen Award I have recently been notified of my selection for the 2017 Regional Distinguished Leadership Citizen Awards from the Rappahannock-Rapidan Regional Commission (page 81). Each of you will receive an invitation to the Commission’s Annual Meeting during which the award is presented. Information about the award and Annual Meeting can be found at http://www.rrregion.org/awards.html. If you are interested in attending, please advise Laura at the meeting, and we will get you registered. The event is scheduled for September 27 at 5:00 at Rock Hill Farm in Culpeper (14461 Norman Rd, Culpeper, VA 22701; 540-717-2465).

Notes, Comments, Questions from online content:

______Strategic Action Plan for Community Mental Health

STRATEGIC ACTION PLAN FOR COMMUNITY MENTAL HEALTH

JUNE 2017

6-2-17 Strategic Action Plan for Community Mental Health

Introduction

Fauquier County is well positioned for advances in the delivery of mental health services for area residents. In fact, successes realized in the last several years provide the foundation for continued improvements. These successes include:

 the telepsychiatry/collaborative care system that is thriving at the Fauquier Free Clinic  the completion of the PRIDE survey and the subsequent engagement of stakeholders involved in committees focused on the challenges identified through the survey  the establishment of the Mental Health Collaborative which is bringing together decision makers from agencies and organizations that have a stake in the behavioral health needs of the residents they serve  the initiation of same day access for those seeking services through the RRCS  the opening of the Crisis Intervention Center and ongoing Crisis Intervention training for local law enforcement professionals.  over 750 (and counting) area residents trained in Youth Mental Health First Aid  the recognition of and emphasis on mental health needs in Fauquier public schools

Still there is much to do. This document presents a strategic action plan for a selected set of behavioral health initiatives in the Fauquier and Rappahannock region. The plan was developed with advisory guidance from a community Behavioral Health Strategy Group convened by the PATH Foundation in 2017. The following sections outline the scope and purpose of the plan, strategic assumptions, and a proposed set of strategic goals and action initiatives.

Scope and Purpose of the Plan

This strategic action plan is not intended to encompass all behavioral health organizations and resources at work in the community. The focus is on a selected set of action initiatives that have or may involve consultation or funding from the PATH Foundation. The purpose of the plan is to define and align these initiatives so that community organizations are positioned to optimize their work, and the PATH Foundation can begin to frame its strategic thinking about future investments. In this context, the plan presents a high-level vision of the action initiatives and how they align, rather than a detailed operational plan for each initiative.

Strategic Assumptions

The plan was developed based on a set of strategic assumptions that shape the results. These include:

1. A three-year time horizon from 2017 through 2019. 2. A population focus on children and adults. 3. A geographic focus on Fauquier County and Rappahannock County. 4. A service focus on awareness, prevention, treatment, and recovery. 5. A resource focus on multiple sources of funding including but not limited to the PATH Foundation. 6. A strategic emphasis on collaboration, innovation, and building upon existing community assets.

Strategic Goals and Action Initiatives

The plan organizes 24 distinct action initiatives into four broad strategic goals, as outlined below.

 Goal 1. Align Multiple Groups Working on Behavioral Health Improvement. Our region is fortunate to have many individuals and multiple groups working to improve community behavioral health. This goal includes initiatives to help community groups optimize their work through active coordination, networking, and information sharing, while also respecting the diversity of interests among the groups.

 Goal 2. Increase Community Awareness, Improve Prevention Activities and Reduce Stigma. Lack of awareness, stigma and early onset substance abuse are continuing obstacles to behavioral health. This goal includes initiatives to continue the work of increasing awareness, reducing stigma and preventing substance abuse through community outreach, education, and support.

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Strategic Action Plan for Community Mental Health

 Goal 3. Improve Access to Community Behavioral Health Services. Access to behavioral health care is a challenge for many community residents. This goal includes initiatives to improve access for at-risk populations by creating innovative community service models.

 Goal 4. Optimize Community Service Locations and Facilities. Access points and architecture are key considerations in efforts to optimize community engagement and access to services for behavioral health. This goal aligns initiatives that may require capital investments for optimizing service locations and facilities.

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Strategic Action Plan for Community Mental Health

Strategic Action Plan for Community Mental Health

Development Key: P = Plan, I = Implement, C = Continue, E = Expand

Development Resource 2017 2018 2019 Goal Initiatives Lead Requirements

Goal 1. Align Multiple Groups Working on Behavioral Health Improvement. Our region is fortunate to have many individuals and multiple groups working to improve community behavioral health. This goal includes initiatives to help community groups optimize their work through active coordination, networking, and information sharing, while also respecting the diversity of interests among the groups. 1. Establish the Mental Health Collaborative (or an alternative structure) as a single coordinating group Mental Health C E E $ with regular meetings for community networking and Collaborative strategy development 2. Support coordinating group members with meeting PATH space, community data, a community asset Foundation/ P/I C/E C/E $ inventory, and targeted education on efficient Mental Health community networking Collaborative 3. Establish a community resource website for Mental Health P/I C/E C/E $ professionals and advocates with community Association calendar 4. Establish advocacy and funding strategies that build Mental Health P/I C C/E $$ sustainable support for behavioral health Collaborative improvements (e.g. SAMHSA)

Goal 2. Increase Community Awareness, Improve Prevention Activities and Reduce Stigma. Lack of awareness, stigma and early onset substance use are continuing obstacles to behavioral health. This goal includes initiatives to continue the work of increasing awareness, reducing stigma and preventing substance abuse. Public Schools / 1. Implement Youth Mental Health First Aid C/E C/E C/E Mental Health $ Association

Mental Health C/E C/E C/E $ 2. Implement Adult Mental Health First Aid Association

3. Implement community education and training on Mental Health specific behavioral health conditions and topics (e.g. C/E C/E C/E $ Collaborative Chris Herren, Stronger than Stigma) Mental Health 4. Implement additional evidence-based prevention School Coalition / programs in schools and other community settings P I C/E Mental Health $$ (e.g. Sources of Strength, Too Good for Drugs) Collaborative / FCPS 5. Implement a multi-media education campaign with Mental Health P I C/E $$ expert guidance on messages to youth and families School Coalition (e.g. We Care)

Goal 3. Improve Access to Community Behavioral Health Services. Access to behavioral health care is a challenge for many community residents. This goal includes initiatives to improve access for at-risk populations by creating innovative community service models. 1. Implement Crisis Intervention Training for law RRCS / C/E C/E C/E $ enforcement Law Enforcement

2. Implement an emergency mental health evaluation service within the hospital emergency department P I C/E Fauquier Health $$ *Required service of the hospital

3. Implement an integrated health/mental health service Fauquier Free C/E C/E C/E $$$ in the free clinic setting Clinic

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Strategic Action Plan for Community Mental Health

Strategic Action Plan for Community Mental Health

Development Key: P = Plan, I = Implement, C = Continue, E = Expand

Development Resource 2017 2018 2019 Goal Initiatives Lead Requirements

4. Expand integrated health/mental health services to Collaborative P P/I C/E Care Work $$$$ additional community settings Group1 5. Implement training in behavioral health for primary Collaborative P P/I C/E $$ care providers and other health care providers (e.g. Care Work Group REACH, SBIRT)

6. Implement same-day access for CSB services C/E C/E C/E RRCS $$

7. Implement an assertive community treatment model P P/I C/E RRCS $$ for children and adults

8. Implement a care coordination program for young adults age 18-24 in need of services for substance C/E C/E C/E RRCS $$$ use

9. Implement a Neonatal Abstinence Syndrome service Fauquier P/I C C $$ at Fauquier Hospital Health

10. Optimize behavioral health services for incarcerated County Sherriff P I C/E $ individuals, and consider drug courts. Offices

11. Increase the number of qualified mental health providers serving the community, especially in Fauquier Health / and children’s mental health P I C/E $$$$ psychiatry . Explore NP Novant scholarship programs or loan forgiveness. (Have .08 FTEs and need 3.6)

12. Increase medicated assisted treatment options for RRCS / C/E C/E C/E Collaborative $$ addictions population. Care Work Group

Goal 4. Optimize Community Service Locations and Facilities. Access points and architecture are key considerations in efforts to optimize community engagement and access to services for behavioral health. This goal aligns initiatives that may require capital investments for optimizing service locations and facilities.

1. Optimize RRCS physical facilities to meet community Facilities Planning P I C/E $$$$ service needs Work Group2

2. Create a community wellness center to provide Collaborative P P/I C/E $$$ wellness outreach and education for community Care Work Group residents and professionals 3. Establish a local recovery house facility using Oxford House or McShin Foundation model to provide RRCS & P I C/E $$$ housing and rehabilitative support for individuals with stakeholders TBD substance use disorders Key: $ < 50K, $$ <100K, $$$ <500K, $$$$ > 500K

1 A Collaborative Care Work Group includes Fauquier Health, Fauquier Free Clinic, Rappahannock-Rapidan Community Services, the PATH Foundation, MHAFC and other community organizations with a direct interest in developing collaborative care models. 2 A Facilities Planning Work Group includes Rappahannock-Rapidan Community Services, the PATH Foundation and Fauquier County government.

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Development of Required Plan for the Financial Realignment of Virginia’s Public Behavioral Health System

Jack Barber, M.D. Interim Commissioner Virginia Department of Behavioral Health and Developmental Services General Assembly Requirement for Financial Realignment Plan

It is the intent of the General Assembly that DBHDS transform its system of care into a model that embodies best practices and state-of-the art services by treating, where appropriate, individuals in the community.

As part of this effort, DBHDS state hospitals shall be structured to ensure high quality care, efficient operation, and sufficient capacity to serve those individuals needing state hospital care.

– Item 284 E.1.

Slide 2 General Assembly Requirement for Financial Realignment Plan • This plan shall include: i. a timeline and funding mechanism to eliminate the extraordinary barriers list in state hospitals and to maximize the use of community resources for individuals discharged or diverted from state facility care; ii. sources for bridge funding, to ensure continuity of care in transitioning patients to the community, and to address one-time, non-recurring expenses associated with the implementation of these reinvestment projects; iii. state hospital appropriations that can be made available to CSBs to expand community mental health and substance abuse program capacity to serve individuals who are discharged or diverted from admission; iv. financial incentive for community services boards to serve individuals in the community rather than state hospitals; v. detailed state hospital employee transition plans that identify all available employment options for each affected position, including transfers to vacant positions in either DBHDS facilities or community services boards; vi. Legislation/Appropriation Act language needed to achieve financial realignment; and vii. matrices to assess performance outcomes.

• Plan is due December 1, 2017

Slide 3 Why Consider Financial Realignment?

State hospitals are over their safe operating capacity and utilization is increasing. The Extraordinary Barriers to Discharge List averaged around 200 people through FY 2017. Additions to LIPOS, DAP, and permanent supportive housing over the past 2-3 years have not arrested the increases in either the census or the EBL. More hospital staff are needed to address the increasing utilization and flow-through, rapidly trending to needing to invest in more state hospital beds despite almost 15 percent of the people no longer needing to be in the hospital. While the state is spending more than $700/day for inpatient care, this care is free to CSBs, jails, and Medicaid for adults. While virtually all of health care has, or will, transition to managed care, general funds for behavioral healthcare is not under a managed system. Virginia’s spending, relative to other states, is much more heavily balanced toward hospitals. Other states spend an average of three times as much in general funds in the community versus the state hospitals. We cannot safely discharge individuals from state hospitals without adequate community capacity and we cannot build adequate community capacity without sufficient funds in the community to do so. The present dynamics are pushing toward more funding for hospitals and beds at the expense of community investment, thus driving the system in the wrong direction. Spending for a hospital level of care when it is not needed is not good stewardship in the present and, given the high cost of maintaining hospitals as key operating systems extend beyond their useful life and changing standards require ever more investment, may be unwise for the future. Olmstead considerations.

Slide 4 The Behavioral Healthcare (BH) Landscape

• Comprehensive BH is essential to population • How does VA measure up nationally? 31st in BH health and cost containment funding in 2013 GFs, non-Medicaid: $92.58 per • BH issues drive up to 35% of medical care costs person. Median (Ohio) is $100.29 per person and individuals with BH disorders cost up to 2-3 • Not maximizing our investment times as much as those without • Roughly 50% of GF funding supports 3% of • Integration of BH and primary care, as well as persons served housing, employment, schools, social services • State Hospital Capacity: 17.3 beds per 100,000 • Decreased reliance on institutions and increased people focus on community services • Virginia spending on hospitals = 46% of overall • State hospital capacity average: 15 beds per BH budget 100,000 people • Virginia spending on community = 54% of overall • National average of state spending on hospitals = BH budget ($47 per capita) 29% of overall BH budget (2013) • Average 200+ individuals ready for discharge in • National average of state spending on VA’s mental health hospitals community = 68% of overall BH budget ($89 per capita), 2013. Now 74%.

Slide 5

Challenging Road to Reforming Virginia’s Behavioral Health System

Crisis Focus Lack of CSB Primary Variability Care

~50% Have ADA/ Olmstead Funding No Payor Alignment

Burden and Cost of BH Care

System of Pieces CSB Variability Approximate Funding Crisis Focus • 40 CSBs/1,927 locations • Funding amount and type • 25% GF • 30% of services • 631 private • Population demographics • 23% Local delivered are crisis providers/4,131 • Local priorities • 40% Medicaid services locations • Service array • ~50% CSB clients lack payor source Major Mental Health Recommendation for 68 Years (since 1949): Virginia needs to expand capacity to serve people in their own communities with coordinated behavioral health programs and supports.

Slide 6 System Transformation, Excellence and Performance in Virginia (STEP-VA)

In-Home Children’s Services

Same Day Access; Medication Assistance Treatment Coverage Primary Care Detoxification; for Integration; Care Housing Uninsured Outpatient Coordination; Services; Virginians Psychosocial Targeted Case Rehab/Skill Management Building for Kids;

Veterans Services; Peer and Family Targeted Case Support; Person- Management for Centered Treatment; Adults Mobile Crisis Services

Education and Employment Social Services

Slide 7 Behavioral Health Services for Uninsured Virginians • Health care has steadily moved towards “managed care” with payment for outcomes rather than “fee for service.” • Virginia needs to align managed Medicaid services with services for the uninsured supported by general fund dollars so that it has one system of standards and outcome measures. • However, Virginia’s community behavioral health system features inconsistent capacity and access. Its current funding is inadequate to cover the uninsured with behavioral health disorders in an outcome based system. Three steps must be taken to transition Virginia’s public safety net services: 2) Align DMAS 3) Address the 1) Build/expand the services, managed care behavioral bifurcated funding health programs with streams for CSBs and access, and measures STEP-VA so the same state hospitals to better incorporated into metrics and align services with STEP-VA. standards apply to needs and achieve the care provided Timeframe: 4 Years better cost to both Medicaid members efficiency. and the uninsured. (per Code) Timeframe: 1-4 Years Timeframe: 1-4 Years

Slide 8 Themes from Other States

National consultants, Behavioral Health Policy Collaborative (BHPC), was selected to provide expert input and review on a similar financial transformation efforts in other states. Eight states were reviewed and four themes found: Significant upfront investments in community-based services are necessary Theme 1: to rebalance systems away from psychiatric hospital-based care. The financial transition of state rebalancing efforts often includes preserving some allocation for state psychiatric hospitals while increasing Theme 2: the investment in community-based services, taking multiple years to see cost savings. Application of managed care principles is critical to divert both insured and Theme 3: uninsured populations from unnecessary hospitalization. Some states have allocated funds directly to counties/localities to purchase Theme 4: psychiatric hospital beds, driven by a state-developed, per-bed formula.

Slide 9 Virginia’s Previous Efforts

DBHDS’ response to a During this time, DBHDS has implemented a JLARC report identified number of “reinvestment” projects, typically the projected costs for based in state hospital downsizing, in Regions community services 1, 4, and 5. These projects shifted state needed to close state hospital funds to communities to accomplish facility beds and the unit closures and required building increased numbers of beds that community capacity, including private would be needed at the inpatient bed purchase. These did not go as end of the next three far as requiring communities to pay for beds in biennia (FY 1998-FY state hospitals (there were simply no beds to 2004) based on a survey use above a certain number). of CSBs.

1997 1999 – 2011

Slide 10 Hospital Challenges - Last Resort and State Hospital Admissions

• Since “Last resort” legislation was passed, a bed was provided for everyone under a TDO who needed a bed since the law was implemented July 1, 2014. • Since FY 2013, TDO admissions have increased 224% and all hospital admissions 58%.

Slide 11 Hospital Challenges – State Hospital Trends

• Occupancy over 85 percent is considered less safe for patients and staff. • From FY 2014 to FY 2017, the average daily census grew from 87% to 93%, with the highest daily census being 5% above the average daily census.

State Hospital Census on the 1st Day of Each Month Total CH CSH ESH NVMHI PGH SVMHI SWVMHI WSH Average FY 2013 78% 75% 88% 96% 89% 79% 94% 90% 86% FY 2014 86% 66% 88% 97% 90% 93% 92% 86% 87% FY 2015 93% 79% 93% 93% 95% 84% 89% 94% 90% FY 2016 90% 78% 93% 91% 98% 77% 88% 91% 88% FY 2017 94% 86% 100% 86% 97% 90% 94% 95% 93% FY 2014 High 87% 75% 91% 100% 94% 97% 98% 96% 92% FY 2014 Low 83% 55% 85% 95% 88% 83% 91% 76% 82% FY 2017 High 100% 91% 101% 94% 101% 100% 98% 99% 98% FY 2017 Low 86% 84% 99% 82% 95% 82% 85% 91% 88%

55-69% 70-84% 85-99% 100%+

• Should this rate of increase continue, the projected state hospital census in FY 2020 would be 99% with a projected high monthly average of 104% of its operational capacity.

Slide 12 Hospital Challenges – Extraordinary Barriers to Discharge List (EBL)

In July 2017, there were 185 individuals in state hospitals who have been clinically ready for discharge for more than 14 days but appropriate community services are not available to facilitate a safe discharge.

Number of Individuals on the EBL 250

200

150

100 181 204 194 185 147 156 168 152 147 50

0

Slide 13 Individuals with Barriers to Hospital Discharge (FY 2017)

The EBL is not static. During FY 2017, 635 individuals went on or off of the list with 564 being discharged. More than 100 suffered a clinical decline prior to discharge and had to be removed from the list.

250

200 Total # on EBL

150 New Indivduals

Discharged 100 Individuals No Longer

Numbers of Individualsof Numbers Ready 50

0

Slide 14 Item 284E – EBL Reduction Strategies

• In March 2017, using hospital census and EBL data, DBHDS established an EBL discharge goal for each DBHDS region which totaled 131 individuals statewide. • DBHDS provided regions $2.5 million in one-time bridge funds for individual service plans and expanded housing and service capacity. • Targeted discharge of individuals with service plans is July 1, 2017; those requiring expanded housing and services targeted by Sept. 1, 2017. • The additional Discharge Assistance Funds appropriated by the General Assembly are available July 1 to cover the ongoing costs of these initiatives. • As of July 10, 2017, a total of 122 individuals on the EBL had been appropriately discharged from state hospitals (93% of the goal). This project is critical to help release immediate pressure on state hospital censuses, but is considered temporary – it buys time until a more permanent solution is implemented.

Slide 15 Region V – Western Tidewater CSB Initiative

• Eastern State Hospital (ESH) has been operating at or above capacity and contributes to most of the diversions between hospitals. Region V has 22% of the total state population but admits over 40% of the state’s forensic admissions. • In March, DBHDS challenged Region V CSBs to propose discharge plans for 20 geriatric individuals from ESH by September 2017 and five more by November so those beds could be available for adult jail transfers. • Western Tidewater CSB (WTCSB) will develop a 65 bed transitional living program for older adults, including those currently hospitalized at ESH. • WTCSB purchased an assisted living facility in Suffolk and renovations are underway to update the physical building and to provide clinical, programming, and crisis stabilization spaces. • The project will be funded through new Discharge Assistance Funds (DAP), the new funds for a geropsychiatric team, and with existing DAP dollars. • This project builds permanent infrastructure. • A similar project is being developed with Region Ten CSB.

Slide 16 Community Services Needed For Individuals Clinically Ready For Discharge In February 2017 a point in time survey was conducted on the community housing, services and supports needed by 228 individuals in state hospitals who were clinically ready for discharge. Of these: 89% (202) had housing needs; and 40% (91) had unfunded service and support needs. Type of Housing Needs – February 2017 Point in Time Survey Permanent Supportive Housing 14 Assisted Living Facility 66 Nursing Home 52 Independent Living 31 Group home 36 Sponsor home 3 Total Individuals with Housing Needs 202

Unfunded Service and Support Needs – February 2017 Point In Time Survey Case management 22 Psychosocial rehab/day program 21 Psychiatry 4 Counseling 1 Medications 16 Extra supervision (1:1, daytime, ADL) 16 Mental health skill building 5 Program of Assertive Community Treatment (PACT) 6 Total Individuals With Unfunded Service and Support Needs 91

Slide 17 CSB Challenges

• Health policy changes (Medicaid CCC Plus Implementation, Medicaid reimbursement, shift in payor mix); • Projecting the profiles of individuals requiring services from CSBs and projecting the kinds and amounts of services and supports needed; • Financial risks if community services are implemented, but do not decrease utilization; • Increasing general population and risk of new demands, e.g. TBI or opioid epidemic; • Risk of static funding from state, decreases in Medicaid reimbursement; • Increasing personnel and operating costs without adequate state government financial support; • Continued workforce shortages in critical positions; and • Local government financial frustrations with state government.

Slide 18 CSB Complexities

• Implementation of same day access and primary care screening; • Implementation of DOJ Settlement Agreement; • Local governmental expectations; • Unique accountability requirements (local, state, Medicaid, insurance plans, accreditation, etc.); • Mix of funding sources; • CSB variations in: geography, population, local funding support, dependency on Medicaid, availability of private providers, total budget and staffing; • Array of services provided; and • Administrative capabilities.

Slide 19 Item 284 E Financial Transformation Concept

The concept would to shift state resources from state hospitals to CSBs coupled with additional funds support to develop and sustain community services and increase capacity. Below compares the realignment concept to maintaining steady state.

Financial Transformation Package Steady State Requirement (Goal of 88% State Bed Utilization) (Moving to 100% Bed Utilization and Above) Resources to CSBs for Community Capacity and Resources Needed for DBHDS System to Address the Census Service Development

• Portion of Current GF Transfer from Facilities • New GF for DAP for EBL and Local Inpatient (Agency 792) to CSBs (Agency 790) due to Purchase of Services reduced Census • New GF for staffing related requests at 9 MH • New GF for CSBs facilities (does not include 56 bed WSH)

OR Cost to the Commonwealth (Budget Request) Cost to the Commonwealth (Budget Request) Additional GF appropriation Additional GF appropriation

• Goal of reducing state bed utilization and the closure of bed units. • Need additional community resources for either course of action. • Facility budget funding required for steady state is a comparable amount to the amount required in transformation package.

Slide 20 Financial Realignment Plan Development

• Objective: Enhance integrated community based options while reducing bed census pressures at the MH Hospitals. • Measures: State hospital utilization, number of individuals on the EBL • Requirements: o Building community capacity through STEP-VA (This plan is incomplete without sustained effort). o Bridge or development support three - six months prior to inception of business operational changes (requires one-time bridge funding). o CBSs would receive additional funding up front, while the larger MH Hospitals would realize reductions in their base operating plans (to be saved on the “back end” if census declines). o CSB funds would come from new GFs and state hospital funds o CSBs would have the option of buying MH Hospitals beds or increasing community / programs and capacity, or some combination. o Greater financial flexibility to shift resources between DBHDS facilities and CSB and across fiscal years.

Slide 21 Available State Resources

FY 2018 FY 2018 FY 2018 GF Appropriation NGF Appropriation Base Operating Plan Central State $64,770,761 $392,063 $65,162,824 Eastern State $68,620,257 $2,357,166 $70,977,423 SWVMHI $32,360,705 $6,488,164 $38,848,869 Western State $50,755,426 $6,363,140 $57,118,566 CCCA $11,048,382 $3,714,326 $14,762,708 Catawba Hospital $14,297,435 $10,335,302 $24,632,737 NVMHI $28,639,650 $3,026,310 $31,665,960 Piedmont Geriatric $6,867,073 $21,226,378 $28,093,451 SVMHI $14,928,391 $1,789,217 $16,717,608

TOTAL $292,288,080 $55,692,066 $347,980,146 Not all facility funding available – funding for jail transfers, beds for some NGRIs, fixed costs. Also, CCCA funding is not available since realignment focus is on adult beds. • Mental Health Hospitals receive $292.3 million GF each year, 38% of system total. • CSBs receive $347.1 million GF each year for MH and SA services or 44.9% of system total. • Commonwealth provides $40.7 million GF for LIPOS and DAP through statewide contracts and distributions to CSBs.

Slide 22 Examples of Challenges

• Formula for assigning bed days to CSBs which translate into dollars: low utilizing CSBs vs. high utilizing CSBs; • Determining state hospital fixed costs unavailable for use; • Projecting community services/supports needed by CSB/region; • State hospital management of flexible costs, staff, surge capacity: hospital “budgets” become dependent on census rather than fixed; • Managing overall financial risk; • Seeking new funds based on demand, population growth; • Managing budget reductions; • Support for staff; and • Change management.

Slide 23 Risk/Challenges/Mitigation

• Currently state hospitals operate with a budget target and the risk and volatility associated with special fund is pooled centrally to absorb this uncertainty. Budget is set for year, independent of census, admission demand, etc. • This allows for hospitals to count on resources being available to them throughout the entire fiscal year. • Having CSBs purchase beds would introduce a new dynamic to the cash flow and operations of the hospitals. • Hospitals would need to navigate both increases and decreases of the census along with the cash flows from the CSB payments. • New staffing procedures and tools would be required to meet with this newly introduced risk to operations and cash flow.

Slide 24 CSB Summary of Identified Needs

In July 2017, DBHDS requested that CSBs identify strategies and resources for reducing state hospital utilization.

Crisis Services Housing Services and supports Crisis stabilization and Permanent supportive In-home supports, jail based detoxification units, housing, transitional services, clinical support for mobile crisis teams, group homes, intensive nursing homes, discharge expanded contracts residential settings, planning for private hospitals, with private hospitals assisted living facilities increased use of peer support services, case management, outpatient therapy, PACT teams, psychosocial programming, and increased access to outpatient psychiatry

Slide 25 Building Community Capacity • STEP-VA • Services, Programs, and Capabilities Required • Timelines – 6 Months prior to Transformation • Bridge / Seed Funding to Build Capacity o One-Time Resource Requirements o Cost Methodology o Potential Sources of Funding

Sustaining the Model • Services, Programs and Capabilities Required • Ongoing Resources Required o Cost Methodology o State Hospital Funding Available o Additional Funding Sources

Slide 26 Community Service Development and Resource Requirements

Building Community Capacity Sustaining the Model • STEP-VA • Services, Programs and Capabilities Required • Services, Programs, and Capabilities Required • Ongoing Resources Required • Timelines – 6 Months prior to Transformation o Cost Methodology • Bridge / Seed Funding to Build Capacity o State Hospital Funding Available o One-Time Resource Requirements o Additional Funding Sources o Cost Methodology

o Potential Sources of Funding

Slide 27 Timeframes for Building Out Community Services

The estimated time frame for building out housing, services and supports will vary based on the type of service and support and the need to acquire or renovate buildings. CSBs which are local government agencies may have longer time frames for building out services and supports.

Timeline for Building Out Services and Supports Category Of Activity Build-Out Timeline Contract for existing services 2 months Hire additional staff to build-out existing services 3 months Start a new program in an existing office/treatment space 3 to 5 months Acquire real estate and start a new service or program 6 to 9 months

Slide 28 State Employee Transition Plans

• With the transformation, each hospital will need to identify staffing needs based on beds. • A staffing plan will need to be developed by each hospital, identifying the critical functions and positions and account for last resort legislation. • During training center downsizing, impacted staff filled critical vacancies. With rare exception, if a unit closes, staff will fill other existing vacancies in the hospital. • Temporary workforce pool may be necessary to manage surges. • Partnerships with CSBs and private providers, including possible staff-sharing arrangements.

Slide 29 Assessing Performance Outcomes

State Hospitals • Larger hospitals with moderate to high bed use rates would reduce their bed capacity by one operating unit to achieve the savings needed for community investment and smaller hospitals would operate at 88% or less of capacity. Aggregate utilization 88% or less. • Long-term statewide EBL reduction, particularly for individuals on EBL > 90 days.

Statewide • Number of CSBs implementing Same Day Access. • Number of CSBs implementing Primary Care Screening. • Increase percentage of total spending going to CSBs. • Successful implementation of managed care principles to this aspect of system.

Slide 30 Next Steps

• Review comments and feedback from this group; • Receive/review comments, advice, etc. from national consultants, HHR, and SJ47 workgroup; • Receive/review comments from consultants on hospital costs: fixed/flexible; • Continue working on community needs assessments, which will vary by region, if not individual CSBs; • Continue working with CSB leaders and HHR to develop costs/funding formulas/procedures; • Provide updates/education/information for Administration and GA members as directed by HHR.

Slide 31

RRCS 2017 ANNUAL PICNIC 10AM – 4 PM

Get ready for a day of fun, relaxation, and new adventures! The RRCS Annual Picnic for all RRCS employees will take place at The Inn at Kelly’s Ford. On the following pages you will find:

• RRCS Activities that are ongoing throughout the picnic event. • A list of RRCS scheduled events. • Listing of activities offered through The Inn at Kelly’s Ford, along with the associated fees that employees are responsible for paying. • Brief description of the RRCS scheduled events. Also, soon you will receive invitations that include the list of activities that are offered. RSVP’s due by 9/8/2017. You will be asked to select the activities that you want to participate in so that we can ensure plenty of materials and supplies are available for the RRCS classes, and to also provide a head count for the activities offered through The Inn at Kelly’s Ford.

RRCS 2017 ANNUAL PICNIC 10AM – 4 PM Ongoing activities

• Volleyball • Softball • Corn hole • Fishing • Board Games • Reading • Giant Jenga • Photo Booth • Bring your bike – bike trails • Bring bag chairs if you plan to sit outside.

RRCS 2017 ANNUAL PICNIC 10AM – 4 PM

Scheduled RRCS Activities 10:30 Rock painting 10:30 -11 Blood pressure checks 10:30 Choir Ensemble 101 11: 00 Auricular acupuncture for stress management 11:30 Make and Take a Card 12:00 – 2 Lunch will be served 1:30 Hair Bow making 2:00 Crocheting 2:00 – 2:30 Blood pressure checks 2:30 Line dancing 3:00 Executive Director : Remarks & then agency photo 3:15 Choir performance 3:30 Drawings

* Schedule is subject to change.

RRCS 2017 ANNUAL PICNIC Activities offered through the Inn at Kelly’s Ford

PRICING (employees responsible for fees) Kayaking $35 per person Canoeing (Kelly’s Ford to Mountain Run) $50 / 2 people Tubing (Kelly’s Ford to Mountain Run) $20 per tube Fishing (equipment) $20 per day Purchase Fishing license (Equestrian center) Horseback riding (Guided trail 1 hour) $ 50 per person TIMES 10:00, 12 noon, & 2:00 for Trail Rides Canoes, & Kayaks; Tubes only 10:00 & noon

SPECIAL NOTES: • Duration: Canoe, Kayak, and tubing activities set run about 4 hours • Lunch: Catered lunch from 12 noon to 2, so you may decide to bring a packed lunch for your 4 hour adventure! • Payment: Please submit your payment to Robin Woodard by September 20th. Cash or check payable to RRCS. • Activities may not be offered depending on the weather or other conditions.

Questions about The Inn at Kelly’s Ford activities, please contact Robin Woodard at 825-3100, ext. 3233.

RRCS Activity Information Relax Choir Ensemble 101 Instructor: Lorraine Sheffield Have you ever wondered what it would be like to sing in a choir ensemble? Let the master choir director work with you. Some of the benefits of singing with a group of people are: learning how to trust others, togetherness, teamwork, relaxation, fun, prioritizing and harmony. The two songs we will learn are: True Colors & Bless the Lord with me.

Get Auricular Acupuncture for Stress Management Active Facilitator: Ellen Adams The insertion of small acupuncture needles into five points on the outer surface of ones ear (auricular) helps to reduce the symptoms of stress and anxiety. Show off Make & Take Cards your Instructor: Barbara Cason talents Learn how to make beautiful and fun all occasion cards and/or gift tags using rubber stamps, punches and ink. RRCS Activity Information

Try Hair Bow Making something Instructor: Katie Lindsay new Learn how to make a stacked ribbon bow that can be attached to either an elastic hair band or clip.

Crocheting Relax Instructor: Elaine Griffith Beginners class to learn crocheting basics like how to hold a crochet hook and how to begin making the most common stitch, the chain stitch.

Line Dancing Instructors: Christine Wilson & Shelby Blankenship If you've enjoyed watching Christine & Shelby at previous picnics here's your chance to join the fun! Don't know any line dances? That's okay, learn one today! Get Active

Dear Mr. Bryan Duncan and Mr. Ryan Banks:

We are writing to convey our gratitude to the RRCSB for sponsoring the YACC Program for area young adults and their families, to recommend that the YACC Program funding be extended, and that the RRCSB support replication of the YACC Program in other CSBs.

Our family has received exceptional care from the talented and committed YACC Program staff. The challenges we face are extreme. A traditional approach—biweekly visits to a clinician and monthly check-ups with a psychiatrist—AFTER waiting in line for three months for an intake appointment—is grossly inadequate to address our needs, where crisis can be an everyday occurrence. Not knowing what to do, whom to consult, and how to make it through the next 24 hours is the reality we often face.

The YACC Program’s innovative treatment model is robust enough to meet the challenges head- on. The integrated team members, each with their own role, work together on an ongoing basis to meet the evolving treatment needs of the young adult and their families. The treatment team is continually communicating and supporting each team member to support the young adult in crisis, transition to recovery and attainment of a new way of life. The goal is not to keep the young adult dependent on the team and its care, but to provide intensive intervention to facilitate stabilization, recovery and attainment of life skills to enable them to live more productive and independent lives.

We receive multifaceted treatment delivered non-traditionally—in the car with team members driving young adults to appointments, conducting home visits, and responding to text messages and phone calls after business hours, on weekends, and even while on vacation. Alli Lowden, Ashley Clark, Ashton Morse, Cory Will and Katie Lindsay have all responded to after-hours text messages and phone calls, and Ashley Clark maintained contact with our family in crisis during her vacation. Ashley Clark, Ashton Morse and Katie Lindsay accompanied us to the court room numerous times over a period of six months. By equipping family members to understand what the young adult may be experiencing and how best to support them, the family is better able to effectively support the young adult.

The parent support group facilitates parent education and is a place to meet and offer support to others in similar circumstances. Parent education materials are targeted to current issues facing participant families, such as thought distortions, the Karpman Triangle, The Power of Ted, Pat Deegan, personal medicine, delusions and hallucinations, the cycle of change, and diagnoses and medications. The material is presented in an informative and organized way with handouts to take home, prompting a significant paradigm shift in the way we think about and respond to our challenges. The parent support team facilitators are always prepared to discuss relevant information that we can use in our everyday lives, and they are always sensitive to the needs of parents in attendance.

The YACC Program team is staffed by exceptionally talented and committed practitioners. Ashley Clark has helped our son face his problems and find a better way to live. No other clinician has helped our son as much has Ashley has. She is an effective communicator, drawing people to her by her open and friendly personality. She has in in-depth command of a wide range of mental health topics and expertly presents them. Alli Lowden puts people going through a lot of stress in their lives at ease. She ably assists with facilitating the parent support group. She stays in contact with us and makes herself available to talk with us if the need arises. Ashton Morse met with us to discuss boundaries as a way of engaging our family in treatment participation. What was different about our sessions was that they didn’t end at a predefined time. They ended when our work for the evening was over, even if that time extending beyond a one-hour interval. That is the YACC difference. It is about truly helping people and not expecting them to fit into a traditional treatment model. Cory Will is the most evolved person we have ever met in terms of the amount of work he has done to achieve mental health in his own life. He is an inspiration and an example of the results that can be obtained by the young adults if they commit themselves to developing effective coping skills. Katie Lindsay is an experienced and effective parent support group facilitator. Our family is grateful to Katie for setting up an IEP for our son, for telephone support when needed, and for her wealth of knowledge about a wide variety of important topics. Michelle Hankey changed our son’s life by giving him an article that gave him hope for the future. She is helping our son map out educational and career goals, visits our son at home and takes him to appointments.

The YACC Program staff goes above and beyond not only because it is prescribed by their treatment model, but because they are exceptionally committed practitioners. Thank you for the YACC Program. Please continue to fund it and to support this program in other jurisdictions. If we can assist you in any way, please do not hesitate to contact us.

Sincerely,

Received July 23, 2017 via email to Brian Duncan Socialization, Activities, and Camaraderie

Fauquier Senior Center offers these keys to remaining engaged and avoiding isolation

BY CAROL SIMPSON

Brenda was a bookkeeper for 31 years. She looked forward to retirement when she could travel, garden, and sleep late. After leaving her job, however, Brenda found that she missed interacting with people. That’s when she found the Fauquier Senior Center in Warrenton. “The Senior Center saved my sanity,” Brenda said. “I had no idea how much I would suffer without people around me. Now I have new friends and I look forward to seeing them.” Brenda isn't alone. For various reasons, many men and women over the age of 59 have found a refuge at the Fauquier Senior Center. Another participant, Ella, insists that activities at the Center “are keeping my brain healthy.” Her days had been spent languishing at home watching mindless TV shows until her son arrived home from work. He suggested the Senior Center, but Ella was reluctant; she had never been a “joiner.” But she gave it a chance and now is so glad she did. Senior centers sprang up in the 1950s and 1960s when social workers sought a way to combat the profound social isolation they saw in many of their older clients. The centers started as nutrition sites: places to get a healthy lunch and enjoy the camaraderie that comes with sharing a meal. The benefits were immediately apparent; the idea caught on and expanded in scope. Now there are 11,000 senior

As appeared in Warrenton Lifestyle Magazine | June 2017 “visit and join in the laughter—it’s contagious.”

centers in the U.S. serving a million older once I came, I realized how happy it BY DEBBIE EISELE DEBBIE BY adults. made me [to attend].” Rose recognized Each center has its own the tremendous potential benefits for her personality. Some are affiliated with child father-in-law, so when he came to live with care centers, gyms, or hospitals. The her she talked to him about joining the Fauquier Senior Center is run by Casey Center. She had to convince him to go: Shelton, an energetic woman who can't ‘Just try it one day a week.’ I knew he was stop raving about her program. “We serve outside his comfort level, but I also knew active adults, aged 60 and wiser,” she it would give him a reason to get up, get bubbled. “Everything is free, even the dressed and look forward to the day.” transportation to and from home.” Casey After only a couple of weeks, he waited at and her “amazing” (as she calls them) the door for her to give him a ride, saying, volunteers set up daily activities. These “Rose, its time to get to the Center.” activities include some you might expect: Rose’s father-in-law ended up attending The Fauquier Senior bingo, cards, and board games. Others you Monday through Thursday every week. Center in Warrenton may not expect, such as exercise class, According to Rose, he slept better, made recently hosted its annual volleyball and trips to Walmart. friends, and enjoyed conversations with Multi-generational Day “We ask folks to try us three times and World War II veterans like himself. Rose where children from the then sign up as members,” said Casey. acknowledges the benefits to the seniors, Head Start Program visit, Once a person is a member, he or she can but also to family members who need time sing, read, and create art come as frequently or infrequently as they to complete errands or go for coffee with with the seniors. Above, wish. “We are always looking for people friends. Betty Bauer and Rose from the community to come in and A person must be able to navigate Brackett are enjoying a share their talents: craft projects, music, the Center independently in order to parade of artwork. magic—you name it, we're interested in join. Individuals needing additional showcasing it at the Senior Center.” assistance can attend the Warrenton Shelton emphasized the health benefits Adult Day Program, co-located at the E. of participating in the Center. She Shirley Avenue building. Molly Snurr, Fauquier recounted the story of a gentleman who program supervisor, welcomes potential came in using a walker and now, only participants and is happy to offer a trial Senior Center occasionally, uses a cane. “He started day. “Many family members tell me, ‘Dad 430 E. Shirley Ave. moving more and was motivated by doesn’t want to come.’ But once they get seeing others dance and have fun.” In here, they get comfortable and it becomes Warrenton, VA 20186 fact, research shows that, compared to part of their routine.” 540-347-7729 their peers, senior center attendees have Helen, a Senior Center participant for Open Mon. - Thurs. better health, social interaction, and life the past three years, smiles broadly as 10 a.m. to 2 p.m. satisfaction. A recent study indicated that she reports, “I love the Center. I love the social isolation is as detrimental to an older different people and all the activities. We Warrenton Adult Day adult’s health as smoking three-quarters of laugh every day. I especially like going out a pack of cigarettes a day. to lunch.” Anyone who thinks the Senior Healthcare Center Reluctance to join is a common Center is one step from a nursing home issue. Ed, a participant at the Center, should visit and join in the laughter—it's 540-347-2797 remembered, “I wasn't sure at first, but contagious. ❖ Open Mon. - Fri. 8 a.m. to 4 p.m. Payment on a sliding scale, Carol Simpson is a graduate of Georgetown University. She was executive director maximum $61/day of the Alzheimer’s Association of Greater Washington, trainer at Home Instead Senior Care, and development manager at the Alzheimer’s Association of Central/ Western Virginia before becoming executive director of Aging Together.

As appeared in Warrenton Lifestyle Magazine | June 2017 BY-LAWS

Rappahannock-Rapidan Community Services Board and Area Agency on Aging

Executive Offices P.O. Box 1568 Culpeper, Virginia 22701 540-825-3100

ARTICLE I - NAME

The name of this organization shall be the Rappahannock-Rapidan Community Services BoardRAPPAHANNOCK-RAPIDAN COMMUNITY SERVICES BOARD and Area Agency on Aging, hereinafter referred to as "the Board."

ARTICLE II - PURPOSE

The purpose of this Board shall be to act as agent of the Counties of Culpeper, Fauquier, Madison, Orange, and Rappahannock in the Commonwealth of Virginia in the establishment and operation of mental health, mental retardationdevelopmental disability, substance abuse use disorder and aging services as provided for in Chapter 5 of Title 37.2 of the CODE OF VIRGINIA OF 1950, as amended and the Federal Older Americans Act of 1965 and 2006, as amended. The Board is an Operating Community Services Board as described in Chapter 5, Title 37.2-500 to 37.2-512.

ARTICLE III - MEMBERSHIP

Section 1. The membership of this Board shall consist of fifteen (15) persons, approved and appointed by the Board of Supervisors of the participating counties. Membership shall be broadly representative of lay and professional elements of the community, but shall specifically exclude any employee of the Virginia Department of Behavioral Health and Developmental Services, the Virginia Department of Aging, and members of the State Board of Behavioral Health and Developmental Services. Members shall be appointed and serve in accordance with Chapter 5, Title 37.2-501 – 502 of the CODE OF VIRGINIA OF 1950, as amended.

Section 2. The Board shall consist of three (3) voting members from each jurisdiction.

Section 3. A member of the Board shall be appointed by the respective County Board of Supervisors for a term of three years from the first day of January of the year of appointment. A Board member may also serve an unexpired term. A member shall sign an Agreement of Understanding that is approved by the Board.

1 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17

Section 4. Vacancies shall be filled for the unexpired terms in the same manner as an original appointment.

ARTICLE IV - POWERS AND DUTIES OF THE BOARD

The Board as a direct agent of the governmental entities which have established it shall be subject to the laws and regulations relating to such agencies of those governments and shall have the general powers, duties and responsibilities of a Board as outlined in Chapter 5 of Title 37.2, 500 – 512, CODE OF VIRGINIA, as amended, and as mandated by State and Federal Aging Legislation. As set forth in the CODE OF VIRGINIA and other applicable legislation the Board shall:

a. Support, advocate and educate the community and local, state and federal government, as well as funding sources about programs, services and needs on mental health, mental retardation, substance abuse and aging populations Review and evaluate public and private community mental health, developmental, and substance abuse services and facilities that receive funds from it and advise the governing body of each city or county that established it of its findings.

b. Review and evaluate all existing and proposed public mental health, mental retardation, substance abuse and aging services and facilities, both public and private, which are available to the community.Pursuant to §37.2-508, submit to the governing body of each city or county that established it a performance contract for community mental health, developmental, and substance abuse services for its approval prior to submission of the contract to the Department.

c. Submit to the governing body or bodies of each political subdivision of which it is an agency, a program of community mental health, mental retardation, substance abuse and aging services and facilities for its approval.Within amounts appropriated for this purpose, provide services authorized under the performance contract.

d. Within amounts appropriated, execute such programs and maintain such services as may be authorized under such appropriations.In accordance with its approved performance contract, enter into contracts with other providers for the delivery of services or operation of facilities.

2 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 e. In accordance with its approved program, enter into contracts for rendition or operations of services or facilities. In the case of operating and administrative policy boards, make policies or regulations concerning the delivery of services and operation of facilities under its direction or supervision, subject to applicable policies and regulations adopted by the Board. f. Make rules or regulations concerning the rendition or operation of services and facilities under its direction or supervision, subject to applicable standards or regulations as promulgated by the State Board. The Board shall, if so constituted, and as directed by the governmental jurisdiction or jurisdictions involved, act as administrator of the program.In the case of an operating board, appoint an executive director of community mental health, developmental, and substance abuse services who meets or exceeds the minimum qualifications established by the Department, and prescribe his duties. g. Appoint an Executive Director whose qualifications meet the standards fixed by the Board and applicable law and prescribe the Executive Director's duties. The compensation of such Executive Director shall be fixed by the Board within the amounts made available by appropriation. The Board agrees and covenants that it shall provide the Executive Director with guidance, support, and direction in carrying out the Executive Director's contract duties and responsibilities and complete an annual evaluation of the Executive Director.Prescribe a reasonable schedule of fees for services provided by personnel or facilities under the jurisdiction or supervision of the board and establish procedures for the collection of those fees. h. Prescribe a reasonable schedule of fees for services provided by personnel or facilities under the jurisdiction or supervision of the Board and collection of the same. All fees collected shall be included in the program submitted to the local governing bodies pursuant to subdivision (2) hereof and in the budget submitted to the local governing bodies pursuant to Title 37. 2-508 and shall be used only for community mental health, mental retardation, substance abuse and aging purposes. The Board shall institute a reimbursement system to maximize the collection of fees

3 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 from persons receiving services under the jurisdiction or supervision of the Board consistent with the provisions of Title 37.2-511 and from responsible third-party payors.Accept or refuse gifts, donations, bequests, or grants of money or property from any source and utilize them as authorized by the governing body of each city or county that established it. i. Accept or refuse gifts, donations, bequests or grants of money or property from any source and utilize the same as authorized by the governing body or bodies of the political subdivision or subdivisions of which it is an agency. Seek and accept funds through federal grants. In accepting federal grants, the board shall not bind the governing body of any city or county that established it to any expenditures or conditions of acceptance without the prior approval of the governing body. j. Seek and accept funds through federal grants. In accepting such grants the Board shall not bind the governing body or bodies of the political subdivision or subdivisions of which it is an agency to any expenditures or conditions of acceptance without the prior approval of such governing body or bodies.Notwithstanding any provision of law to the contrary, disburse funds appropriated to it in accordance with such regulations as may be established by the governing body of each city or county that established it. k. Have authority, notwithstanding any provision of law to the contrary, to disburse funds appropriated to it in accordance with such regulations as may be established by the governing body of the political subdivision of which the Board is an agency. Apply for and accept loans as authorized by the governing body of each city or county that established it. l. Apply for and accept loans as authorized by the governing body or bodies of the political subdivision or subdivisions of which it is an agency. This provision is not intended to affect the validity of loans so authorized and accepted prior to July 1, 1984.Develop joint written agreements, consistent with policies adopted by the Board, with local school divisions; health departments; boards of social services; housing agencies, where they exist; courts; sheriffs; area agencies on

4 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 aging; and regional offices of the Department for Aging and Rehabilitative Services. m. Develop joint annual written agreements, consistent with policies and procedures established by the State Board, with local school divisions; health departments; boards of social services; housing agencies, where they exist; courts; sheriffs; area agencies on aging and regional Department of Rehabilitative Services offices. The agreements shall specify what services will be provided to clients. All participating agencies shall develop and implement the agreements and shall review the agreements annually. Develop and submit to the Department the necessary information for the preparation of the Comprehensive State Plan for Behavioral Health and Developmental Services pursuant to §37.2-315. n. Advocate for programs and policies to support consumers, persons with long-term care needs and their families with local, state, and federal legislative and regulatory bodies.Take all necessary and appropriate actions to maximize the involvement and participation of individuals receiving services and family members of individuals receiving services in policy formulation and services planning, delivery, and evaluation. o. Assist in fund raising and resource development to support programs.Institute, singly or in combination with other community services boards or behavioral health authorities, a dispute resolution mechanism that is approved by the Department and enables individuals receiving services and family members of individuals receiving services to resolve concerns, issues, or disagreements about services without adversely affecting their access to, or receipt of appropriate types and amounts of current or future services from the community services board. p. Notwithstanding the provisions of §37.2-400 or any regulations adopted thereunder, release data and information about each individual receiving services to the Department as long as the Department implements procedures to protect the confidentiality of that data and information.

5 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 q. In the case of an operating board, have the authority, notwithstanding any provision of law to the contrary, to receive state and federal funds directly from the Department and act as its own fiscal agent, when authorized to do so by the governing body of each city or county that established it.

r. All powers and duties associatesd with its function as the designated Area Agency on Aging.

s. Advocate for services consistent with its mission within the five County service area.

Pst. And other applicable duties and powers as they may apply.

ARTICLE V - OFFICERS OF THE BOARD AND THEIR DUTIES

Section 1. The officers of the Board shall consist of a Chair, Vice-Chair, and Secretary who shall be elected by the Board. Term of office shall be one (1) year, renewable once at the option of the Board.

Section 2. The duties of the Chair shall be:

a. To call and preside at all meetings of the Board and Executive Committee.

b. To appoint all committee members deemed necessary for the operation of the Board, pursuant to the By-Laws.

c. To represent the Board at appropriate local, state and national meetings.

d. To supervise the Executive Director in decision-making about Board related functions.To maintain ongoing communication with the Executive Director in order to represent the Board’s interest and priorities and in support of Executive Director’s goals and essential duties.

e. To perform any other duties determined by the Board.

Section 3. The duties of the Vice-Chair shall be:

a. To perform in the absence of the Chair all the duties of the Chair.

6 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17

b. To perform any other duties as assigned by the Board.

Section 4. The duties of the Secretary shall be:

To attest to all actions of the Board, including signing the official minutes and documents as needed.

ARTICLE VI - NOMINATIONS, ELECTIONS AND TERMS OF OFFICE

Section 1. The Board shall elect its officers in accordance with the Nominating Committee procedure:

a. The Committee shall consist of at least five members, one from each County.

b. The Committee and its chair shall be appointed by the Board Chair no later than October of each year to return with a full slate of officers in November to be presented to the full Board in December.

c. In addition to the Committee's slate presented in December, nominations for officers shall be accepted from the floor at the December meeting.

d. Election of officers shall be held at the December meeting and the new officers shall assume their duties on January 1 of the new calendar year.

Section 2. Any vacancy occurring in the officers shall be filled by the Board.

ARTICLE VII – MEETINGS

Section 1. Regular monthly meetings of the Board shall be held the second Tuesday of every month unless cancelled by the Executive Director upon approval of the Board Chair, or by action of the Board at a previous meeting.

Section 2. Special meetings of the Board may be called by the Chairman or upon the written request of three members, upon proper notice pursuant to the requirements of the Virginia Freedom of Information Act.

Section 3. The quorum for all Board meetings shall be one-half of its members plus the Chair or Vice-Chair.

7 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17

Section 4. All committees meet at the discretion of the committee or upon request of the Board Chair.

Section 5. The quorum for all committee meetings shall be a majority of the committee.

Section 6. Any Board member who has three or more un-excused absences from board meetings within a calendar year may be recommended by the full Board for removal from his/her seat to be determined by his/her Board of Supervisors.

ARTICLE VIII - PERMANENT COMMITTEES OF THE BOARD

Section 1. There shall be the following Permanent Committees:

a. An Executive Committee, comprised of the Board Chair, who shall serve as Chair of the Committee, represent his/her County and have one vote; the Board Vice-Chair who shall represent his/her County and have one vote; the Secretary who shall represent his/her County and have one vote; and two members from the Counties not previously represented chosen by their respective County delegations and have one vote each. The Executive Committee shall be comprised of one (1) member from each County which shall:

1. Conduct all necessary business between Board meetings.

2. Participate by locality in annual presentations and requests to local and state governments for funding.

3. Prepare and present necessary and appropriate reports to the full Board.

4. Have staff liaison services from the Executive Director.

5. Be responsible for the annual evaluation of the Executive Director.

6. At the request of any other Committee, review materials.

8 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 b. A Program Committee which shall be a Committee of the whole Board and shall elect its own Chair with input from the Nominating Committee at the last meeting of each calendar year and be educated about Community Services Board (CSB) and Area Agency on Aging (AAA) programs and services. At the discretion of the Committee Chair, members may be appointed to program specific Ad Hoc committees (e.g., MH, MR, SA, and Aging Mental Health, Developmental Disability, Substance Use Disorder and Aging). The full Committee shall:

1. Conduct necessary business related to programs and services and forward policy recommendations to the full Board for action.

2. Identify unmet program needs and plan accordingly.

3. Review and make recommendations on all new and existing programs.

4. Enhance community relations and acceptance of all Board services.

5. Prepare and present reports to the full Board.

6. Function as the Board's liaison with all related advisory boards and with the boards of all related contractual services.

7. Perform all other tasks as shall be assigned by the Board and the Chair.

8. Have staff liaison from upper level management. c. An Administrative Services Committee which shall be a Committee of the whole Board and shall elect its own Chair with input from the Nominating Committee at the last meeting of each calendar year and be educated about CSB and AAA programs and services. At the discretion of the Committee Chair, members may be appointed to program specific Ad Hoc committees (e.g., Human Resources, Procurement, Management Information Systems,

9 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 Accounting and Reimbursement). The Administrative Services Committee shall be responsible for:

1. Review and provide to the full Board financial statements for all agency activities.

2. Review and make recommendations to the full Board all policies related to Human Resources and Financial Management.

3. Periodically review accounting practices and cash management procedures.

4. Annually meet with the independent auditor to hear his/her report on audit findings and report these findings to the full Board.

5. Provide oversight and guidance to all agency administrative activities to assure compliance with applicable standards in procurement, reimbursement, human resources, accounting, and management information systems.

6. Perform all other tasks as shall be assigned by the Board and the Chair.

7. Have staff liaison with the Executive Director and the Director of Finance and Administrative Services. d. A Development Committee, which shall be comprised of at least five members of the Board and shall elect its own Chair with input from the Nominating Committee at the last meeting of each calendar year. The Committee may recruit non-RRCSB AAA Board members to serve on ad hoc subcommittees for the purpose of developing and carrying out its various development projects, programs, events, etc. The names of these volunteer recruits shall be submitted to the full Board for approval. The full Committee shall:

1. Develop and oversee execution of an annual Development Plan to raise funds toward an annual goal established in consultation with the Executive Director; and establish the specific purposes to which these funds will be devoted.

2. Consider and carry out, as seems feasible, various methods of fund- raising to benefit RRCSB AAA or specific programs of the agency, such as an annual appeal for contributions; fund-raising events; grant proposals; other methods as may be found.

10 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17

3. Develop entrepreneurial programs that draw on agency resources, in consultation with the Executive Director.

4. Develop and oversee public relations and publicity efforts to help ensure public support for the agency, including website development, electronic and print newsletters, signage on buildings and vehicles, print literature, press releases, special events, etc.

5. Work with advice and assistance of the Executive Director, and evaluate the need and availability of staff support for these activities.

6. Report regularly to the Board on its activities and enlist the support of Board members in volunteer roles.

Section 2. Other Permanent Committees may be created by the Board as necessary.

Section 3. The Committee Chair of Permanent Committees shall designate a staff person to take minutes at each meeting of the Committee and make them available to the full Board.

Section 4. All reports and recommendations of the Permanent Committees are subject to review and action by the full Board.

ARTICLE IX - AD HOC COMMITTEES OF THE BOARD

Section 1. There shall be Ad Hoc Committees of the Board to exist from time to time, and shall be appointed and serve at the pleasure of the Board Chair.

Section 2. An Ad Hoc Committee shall examine issues, make plans, and take actions on its assigned business and make recommendations to the full Board.

Section 3. The Board Chair shall dissolve an Ad Hoc Committee when its tasks are complete.

ARTICLE X - ARTICLES OF ASSOCIATION

THESE ARTICLES OF ASSOCIATION were adopted by the Rappahannock- Rapidan Community Services Board and Area Agency on Aging the 13th day of June 1995.

11 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 WHEREAS, the Rappahannock-Rapidan Community Services Board and Area Agency on Aging has been created by resolutions of Culpeper, Fauquier, Madison, Orange, and Rappahannock Counties of Virginia, and

WHEREAS, the Rappahannock-Rapidan Community Services Board and Area Agency on Aging wishes to set forth herein its purpose, and the Dedication and Distribution of its Assets upon dissolution,

NOW, THEREFORE, the Rappahannock-Rapidan Community Services Board and Area Agency on Aging does hereby certify:

FIRST: Said organization is organized exclusively for charitable, educational, and scientific purposes, including for such purposes, the making of distributions to organizations that qualify as exempt organizations under Section 501(c) (3) of the Internal Revenue Code, or the corresponding section to any future Federal tax code.

SECOND: No part of the net earnings of the organization shall inure to the benefit of, or be distributable to its members, trustees, officers, or other private persons, except that the organization shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth in paragraph FIRST. No substantial part of the activities of the organization shall be carrying on of propaganda, or otherwise attempting to influence legislation, and the organization shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of or in opposition to any candidate for public office.

Notwithstanding any other provision of these articles, the organization shall not carry on any other activities not permitted to be carried on (a) by an organization exempt from Federal income tax under Section 501(c) (3) of the Internal Revenue Code (or corresponding section of any future Federal tax code), or (b) by an organization, contributions to which are deductible under Section 170(c) (2) of the Internal Revenue Code, or corresponding section of any future Federal tax code.

THIRD: Upon dissolution of this organization, assets shall be distributed for one or more exempt purposes within the meaning of Section 501(c) (3) of the Internal Revenue Code, or corresponding section of any future Federal tax code, or shall be distributed to the Federal government, or to a state or local government, for a public purpose. Any such assets not so disposed of shall be disposed of by a Court of Competent Jurisdiction of the county in which the principal office of the organization is located, exclusively for such purposes or to such organization or organizations, as said Court shall determine, which are organized and operated exclusively for such purposes.

12 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 ARTICLE XI - PROCESS OF AMENDMENT

Section 1. These By-Laws may be amended according to the following procedure:

a. Any By-Laws amendment may be introduced by any Board member at a regular Board meeting.

b. A By-Laws amendment that is introduced shall be read at that meeting and the next regular meeting.

c. A vote on the By-Laws amendment may be taken after the second reading.

d. A two-thirds (2/3) affirmative vote is necessary to amend these By-Laws.

ARTICLE XII - PARLIAMENTARY AUTHORITY

Section 1. ROBERT'S RULES OF ORDER, NEWLY REVISED shall be the parliamentary authority for the Rappahannock-Rapidan Community Services Board and Area Agency on Aging. Conflicts of interpretation shall be decided by the Chair of the Board.

By-Law Revisions/Implemented: 07/09/85 Revised 07/14/87 Revised 01/01/91 Revised & Implemented 11/10/92 Revised 04/13/93 Revised 04/12/94 Revised & Implemented 01/10/95 Revised & Implemented 10/10/95 Revised & Implemented 04/09/96 Revised & Implemented 02/10/98 Draft Presented 04/14/98 Revised and Implemented 06/08/99 Revision Presented to Board of Directors 07/13/99 Final Draft Revision #2 Presented to the Board 09/14/99 Final Document Presented to the Board for Approval 09/14/99 Approved and Implemented 11/14/00 Revision Presented to Board of Directors 12/12/00 Presented to Board of Directors for approval 12/12/00 Approved and Implemented 09/11/01 Presented to the Board of Directors 10/09/01 Revised and Implemented

13 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 05/14/02 Revision Presented to Board of Directors 06/11/02 Final Document Presented to the Board for Approval 06/11/02 Approved and Implemented by the Board 02/03/09 Revision Presented to Executive Committee 03/09/10 Proposed Revisions from 1/12/10 Board Meeting 09/12/18 Revisions Presented to the Board of Directors

14 REVISION VERSION 1 – 6/1/17 2 – 6/30/17 3 – 8/1/17 2017 RRCS Golf Tournament Final

Item Amount Comment

Expenses Country Club of Clupeper $ 6,418.00 Beverages (Gatorade/Water/Soda) $ 16.00 water sodas Awards (Tourney winners) $ 1,218.00 Visa cards Plaques for Sponsors $ 255.00 Ed's Engraving Silent Auction Signs $ 125.00 X-press Copy (as of 5/25/17) Goodies bags $ 163.00 X-press Copy/Office Depot Crackers /Snacks $ 123.00 On-Course gifts $ 139.00 Warrior Brochures / Fliers / Signs $ 382.00 X-press Copy/Office Depot media / advertisement $ - Table decorations $ - In-Kind PayPal Fee $ 18.00 Street Banner $ 340.00 $680 - RRCS pays 1/2 Postage $ - In-Kind Misc. Supplies $ 247.00 Gatorade $ - In-Kind

Total Expenses $ 9,444.00 Budget: $ 10,000

Revenue Teams (22) $ 6,500.00 Current Sponsors/Donors $ 12,748.00 Match Donor $ 25,000.00 Putting Contest, Mulligans, Raffles $ 1,353.00 Total Revenue $ 45,601.00 Less Match Donation $ (25,000.00) Less Expenses $ (9,444.00) Total Cleared $ 11,157.00

HPR 1 EMERGENCY SERVICES REPORT SUMMARY - FY18 RRCS Board of Directors Region 1 Jul-17 Aug-27 Sep-27 Oct-27 Nov-27 Dec-27 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Average/MN CSB/BHA Number of Emergency Evaluations - by Month Allegheny Highlands Community Services Board #DIV/0! Harrisonburg-Rockingham Community Svc. Bd. #DIV/0! Horizon Behavioral Health #DIV/0! Northwestern Community Services #DIV/0! Rappahannock Area Community Services Board #DIV/0! Rappahannock-Rapidan Community Services Board 121 121.0 Region Ten Community Services Board #DIV/0! Rockbridge Area Community Services #DIV/0! Valley Community Services Board #DIV/0!

Jul-17 Aug-27 Sep-27 Oct-27 Nov-27 Dec-27 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Average/MN CSB/BHA Number of Temporary Detention Orders (TDO) Issued Allegheny Highlands Community Services Board #DIV/0! Harrisonburg-Rockingham Community Svc. Bd. #DIV/0! Horizon Behavioral Health #DIV/0! Northwestern Community Services #DIV/0! Rappahannock Area Community Services Board #DIV/0! Rappahannock-Rapidan Community Services Board 17 17.0 Region Ten Community Services Board #DIV/0! Rockbridge Area Community Services #DIV/0! Valley Community Services Board #DIV/0! Addressing the Opioid Crisis: Treatment that Works

Wednesday, October 11, 2017 8:30 am – 4:30 pm Sycamore Rooms, Fauquier Health

Sponsored by: Fauquier Health Mental Health Association of Fauquier Rappahannock Rapidan Community Services Come As You Are Coalition

Learn About: • Impact of opioid addiction on women, pregnancy and newborns • State of the art treatment for opioid and other addictions • Evidence-based recovery supports • New substance use treatment in our region - working together to offer hope

Speakers: Dr. Mishka Terplan, Virginia Commonwealth Dr. Alta DeRoo, Novant Health/UVA Health/ University, Professor of OBGYN and Psychiatry; Culpeper Medical Center, Director of OBGYN; Associate Director of Addiction Medicine Board Certified in Addiction Medicine Dr. Elsie Mainali, Fauquier Health, Medical Nick Szubiak, LCSW, National Council for Director, Neonatal Intermediate Care Nursery Behavioral Health, Director of Clinical Excellence in Addictions Ryan Banks, LPC, Rappahannock Rapidan Ashley Clark, PhD, Rappahannock Rapidan Community Services, Clinical Services Director Community Services, Program Manager, Young Adult Coordinated Care

Conference Registration: www.fauquier-mha.org Space is limited – early registration is recommended

Light breakfast and lunch provided by Fauquier Health CME credits available

Inquiries: Mental Health Association [email protected] (540-341-8732)

MEDICAID

Department of Medical Assistance Services 600 East Broad Street, Suite 1300 Richmond, Virginia 23219 MEMO

www.dmas.virginia.gov

TO: All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program

FROM: Cynthia B. Jones, Director MEMO: Special Department of Medical Assistance Services (DMAS) DATE: 7/17/17 SUBJECT: DMAS Comprehensive Response to the Opioid Addiction Crisis in Virginia

The purpose of this memorandum is share with providers DMAS’ efforts to address the opioid addiction crisis in Virginia. DMAS’ comprehensive response to the opioid epidemic is multi-faceted and includes an enhanced Medicaid substance use disorder treatment benefit for members, a patient utilization and safety program and the adoption of the Center for Disease Control Guideline for Prescribing Opioids for Chronic Pain and the Virginia Board of Medicine’s Regulations Governing Prescribing of Opioids and Buprenorphine across all Medicaid programs and health plans.

Addiction Recovery and Treatment Services (ARTS) On April 1, 2017, Virginia’s Medicaid program launched an enhanced substance use disorder treatment benefit - Addiction and Recovery Treatment Services (ARTS). The ARTS benefit provides treatment for those with substance use disorders across the state. The ARTS benefit expands access to a comprehensive continuum of addiction treatment services for all enrolled members in Medicaid, FAMIS, FAMIS MOMS and the Governor’s Access Plan (GAP), including expanded community-based addiction and recovery treatment services and coverage of inpatient detoxification and residential substance use disorder treatment.

The ARTS benefit increases access to Medication Assisted Treatment, the evidence-based combination of medication, counseling, and psychosocial supports that results in the highest chances of recovery by recognizing Preferred Office-Based Opioid Treatment (OBOT) Providers. DMAS has recognized 37 Preferred OBOTs across the Commonwealth that have licensed behavioral health professionals providing co-located counseling and “high touch” care coordination at the same clinic as buprenorphine-waivered practitioners to members with opioid use disorder (See Attachment A).

DMAS is strongly encouraging the health plans to assign members receiving buprenorphine to a Preferred OBOT Provider or any other in-network providers if a Preferred OBOT Provider is not available and accessible. The health plan will cover all the members’ addiction treatment services (e.g., physician visit, lab tests, counseling, medication, etc.) instead of members needing to pay out of pocket at out-of-network providers. This increased access to Preferred OBOT Providers will ensure that the member receives the counseling and “high touch” care coordination that will result in the best outcomes.

Medicaid Memo: Special July 17, 2017 Page 2

DMAS is providing a list of current Preferred OBOTs as an Attachment to this memo. Providers can use this as a resource to refer their patients with opioid use disorder to high quality treatment.

Medicaid health plans have the contractual authority to deny coverage of buprenorphine prescribed by out-of-network providers and will not pay for buprenorphine prescribed by out- of-network providers beginning November 1, 2017.

Additional information about the ARTS program can be found at http://www.dmas.virginia.gov/Content_Pgs/bh-sud.aspx.

Patient Utilization and Safety Management Program (PUMS) All contracted Medicaid managed care plans including Medallion 3.0 and Commonwealth Coordinated Care Plus (CCC Plus) are required to have a Patient Utilization & Safety Management Program (PUMS). The PUMS program is intended to coordinate care and ensure that members are accessing and utilizing services in an appropriate manner in accordance with all applicable rule and regulations. The PUMS Program is a utilization control and case management program designed to promote proper medical management of essential health care. Upon the member’s placement in the PUMS, the Contractor must refer members to appropriate services based upon the member’s unique situation.

Placement into a PUMS Program Members may be placed into a PUMS program for a period of twelve (12) months when either of the following trigger events occurs: • The Contractor’s specific utilization review of the member’s past twelve (12) months of medical and/or billing histories indicates the member may be accessing or utilizing health care services inappropriately, or in excess of what is normally medically necessary, including the minimum specifications found in the Managed Care Technical Manual (MCTM). • Medical providers or social service agencies provide direct referrals to the Department or the Medicaid managed care health plan (MCO).

Members identified for placement in the PUMS program may also be evaluated for referral to ARTS.

CDC Guideline for Prescribing Opioids for Chronic Pain and Virginia Board of Medicine (BOM) Regulations for Prescribing Opioids and Buprenorphine In March 2016 the U.S. Centers for Disease Control and Prevention (CDC) published the Guideline for Prescribing Opioids for Chronic Pain. This guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up and discontinuation; 3) assessing risk and addressing harms of opioids use. The Guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. In addition to the CDC Guideline, the Virginia Board of Medicine recently promulgated regulations on the prescribing of opioids for pain and buprenorphine for treatment of substance abuse in response to the escalating opioid crisis in Virginia.

DMAS worked with the Virginia Department of Health, Department of Health Professions, Medical Society of Virginia, and Medicaid health plans to develop uniform policies that align with the CDC Guideline and the Virginia BOM Regulations across all Medicaid health plans. These uniform policies have been phased in over the past year and will be effective for all Medicaid members effective July 1,

Medicaid Memo: Special July 17, 2017 Page 3

2017. These policies are described in the Medicaid Memo published on December 1, 2016 at www.virginiamedicaid.dmas.virginia.gov. Since the implementation of these policies in the Medicaid Fee-for-Service program in July 2016, DMAS has seen a 44% decrease in the total day supply of opioids and a 42% decrease in the total drug quantity dispensed. The number of patients receiving opioids has only decreased by 17%.

DMAS six (6) managed health plans have seen similar results since implementing the CDC Guidelines for opioid-naive members on December 1, 2016. In the first quarter of 2017, the plans have seen a 16- 61% reduction in the quantity of drug dispensed and a similar reduction in the number of prescriptions or total days supply while the number of patients receiving opioids decreased by 12-60%.1

These actions are critically important to the Commonwealth’s response to the opioid epidemic. We believe that by addressing the opioid crisis through expanded treatment options, promoting evidence- based best practices, and working with other state agencies and our Medicaid health plans to reduce misuse of prescription opioids that that we can improve the quality of life for our citizens impacted by this crisis.

1The MCO with 60% reduction rates implemented several additional strategies to address the overutilization of opioids including prescriber education on appropriate management of pain and opioid prescribing, consultations with pain Medicine and Addiction Psychiatry specialists, Mind/Body Medicine and alternative medicine referrals and monthly Chronic Pain Board meetings to review challenging chronic pain cases.

Attachment A: Preferred OBOTs by Medallion 3.0 Managed Care Regions

MAGELLAN BEHAVIORAL HEALTH OF VIRGINIA (Behavioral Health Services Administrator) Providers of behavioral health services may check member eligibility, claims status, check status, service limits, and service authorizations by visiting www.MagellanHealth.com/Provider. If you have any questions regarding behavioral health services, service authorization, or enrollment and credentialing as a Medicaid behavioral health service provider please contact Magellan Behavioral Health of Virginia toll free at 1-800-424-4046 or by visiting www.magellanofvirginia.com or submitting questions to [email protected].

MANAGED CARE PROGRAMS Most Medicaid individuals are enrolled in one of the Department’s managed care programs: Medallion 3.0, Commonwealth Coordinated Care (CCC), Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan/PACE provider may utilize different prior authorization, billing, and reimbursement guidelines than those described for Medicaid fee-for-service individuals. For more information, please contact the individual’s managed care plan/PACE provider directly.

Contact information for managed care plans/PACE providers can be found on the DMAS website for each program as follows:

 Medallion 3.0: http://www.dmas.virginia.gov/Content_pgs/mc-home.aspx  Commonwealth Coordinated Care (CCC): http://www.dmas.virginia.gov/Content_pgs/mmfa-isp.aspx

Medicaid Memo: Special July 17, 2017 Page 4

 Commonwealth Coordinated Care Plus (CCC Plus): http://www.dmas.virginia.gov/Content_pgs/mltss-proinfo.aspx  Program of All-Inclusive Care for the Elderly (PACE): http://www.dmas.virginia.gov/Content_atchs/ltc/WEB%20PAGE%20FOR%20PACE%20Sites%20in% 20VA.pdf

COMMONWEALTH COORDINATED CARE PLUS Commonwealth Coordinated Care Plus is a required managed long term services and supports program for individuals who are either 65 or older or meet eligibility requirements due to a disability. The program integrates medical, behavioral health, and long term services and supports into one program and provides care coordination for members. The goal of this coordinated delivery system is to improve access, quality and efficiency. Please visit the website at: http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx.

VIRGINIA MEDICAID WEB PORTAL DMAS offers a web-based Internet option to access information regarding Medicaid or FAMIS member eligibility, claims status, payment status, service limits, service authorizations, and electronic copies of remittance advices. Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: www.virginiamedicaid.dmas.virginia.gov. If you have any questions regarding the Virginia Medicaid Web Portal, please contact the Conduent Government Healthcare Solutions Support Help desk toll free, at 1-866-352- 0496 from 8:00 a.m. to 5:00 p.m. Monday through Friday, except holidays. The MediCall audio response system provides similar information and can be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options are available at no cost to the provider.

KEPRO PROVIDER PORTAL Providers may access service authorization information including status via KEPRO’s Provider Portal at http://dmas.kepro.com.

“HELPLINE” The “HELPLINE” is available to answer questions Monday through Friday from 8:00 a.m. to 5:00 p.m., except on holidays. The “HELPLINE” numbers are:

1-804-786-6273 Richmond area and out-of-state long distance 1-800-552-8627 All other areas (in-state, toll-free long distance)

Please remember that the “HELPLINE” is for provider use only. Please have your Medicaid Provider Identification Number available when you call.

TO ALL MEDICAID PROVIDERS: PROVIDER APPEAL REQUEST FORM NOW AVAILABLE

There is now a form available on the DMAS website to assist providers in filing an appeal with the DMAS Appeals Division. The link to the page is http://www.dmas.virginia.gov/Content_pgs/appeal-home.aspx and the form can be accessed from there by clicking on, “Click here to download a Provider Appeal Request Form.” The form is in PDF format and has fillable fields. It can either be filled out online and then printed or downloaded and saved to your business computer. It is designed to save you time and money by assisting you in supplying all of the necessary information to identify your area of concern and the basic facts associated with that concern. Once you complete the form, you can simply print it and attach any supporting documentation you wish, and send to the Appeals Division by means of the United States mail, courier or other hand delivery, facsimile, electronic mail, or electronic submission supported by the Agency.

Preferred OBOTs by Medallion 3.0 Managed Care Regions

Central Region OBOT Address Phone Number Family Counseling Center for Recovery 905 C Southlake Blvd. Richmond, VA, 23036 540-735-9350

11720 Main St., Fredericksburg, VA 22408

4906 Radford Ave., Richmond, VA 23230 Kaiser Foundation Health Plan 1201 Hospital Dr., Fredericksburg, VA 22401 301-816-5980 Medical College of Virginia Associated 501 North 2nd St., Richmond, VA 23219 804-628-8525 Physicians Richmond Behavioral Health Authority 107 N. 5th St., Richmond, VA 23219 804.819.4024 The Daily Planet 517 W. Grace St., Richmond, VA 23220 804-934-1831 Virginia Center for Addiction Medicine 2301 N. Parham Rd., Ste. 4, Richmond, VA 23229 804-332-5950

Charlottesville OBOT Address Phone Number Region Ten CSB 800 Preston Ave., Charlottesville, VA 22902 434-972-1869

Far Southwest OBOT Address Phone Number Cumberland Mountain CSB 216 Gilmer St., Lebanon, VA 24266 276-964-6702

113 Cumberland Rd., Cedar Bluff, VA 24609 Frontier Health 43 Champions Ave., Big Sone Gap, VA 24219 276-523-8341

34084 Wilderness Rd., Jonesville, VA 24263 Highpower 2003 E. Main St., PO Box 2964 Lebanon, VA 24266 804.276.6456 Opt 3 Southwest Va Community Health 319 5th Ave., Saltville, VA 24370 276-496-4492 x 1024 System (New Day Recovery)

Halifax/Lynchburg OBOT Address Phone Number Centra Medical Grp – Ctr for Addiction 1330 Oak Lane, Suite 202 434-200-6565 in Medicine Lynchburg, VA 24503 Danville/Pittsylvania CSB 245 Hairston St., Danville, VA 24540 434-799-0456 x 3048 Horizon Behavioral Health 620 Court Street, Lynchburg, VA 24504 434-455-5342 Virginia Treatment Centers 4000 Murray Place, Lynchburg, VA 24501 760-710-0836 Lynchburg Treatment Ctr

Northern/Winchester OBOT Address Phone Number Arlington County Govt. 2120 Washington Blvd., 4th flr., Arlington, VA 22204 703-228-1698 Fairfax/Falls Church CSB 8221 Willow Oaks Corporate Dr., Fairfax, VA 22031 703-324-2481 INOVA Comprehensive Addiction 8221 Willow Oaks Corporate Dr., Suite 4-425 703-286-7592 Treatment Fairfax, VA 22031 Kaiser Foundation Health Plan 5999 Burke Commons Rd., Burke, VA 22015 301-816-5980

201 N. Washington St., Falls Church, VA 22046

14139 Potomac Mills Rd., Woodbridge, VA 22192 Madison Family Medicine 2555 Chain Bridge Rd., Vienna, VA 22181 703- 261-6550 Northwestern CSB 209 West Criser Rd., Suite 300 540-636-4250 Front Royal, VA 22630

Roanoke/Alleghany OBOT Address Phone Number Alleghany Highlands CSB 205 Hawthorne St., Covington, VA 24426 540-965-2135 x 109 311 South Monroe Ave., Covington, VA 24426 Anderson & Associates 4212 Cypress Park Dr., Roanoke, VA 24018 540-400-7841 Blue Ridge Behavioral Healthcare 611 McDowell Ave., NW Roanoke, VA 24016 540-345-9841 540-266-9200 Carilion Medical Ctr., Carilion Psych 2017 S. Jefferson St., Roanoke, VA 24014 540-981-8025 and Beh. Medicine Clinic Comprehensive Counseling Center 1115 First St., SW, Roanoke, VA 24016 540-343-0004 National Counseling Grp 16 Walnut Avenue, SW, Roanoke, VA 24016 540-345-6468 National Counseling Grp 20 Walnut Ave., SW, Roanoke, VA 24016 540-344-3400 New River CSB 700 University City Blvd., Blacksburg, VA 24060 540-961-8300 Va Premier Medical Home 5060 Valley View Blvd., Roanoke, VA 24012 540-278-1051 Va Treatment Centers 3208 Hershberger Rd., NW, Roanoke, VA 24017 760-710-0836 Roanoke Treatment Center

Tidewater OBOT Address Phone Number Apache MAT Systems 2501 Marshall Ave., Newport News, VA 23607 757-247-3910 Colonial Beh. Health 1657 Merrimac Trail, Williamsburg, VA 23185 757-253-4061 Eastern Shore CSB 19056 Greenbush Rd., Parksley, VA 23421 757-656-4912 GHR Center for Opioid Addiction 850 Tidewater Dr., Suite B, Norfolk, VA 757-560-3668 Treatment & Recovery Hampton/Newport News CSB 300 Medical Dr., Hampton, VA 23666 757-788-0065

400 Medical Dr., Hampton, VA 23666 Meridian Psychotherapy 4509 Whitechapel Dr., Virginia Beach, VA 23455 757-460-4655 The City of Norfolk CSB 225 W. Olney Rd., Norfolk, VA 23510 757-823-1607

7460 Tidewater Dr., Norfolk, VA 23505 Tidewater Psych Services 260 Grayson Rd., Va. Beach, VA 23456 757-472-2776

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SUP1031A_4.16 Administrative Offices

P. O. Box 1568 Culpeper, VA 22701 Telephone: (540) 825-3100 FAX: (540) 825-6245 TDD: (540) 825-7391

Community Partner Prevention Program Support Grant

Important Contact Information for this Grant Opportunity

RRCS Prevention Services [email protected]

Program Area  Substance Abuse Prevention  Mental Health Education and Suicide Prevention

Grant Description The primary goal of this grant opportunity is to build community capacity and strengthen the resources of the Rappahannock Rapidan Community Services’ catchment area of Culpeper, Fauquier, Orange, Madison, and Rappahannock counties. Applicants may apply for this one time grant to support the following goals of RRCS Prevention: 1) Increase awareness of opiate misuse and heroin epidemic 2) Increase awareness of mental health issues Grant money use is up to the discretion of the community partner as long as the use satisfies one of the aforementioned RRCS Prevention Goals.

Important Dates  Submissions are due September 15, 2017  Funds will be dispersed September 30, 2017

Anticipated Funding Amount Funds can be awarded up to a maximum of $2,000.

Eligibility and Requirements All eligible applicants must be a community partner working in the Rappahannock Rapidan Community Service catchment area of Culpeper, Fauquier, Orange, Madison, and Rappahannock counties. The community partner’s main purpose must also align with one or both of the aforementioned goals of RRCS Prevention. All applicants must submit a cover sheet and 250-500 word brief overview of their coalition/community work and how they plan to use this grant money to further one or both of the RRCS Prevention goals. Cover sheet must include name of organization, contact person, mailing address, phone number, and email address. (See attached cover sheet and application form) NOTE: Funds must be spent by June 30, 2018 data report will be required by all funded groups 15 days after funds are expended. Application Submission Information Community partners wishing to apply for this grant must submit their 250-500 word brief overview by September 15, 2017. Please send all submissions to [email protected]

Award Information Funds will be awarded on September 30, 2017 if chosen.

Virginia Association of Community Services Boards 2017 Public Policy Conference October 4-6, 2017

Williamsburg Lodge 310 South England Street ~ Williamsburg, Virginia

Conference Lodging

VACSB has a block of rooms for the conference* Room Type: Deluxe - $119 per night plus taxes Cozy - $119 per night plus taxes

Please only reserve the rooms you will use. Additional lodging and a wait list (for the Williamsburg Lodge) will be posted if necessary.

The cut-off date for the VACSB conference rate is September 11, 2017. A first-night room deposit is required to guarantee the reservation.

To Make Reservations at the Williamsburg Lodge: Online Reservations – Click HERE Telephone reservations: 1-800-261-9530/Booking ID 44066

Cancellation: 72-hour cancellation notice to avoid fees Check-in: after 4:00 pm Check-out: 11:00 am

*This lodging rate is available for three (3) days prior and three (3) days after the conference dates. VACSB conference attendees may purchase a Colonial Williamsburg Single-Day Ticket to use throughout their stay vs. one day at the conference rate of $20 per ticket. The tickets can be purchased at the Concierge Desk of the Williamsburg Lodge. Watch for spa and golf specials! Colonial Williamsburg Website

2017 Public Policy Conference schedule and conference information will be posted to the conference website! www.vacsb.org/October2017

Rappahannock Rapidan Community Services Administrative Services Committee Meeting August 22, 2017 Bradford Road Offices 2:30 p.m.

MINUTES

Members Present: Alan Anstine, Pat Balasco-Barr, Marcia Brose, Bonita Burr, Elizabeth Davis, Dawn Klemann, Robert Legge, Clare Lillard, Robert Weigel

Members Excused: William Hepler, Paula Howland, Donalda Lovelace, Demaris Miller, Matthew Parker

Staff Present: Brian Duncan, Anna McFalls, Laura Wohlford

Guest Present: Joel Rothenberg, DBHDS

• Meeting Called to Order – Bonita Burr Bonita Burr, Chair, called the meeting to order at 2:50pm.

• Review Agenda for Additions/Deletions There were no additions or deletions to the agenda.

• Items: 1. Updates – Brian Duncan At the beginning of the summer, Brian discussed with the board the opportunity for RRCS to work with the Department of Behavioral Health and Disability Services as construction manager for two new crisis homes. We have received funding from DBHDS and we should have property information available by the September Administrative Services meeting. RRCS would enter into option contracts that would allow us to determine suitability of the sites for the proposed construction before committing to a purchase. The two properties are in Culpeper County.

2. HR Policy – Contractors, Interns, and Volunteers (ACTION ITEM) We have been updating our policies this year. HR policies are always reviewed by the board. This policy used to be imbedded with another policy that addressed various employee categories. We developed this separate policy for the noted categories since the incumbents are not employees of the agency.

ACTION: Alan Anstine moved to approve HR Policy #423 Contractors, Interns, and Volunteers as presented and forward to the full board for final approval. Pat Balasco-Barr seconded the motion. There being no further discussion, the Board voted unanimously to approve the HR Policy #423 Contractors, Interns, and Volunteers as presented.

Rappahannock Rapidan Community Services Administrative Services Committee Meeting August 22, 2017 Bradford Road Offices 2:30 p.m.

3. Classification Review (ACTION ITEM) o Crisis Services Clinicians o Group Home Supervisors o Purchasing Assistant o Psychosocial Rehab Providers and Community Living Support Specialists

One of our goals is to keep our compensation scale competitive through the use of classification and compensation studies, cost of living increases and merit increases, when possible. We participate with other CSBs when they are doing compensation market studies – these CSBs provide their market survey results to RRCS as a benefit which we can use to verify our salary scales or make adjustments when necessary.

Last year, in July, we implemented our benchmarking program to review all of our compensation levels and adjust any that were out of line with the market. In January, we used our performance evaluations in the fall to give merit increases. Through merit increases, cost of living increases, and adjustments due to market surveys, we hope to maintain a competitive salary scale.

We have uncovered several classifications that are difficult for us to recruit or that market research indicates that we are not paying at market levels. These positions are included in this classification review.

Questions/Discussion: Is there money in the budget allocated for this? Response: Not specifically, but it can be covered due to vacancies. The positions are budgeted, but have been vacant for a period of time.

ACTION: Pat Balasco- Barr moved to approve the changes to compensation as presented in the classification review and forward to the full board for final approval. Alan Anstine seconded the motion. There being no further discussion, the Board voted unanimously to approve the changes to compensation as presented in the classification review.

4. Financial Statements – June 2017 (preliminary) The auditors were here in July to complete their preliminary fieldwork. They returned last week for the review of our HUD group homes. They will be back in October to finalize their audit.

We are pleased with our year-end financial statements.

5. Munis Update We went live on July 10 for the financial system module, including our general ledger, accounts payable and partially with procurement. We don’t have everyone keying in their own procurement requisitions. The procurement requisition process has never been automated, so that will be converted incrementally.

Rappahannock Rapidan Community Services Administrative Services Committee Meeting August 22, 2017 Bradford Road Offices 2:30 p.m.

We have been running some reports and will have Munis representatives here next week to work with us to close out the month and reconcile our bank statement. This will change how your financial statements will look going forward.

The modules for human resources and payroll kicked-off last week. Payroll will go live in January 2018; the balance will go live in the spring of 2018.

6. Division Updates Mark your calendars for September 29th for the employee picnic at the Inn at Kelly’s Ford. We will send out directions to all board members and will have a shuttle from our offices.

7. Other There was no other business.

• Adjourn The meeting adjourned at 3:40pm.

The next regularly scheduled Administrative Services Committee meeting will be held on September 26. RRCS Aging Services Advisory Council Meeting July 18, 2017

M I N U T E S

Members Present: Nancy Babb, Erika Bays, Marcia Brose, Jackie Dare, Richard Fletcher, Eileen Peet, David Pollok, Carol Simpson, Bonnie Vermillion

Staff Present: Lola Walker, Sabrina Jennings, Doug George, Mary Honeycutt, Anita Richards

Jackie Dare, Vice-President, called the meeting to order at 10:05 AM.

Approval of Minutes Jackie Dare asked for a motion to approve the June 20, 2017 minutes. David Pollok made a motion to approve the minutes. Bonnie Vermillion seconded the motion. There being no further discussion, the motion to approve the minutes was passed.

New Business None

Old Business None

Mary Honeycutt, FAMS Mobility Specialist – Call Center updates • Materials distributed: Timeline/Requests for Transportation; FAMS Call Center Report January 2017 – June 2017; Volunteer Application; FAMS Info Card. • FAMS is a transportation resource center for the five county area to identify, promote, and assist with access to any form of transportation. The Call Center staff help to arrange volunteer transportation, assists with scheduling Medicaid transport, provide travel training and more. The office is located at the Culpeper Senior Center. • Timeline/Requests for Transportation: indicates the increased number of requests from October 2016 – June 2017. • FAMS Call Center Report January 2017 – June 2017: provides statistics on the number of travel trainings, use of Foothills Express, scheduled Care-A-Van Rides, gas card dollar amount, unmet needs, etc. The gas voucher program started January 2017 – vouchers are issued as a last resort if no other resources are available. Recipients must provide receipts. Questions: Is the travel training provided for the Foothills Express service in Madison? Response – Yes, staff can assist and train passengers. Can you explain the Unmet Needs total (125)? Response – It is mainly due to geography, isolation, no taxi or public transportation available, volunteers unavailable, and short notices. What is Care-A-Van? Response – The RRCS Volunteer Services Program where trained volunteers transport seniors 60 years of age and older and/or persons with disabilities, to health care and/or legal appointments. The Call Center staff assists Lola with coordinating volunteer rides. • Volunteer Application: Rough draft of common Application for Volunteer Transportation Drivers, developed by the Call Center staff. The application can be used for the multiple volunteer transportation organizations (i.e. LOWLINC, Rapp at Home, Road to Recovery, Care-A-Van, etc.). • The Transportation Guide is updated regularly – copy passed around to review. • FAMS Info Card: Lists contact info and general services. • Question: Do you still accept donations for service? Response – Yes, through the volunteer driving program; donation envelopes are available in the Care-A-Van vehicles.

Volunteer Services Program updates – Lola Walker • Materials distributed: RRCS Volunteer Services Report; The Art of Aging EXPO flyer; copy of Congress of United States letter. • Bowl for Seniors – Lola thanked everyone for making the annual BFS fund raiser a great success! We raised over $15,000 to assist all of the senior services provided by RRCS, including home delivered meals and the senior centers. • May was Older Americans Month - the theme was “Age Out Loud”. Using a chalk board, some senior center participants finished “I believe. . . .” sentences on the aging process; pictures were taken and a video will be sent to DARS in Richmond. We plan to share the video at a future Council meeting. • Question: Is the Klutter to Klass Shop open yet? Response – Yes, it opened July 8. Four senior centers (FSC, MSC, OSC, and RSC) will participate and rotate Saturdays; proceeds will be divided evenly at the end of each month. • RRCS Volunteer Services Report – Lola reviewed some statistics.

Aging Services updates – Lola Walker (for Ray Parks) • Chair of RRCS Board of Directors announced the retirement of Brian Duncan following the regular meeting of the Board on July 11. Mr. Duncan is planning to retire in February 2018 after 25 years as the agency director. • Aging Together updates – Carol Simpson discussed some upcoming programs & events: o 8/22 Madison Senior Center – How to use smartphones o 9/26 Lake of the Woods Church – Seven speakers to present stages of care for the chronically ill; lunch will be provided. o 10/3 Daniel Technology Center - The Art of Aging EXPO from 10:00–2:00 PM. There will be exhibitors, healthy steps, self-defense, and much more. o 6/19/18 Daniel Technology Center – Teepa Snow, dementia-care education specialist to discuss the best care for someone with dementia. • Permanent Supportive Housing (PSH) program grant was awarded to RRCS. Ray and the Housing staff completed and submitted a program plan and application. The program will help to support the homeless or people at risk and suffering from serious mental illness. Lola will invite Ginger McAlister, Housing Program Supervisor to do a presentation to the Council this fall. • Information from Jenny Biche: A letter was mailed to the US House of Representatives in support of funding for the State Health Insurance Assistance Program (SHIP) and the Senior Community Service Employment Program (SCSEP). RRCS is potentially at risk of losing funding for the VICAP program based on upcoming federal budget proposals; this funding (SHIP) goes toward insurance counseling and enrollment assistance for seniors. Jenny asked Lola to extend her thanks to council members for their support of their advocacy for the VICAP program. We would like to thank Jenny for successfully getting the letter together. • Senior Center Satisfaction Surveys 2017: o The annual surveys are conducted to gather their input to improve the overall experience at the senior centers. o To insure that the seniors will have enough time to complete the surveys, we will send a list of the questions to each senior center next week to review and think about their responses before the actual survey is completed. o The following council members volunteered to administer the surveys: . Eileen Peet & Jackie Dare - Culpeper . Nancy Babb - Fauquier . D. Pollok & R. Fletcher - Madison . Erika Bays & Marcia Brose - Orange . Bonnie Vermillion - Rappahannock o Please contact the Senior Center Administrators to schedule a date(s) for the surveys. The completed surveys can be returned to Lola via interoffice mail at each senior center. All surveys should be returned by Friday, August 25. o Council members will receive copies of the survey results / analyses at an upcoming meeting.

• We will not have a meeting in August. The next meeting is scheduled for Tuesday, September 19.

Adjournment Eileen Peet asked for a motion to adjourn. David Pollok made a motion to adjourn the meeting. Richard Fletcher seconded the motion. There being no further discussion, the meeting adjourned at 11:20 AM. Rappahannock Rapidan Community Services Executive Committee Meeting August 1, 2017 – 1:00 p.m. Bradford Road Offices – Culpeper

MINUTES

Members Present: Pat Balasco-Barr, Elizabeth Davis, Paula Howland, Robert Legge, Robert Weigel

Members Excused: Marcia Brose

Staff Present: Brian Duncan, Laura Wohlford

1. Call to order: Robert Legge Robert Legge, Chair, called the meeting to order at 1:05pm.

2. Review of agenda for additions / deletions Brian had two announcements and Paula had a newspaper article to share.

Brian announced the open house for the Bridges Workshop on August 21. We will close out the construction loan and the Rural Development loan over the next 45 – 60 days. The programs will move into the facility later in the week of August 21.

Brian announced the REVIVE! training on the use of Naxolone on August 22 at 5:00.

Paula discussed a recent article in the Washington Post regarding waiting lists for individuals with developmental/intellectual disabilities (attached).

3. Update on Fauquier Behavioral Health facility planning Brian and the architect will meet with officials from the town of Warrenton to determine how flexible local zoning will be with regard to using the existing site. The land is a triangle, so the set-back requirements are hard to apply. We are proceeding under a “rule-out-the-existing” site first, because of the cost of acquiring a new site. If we can maintain the existing site, we would demolish the existing site and rebuild. Both the PATH Foundation and the County have pledged 1/3 each for the construction costs. RRCS would be responsible for 1/3 of the cost, which could either be borrowed or drawn from existing reserves (if available). We are at least two to two and one-half years away from construction.

4. Update on development of two Crisis Stabilization (REACH) homes Brian met with the architect yesterday and he provided drawings of the homes, based upon the REACH houses build in Richmond. Each home is around 4,500 sq. feet with six bedrooms. One home will be for adults and one will be for children. We will only build and lease the homes; we will not operate the homes. These are not permanent residences, but temporary respite care (either planned or emergent). Individuals are referred to these facilities from all over the state. We have not located the property yet.

5. Positions reviews – Crisis staff plus others At the last meeting, we discussed the issues with crisis services staffing needs. At the next administrative services committee meeting in August, we will have several positions that need to be reviewed, not just crisis services positions. Nearly everything on the agenda will be HR related. Rappahannock Rapidan Community Services Executive Committee Meeting August 1, 2017 – 1:00 p.m. Bradford Road Offices – Culpeper

6. Update on Psychiatrist staffing and recruitment We have not been able to hire full-time psychiatrists, but we have found part-time psychiatrists who are employed by Western State. Between the part-time staff, this has filled an open full-time slot. We are still recruiting for a full-time staff. This is not a telepsychiatrist position.

7. Discussion of affiliated nonprofits and leadership transition. Brian is the CEO of all the affiliated non-profits. This needs to be addressed when Brian retires. The state corporation needs to be updated to reflect the new CEO. Brian will facilitate this in January.

8. Bridges: Update on Open House and program start-up Discussed above

9. Preliminary discussion on how to handle Executive Director Contract and evaluation process this year. Brian’s employment contract expires in November. Normally, the Executive Committee would begin talking about the evaluation and goals for next year in September. Given the board activity on the search committee, Brian suggests that the contact be extended and the evaluation be suspended. The committee agrees with this approach. Brian will present his contract in for executive committee in September for review and board approval in October.

10. Other There was no other business.

There being no further business, the meeting adjourned at 2:30pm.

Rappahannock Rapidan Community Services Executive Committee Meeting Bradford Road Offices - Culpeper September 5, 2017 – 1:00

MINUTES

Members Present: Pat Balasco-Barr, Marcia Brose, Elizabeth Davis, Paula Howland, Robert Legge, Robert Weigel

Staff Present: Brian Duncan, Laura Wohlford

1. Call to order: Robert Legge, Board Chair Robert Legge, Chair, called the meeting to order at 1:00pm.

2. Review of agenda: Additions / Deletions Elizabeth will discuss the Golf Tournament and Brian has an announcement. Both items will be added under other updates.

3. Update on meeting with Town of Warrenton on Fauquier Behavioral Health facility matter Brian met with the architect and town planning department regarding our existing Fauquier clinic site. This is part of the feasibility study currently under way for a new clinic building funded through RRCS, the PATH Foundation, and Fauquier County. Because of the layout of the existing site, the zoning requirements are difficult to apply and the meeting was to clarify the town’s interpretation of the zoning rules as applied to the site. We would prefer to redevelop the site without a variance. The objective is to get a feasibility study and cost estimates done – we want this project included in the Fauquier County 2018 capital plan.

4. Update on review of two properties for group home developments that have been discussed These are the crisis homes we are developing for Department of Behavioral Health and Disability Services. One will be for children and the other will be for adults. The architect is visiting tomorrow; we will meet with the realtor to review potential sites. We need a “study” period of 60 – 90 days before committing to purchase. The study period allows for title work (easements and restrictions), geo-technical work, septic assessment, well testing, etc. These are six bedroom homes, which are larger than the typical home. We are looking for 3.5 to 5 acre sites for each building.

5. Information on study being completed by DBHDS on community versus hospital funding and different funding models that are being examined. In the upcoming board report, there will be a document addressing future funding models for CSBs. This study was ordered by the General Assembly. The study addresses the question: What if local CSBs had to pay for the use of state hospital beds for local citizens? Something may come of this in 2019-2020. The report will be given to the General Assembly in 2018.

6. Orientation of Ann Baumgardner, new appointee from Rappahannock County Robert joined Brian for the orientation of the newest board appointee. Ann is a counseling psychologist. She has a background in our mission and has been employed by CSBs in the past. She is interested in painting, watercolor, hiking, kayaking, and horses. She also volunteers at Trinity Episcopal Church.

Rappahannock Rapidan Community Services Executive Committee Meeting Bradford Road Offices - Culpeper September 5, 2017 – 1:00

7. Completion of County presentations as of September 5th with presentation to Culpeper County Board of Supervisors This was the last presentation; Brian spoke for 30 minutes. The supervisors were interested in addiction issues and the transportation call center. Several of the supervisors had received positive feedback about the call center.

8. Recommendation for extension of Executive Director Contract through to February 1, 2018 with provision that addresses annual leave. (no evaluation to be completed) Brian recommends that the payout be based on his leave status as of 12/31/17. Brian would like to have all unused leave paid upon his retirement based on the 12/31/17 balance.

ACTION: Paula Howland moved that the Executive Committee not complete an evaluation of Brian Duncan for his 2017 contract given the timing of his retirement on February 1, 2018. Marcia Brose seconded the motion. There being no further discussion, the Executive Committee voted unanimously to cancel Brian Duncan’s performance evaluation for 2017.

ACTION: Marcia Brose moved to recommend to the Board that Brian Duncan’s contract be extended through February 1, 2018 with a modification to allow the payout of the full value of his total accrued paid time off based upon his leave balance as of 12/31/17. Paula Howland seconded the motion. There being no further discussion, the Board voted unanimously to approve this recommendation to the full Board for consideration.

9. Information on RRCS and discontinuing voluntary evaluations in local hospitals – updates Historically, RRCS has provided voluntary evaluations at our local hospitals; it is not a requirement that we do voluntary evaluations. Although this activity has been taken over by Culpeper Hospital; Fauquier Hospital requested a 30-day extension until October 1. We will continue to do these via telepresence for the 30 day extension period with Fauquier Hospital.

10. Bylaws updates will go to the full Board in September for a vote in October – discuss if needed. This initial presentation in September will be for board information only; the board will vote on the bylaws during their October meeting.

11. Other updates Golf Tournament – the tournament was very successful; we raised about $20,000 at the gate. We should clear around $14,000 after expenses. The golf committee as a whole is not committed to repeating the tournament. They are looking for more participation from the counties through an increased board commitment for more players and sponsors. The core planning group has been very Culpeper centered.

Brian will receive the Regional Leadership Award from the Rappahannock Rapidan Regional Commission (RRRC). The Board will be invited to the award presentation at the RRRC annual meeting at Rock Hill Farm in Culpeper County on September 27th.

The meeting adjourned at 2:30pm. Rappahannock Rapidan Community Services Program Committee Meeting August 22, 2017 – 1:00 PM – Bradford Road Offices MINUTES

Members Present: Alan Anstine, Pat Balasco-Barr, Marcia Brose, Bonita Burr, Elizabeth Davis, Paula Howland, Dawn Klemann, Robert Legge, Clare Lillard, Donalda Lovelace, Robert Weigel

Members Excused: William Hepler, Demaris Miller, Matthew Parker

Staff Present: Brian Duncan, Ryan Banks, Laurie Dodson, Courtney Janeski, Valerie Sparks, Laura Wohlford

Guest Present: Joel Rothenberg, DBHDS; Heather Fossen, Peer Support Specialist

1. Call to order: Donalda Lovelace, Chair Donalda Lovelace, Chair, called the meeting to order at 1:06pm.

2. Review of agenda for additions / deletions There were no additions or deletions to the agenda.

3. Presentation on RRCS QA functions: Brian and three QA staff: Valerie Sparks, Laurie Dodson, and Courtney Janeski Brian introduced the Quality Assurance (QA) staff. Brian indicated that, as a medium-sized agency, the staff reports directly to him. It is beneficial that the QA staff reports directly to senior management or an administrative function. Brian also discussed the CHRIS reporting system used by Department of Behavioral Health and Disability Services.

Brian reviewed the specialty areas within QA and each QA staff member discussed their areas of expertise. Valerie Sparks distributed a handout outlining the regulatory overview of RRCS and the DMAS (Medicaid) manual references pertaining to RRCS services.

Discussion/Questions: Are the regulations well written and easily understandable? Do the interpretations of the requirements change with administration? Response: Licensing regulations are very well written and clear. The Department helps with topics and tips. We frequently meet with other QA staff within HPR-1 to share information and knowledge. Some of the providers give CSBs latitude in developing forms and procedures and we will seek information from the provider for guidance as needed.

What does “founded complaint” mean? Response: Typically, it means that staff didn’t do something they should have - for example, a staff member spoke harshly to a client. We use each review as a learning opportunity for staff and management.

How does QA respond to client deaths? Response: We report all deaths. Most of our client deaths are natural; many of our clients are getting older. We also report client deaths even if we only handle case management. There are also overdose and suicide deaths by clients. If we have a reported death that is a suspected or known suicide, we have specific protocols that we must follow. If appropriate, we evaluate the last contact the client had with RRCS. We review these cases closely. Brian would provide information about any death resulting in litigation to the board. There has never been an incidence of this in Brian’s tenure. Often, we only have the obituary as notification of the death. Rappahannock Rapidan Community Services Program Committee Meeting August 22, 2017 – 1:00 PM – Bradford Road Offices

Is there way to compare the number of deaths per year with results from other CSBs? Response: It would be hard to get an apples-to-apples comparison - some CSBs use contracted providers; others provide direct services, etc.

Should the annual report by QA be changed to better reflect the various causes of death and what we did? Response: Privacy requirements limit what can be publically discussed. We can improve our reporting in a general way that maintains client privacy. We can do something that better shows what the agency does to help mitigate deaths and how deaths are reviewed. We can add more detailed procedures for more significant events.

If there is a death of a client who is in our care 24/7, the board chair is notified of that death and the details.

When there is a death, we have an internal mortality review process. If there is a death from unknown causes, we ask for a copy of the incident report from the Medical Examiner. We compare our investigation with that from the Medical Examiner. We use this information for training and review of any care we may have provided preceding the death. The department may also do a review, depending upon the type of client.

Do incidents become a termination action? Response: There a few terminations each year due to incidents.

4. RRCS prescribing practices, changes related to the use of benzodiazepines (attached) – Brian and Ryan These drugs have been used for many years and in many different medical practices. Current best practices are removing benzodiazepines from treatment protocols. Because this is a recognized best practice, and after consulting with outside medical professionals, we are moving away from widespread use of these anxiety-reducing drugs in our programs. Implementation will be individualized for each client; some may be able to taper off quickly; other clients may take a while to reduce/end their usage of benzodiazepines. We will be offering a variety of supports for all of our clients making this transition from benzodiazepines.

5. Other updates There were no other updates.

6. Adjourn

The meeting adjourned at 2:40pm.

The next meeting is scheduled for September 26, 2017 at 1:00. RRCS - Regulatory Overview August 2017 Licensing Two state agencies license the services RRCS provides. Note: this “licensing” is different than the professional license issued to individual staff members (e.g., Nursing, LPC, LCSW, etc.).

Licensing Agency Acronym RRCS Programs

Dept. of Behavioral Health and Developmental Services DBHDS All MH, DD and SA programs http://www.dbhds.virginia.gov/professionals-and-service- providers/licensing (except Infant Toddler Connection) Jill James is our Licensing Specialist Dept. of Social Services DSS Warrenton Adult Day Care http://www.dss.virginia.gov/facility/adcc.cgi

Ken Koontz is our Licensing Specialist

Virginia Department for Aging and Rehabilitative Services (DARS) DARS doesn’t license our programs the same way DBHDS does. However, they do monitor our Aging programs for compliance with their service standards.

https://www.vadars.org

Human Rights DBHDS Office of Human Rights regulations apply to our agency. We are assigned a Regional Human Rights Advocate. DBHDS Human Rights and Licensing regulations are related; the Human Rights Advocate and our Licensing Specialist often work together to review client/program issues.

http://www.dbhds.virginia.gov/professionals-and-service-providers/human-rights-for-service-providers

Other Regulatory Agencies • Dept. of Health (VDH) – Environmental Health Services o Bradford Road, Boxwood and Visions – These commercial kitchens are reviewed by the Health Inspector. o Bradford Road’s water system (well) is also reviewed by VDH.

• Fire Marshal Inspectors from the State Fire Marshal’s Office review many (though not all) of our agency programs.

Questions about Regulatory Requirements? If you have questions about regulations, contact QA staff. DMAS (Medicaid) Manuals Covering RRCS Services August 2017  DMAS = Department of Medical Assistance Services

 These manuals can be found at DMAS’ website:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

 QA staff regularly check for updates to DMAS manuals. Supervisors will be notified about changes so you can update manuals accordingly.

 If you have questions about Medicaid services or manuals, contact QA staff.

DMAS Manual Name RRCS Services Covered

Addiction Recovery and Treatment • Boxwood Residential Services (ARTS) • Boxwood Detox • Substance Abuse Support Coordination • SA Outpatient Services

Mental Retardation/Intellectual All DD (Developmental Disability) Services: Disability Community Services Manual • DD Support Coordination (Case Management) • Bridges • DD Group Homes

Mental Health Clinic** MH Outpatient Services

This includes individual and group therapy, psychiatrist visits and medication services Community Mental Health • Mental Health Support Coordination Rehabilitative Services (Note: this includes SED Support Coordination) • Crisis Intervention Services • Psychosocial Rehabilitation (Visions) • MH Skill Building Services

Early Intervention Infant Toddler Connection

Transportation Transit Services Note: In Virginia, DMAS uses a “broker” to administer non- emergency transportation services (like RRCS provides.) ** Note: RRCS Outpatient services are not covered in the Psychiatric Services manual.

DMAS Manuals are organized similarly: Chapter I – General Information Chapter II – Provider Participation Requirements Chapter III – Member Eligibility Chapter IV – Covered Services and Limitations (this is an important chapter) Chapter V - Billing Instructions Chapter VI – Utilization Review and Control Rappahannock Rapidan Community Services Senior Management Team Meeting July 11, 2017 – 9:00 am

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Paula Stone

Staff Excused: Anna McFalls, Ray Parks

The meeting started at 9:05am. Item Discussion Action/Follow-up Who Retirement Brief discussion on our work together over The board will create a search committee at today’s meeting. the next 6.5 months and priorities. Joel Rothenberg, DBHDS, will be in attendance. The department has a voting presence for the selection of the new executive director. They ensure that the individual selected meets the minimum requirements. Katia will also help with the administrative process.

Do senior managers have an opportunity to meet with candidates before hire? What about a tour of programs? Response: Brian would recommend that part of the search committee approach would be a round-table discussion with senior management about the future of the agency. There is nothing in the process that would prevent the board from seeking senior management input. This would be beneficial for the board to better understand the agency and future needs.

What happens if a director is not identified in time? Response: It would be better if the board took an interim position.

Financial and FY18 Budget – Reimbursement • PSH Funds call with DBHDS – Brian and Ray participated in the call and received needed clarifications from call and program clarification; this project is moving forward. Reports start-up

Rappahannock Rapidan Community Services Senior Management Team Meeting July 11, 2017 – 9:00 am • Virginia Opioid Prevention, The contract is on its way to Dr. DeRoo. Treatment-Recovery (OPT-R) funds updates – clarifications from f/u email and program start-up

• YACC SA program planning – We are recruiting for the support coordinator; we need to recruiting for SA position separate the recruitment for general clinicians and this clinician position. We are in the process of general recruitment for clinicians now.

• CVRJ position recruitment / MOA We are reviewing the contract from CVRJ.

• Budget meetings taking place now Brian is also discussing reimbursement at the meetings, focusing on the need to generate receipts in the first six months of the budget year. • Other Finance is focused on the Munis conversion. It went live yesterday, except for procurement. Requisition processing will remain a manual process for the time being. Reimbursement Are there any sources for Stand Up for Mental Health • Updates / discussion funding? Response: You may want to consider the Northern

Piedmont Foundation. Board Committee Program Committee Support • July: No Committee meeting No updates. • August: QA plus other updates No updates.

Administrative Services Committee • July: No meeting No updates. • Aug: To be determined No updates.

Other Committees: • Development Committee No updates. (September) • Search Committee Discussed above. Katia will send out a notice to all staff on behalf of the board chair announcing Brian’s retirement. Rappahannock Rapidan Community Services Senior Management Team Meeting July 11, 2017 – 9:00 am HR Recruitment Report How is the staffing transition from the group homes working? Response: Everyone is settling in to the new homes, procedures, and schedules.

Katia has a recommendation regarding the Crisis staff; she Katia, Ryan will talk to Ryan to review.

Policy: Contractors/Interns/Volunteers, Do we ever include managers or front line staff in the review Recognition Program - pending of policies before implementation? Sometimes they don’t read the policy the same way we do. Response: This would be a “reality check” read. Sometimes you do have to interpret policies. We have done this before; typically for agency-wide policies. This is not a bad idea; there is nothing to stop us from doing this. It can be done on your own within your management team.

Non-FMLA Policy: Done Not discussed.

Other: Position Reviews / Katia / HR Not discussed.

DBHDS Licensing Updates as needed – New Bridges Bridges is moving along. We will have a visit by the board, but not around a committee meeting. We have a walk- th through on the 24 . We would still need to do a final inspection with the architect for occupancy. The lift will be installed in the first week of August.

Credible Updates as needed No updates

Other Bridges Project – updates Discussed above.

Local Government Presentations – Not discussed. scheduled accept for Rappahannock

Guinn Lane renovation – If possible, Brian and Paula will look at Guinn Lane today.

Rappahannock Rapidan Community Services Senior Management Team Meeting July 11, 2017 – 9:00 am We would like to hire a company to handle the internal move Ryan, Brian, for Clinical at Bradford Road. We could use the contractor Charlene hired for the Bridges move. Send the request to Brian; he will coordinate with Charlene.

CCC+ - The meeting with Anthem went well; they were very helpful and knowledgeable.

Other: Make sure that all your staff are aware of the new procedure for work-place accidents.

Divisional Reports Clinical Division: OPT-R (Opioid Prevention Treatment – Recovery) is the biggest project we have right now. There is treatment and with Dr. DeRoo. This will not be provided as a stand-alone service; clients must be using other RRCS services. We hope to be able to start funding medication as needed by the first week in August. Ryan and Wanda will be working on a fee schedule. ● Announcements OBOT (Outpatient Based Opioid Treatment) is the model we are following, which requires integrated care. This was driven by ARTS. ● Dr. DeRoo will also provide educational seminars on medication assisted treatment at Boxwood. ● Recovery is the second segment of the program – we are in a regional program with Northwestern CSB and RACSB. We will have peers in emergency rooms for substance abuse and mental health. Northwestern will handle the hiring. We will have someone placed in Fauquier Hospital. Peers will also staff the warmline. ● Prevention – we will maintain our current effort. ● Who do we talk to at Genoa about the prescription piece of the treatment? Once the treatment piece is established, we will start with marketing, etc. ● The next step is intensive treatment and partial hospitalization. We will have 23 groups per week, offered at varying times of the day. If someone is in partial hospitalization, they are in treatment and will not be able to maintain work schedules at the same time. This will require filling a number of vacant positions. Could private providers make referrals? Yes, but for substance abuse only. ● Children’s services is ramping up Parent Café and Too Good for Drugs. ● Kristi South is partnering with the Culpeper Health Department to provide training in Revive procedures. The training will be open to all five counties and held at Bradford Road.

Finance and Admin Services: Not discussed in Anna’s absence.

Community Support: We need cross training for the new DD population. ● Sheri would like to use this Bridges transition to establish some programmatic goals and expectations, with measurable results, for the program going forward. ● The settings rules did come out for the group homes and staff are working on this. Brian will ask for some opinions on the settings when he starts working on the two crisis group homes. ● We still have a supervisor vacancy for Visions; there have been no applications for the provider position. Existing staff are helping out. ● Peer support training is scheduled for August; it will be held at VRT. DBHDS is helping with materials; we will do some marketing here and she is also using VOCAL as a marketing tool. ● The golf tournament is next week. Please review the program. Pretty much everything is in place; we are where we were last year and Rappahannock Rapidan Community Services Senior Management Team Meeting July 11, 2017 – 9:00 am we still have a week + left to go. We received more sponsorships and donors this year. We will be providing plaques to the gold, silver, and bronze sponsors. Paula asked for feedback as to the language on the plaques. Ryan is ok with the wording. The committee has been struggling with offering alcohol for sale at the tournament. We have a board policy stating that we do not sponsor events where alcohol is served. We are paying for the beverage cart; we can specify that the cart will only offer non-alcoholic beverages. If individuals want alcohol, they can order something from the Country Club bar. Our street banner stayed up for two weeks. We have signage at the country club and in Madison. There will only be one tri-fold board this year to represent the agency.

Aging and Transportation Services: Not discussed in Ray’s absence.

Next meeting: July 26 – 9AM Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report

Human Rights Problem Resolution No report

Stakeholder Communications – Updates as needed Newsletter

Workforce Development Updates No meeting until August

Planning and Development No report Risk Management Use and Disclosure Policy – updated (attached) – There were no further questions on this QA Policy Reviews / Updates QA will do training on this. policy. The meeting ended at 10:50am.

Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 1 of 9 Date Revised: 4/04, 3/15, 7/17

Policy Coordinator Quality Analyst Staff

Scope Entire organization.

Purpose To protect clients’ right to privacy and confidentiality by establishing guidelines for the use of disclosure of protected health information.

Content 1. General Policy for Use and Disclosure of Protected Health Information 2. Related Policies 3. Consent 4. Requesting Information from Others 5. Answering Requests from Others a. Authorization Requirements b. Procedure for Answering Requests c. Redisclosure d. Requests for Any and All Information e. Verbal requests for information f. Voice Signatures 6. Charges for Records 7. Communication with Families, Relatives and Friends 8. Authorized Representatives 9. Minors 10. Authorization Not Required & Emergencies 11. Disclosures to Business Associates 12. Leaving Messages

Definitions Business Associate - A person, other than in the capacity of member of workforce, who performs or assists in the performance of, a function or activity (excluding treatment) involving the use or disclosure of protected health information.

Confidentiality - refers to the expectation that the personal information shared by an individual with a provider during the course of care will be used only for its intended purpose. It includes the responsibility to use, disclose, or request such information only with the knowledge and consent of the individual.

Credible Case Manager – RRCS staff assigned as the case coordinator of the EHR record.

Emergency - A situation which poses an immediate threat to the health of an individual/individuals and requires immediate medical intervention. A psychiatric intervention is a medical intervention. (From CFR 42 Part 2 Subpart D (2.51)

Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 2 of 9 Date Revised: 4/04, 3/15, 7/17

Privacy - is the right of individuals to control access to their personal health information. It includes freedom from intrusion or observation into one’s private affairs and the right to maintain control over certain personal and health information.

Protected Health Information (PHI) - All individually-identifiable client health information transmitted or maintained in any form or medium.

It excludes individually identifiable health information in: • Education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. 1232g including records described at 20 U.S.C. 1232g(a)(4)(B)(iv) • Employment records held by the agency in its role as employer.

Release of Information (ROI) – Form used for clients/Authorized Representatives to give permission to use/disclose their medical record. RRCS has a ROI form; we will also accept other organizations’ ROIs if it contains the required data elements (see #5 below).

1. General Policy for Use and Disclosure of Protected Health Information All uses, disclosures and requests will be limited to the information necessary to accomplish the purpose of the use, disclosure or request. Agency policies differentiate among levels of authorized users within the agency.

Disclosure of client-identifiable data and healthcare information is restricted to those individuals who have received training covering applicable agency policies and procedures, as well as federal and state laws and regulations.

Confidential information may be disclosed only when the client, or the client’s legal representative, gives written authorization, or when federal or state law, subpoena, or court order requires such disclosure. Use and disclosure is consistent with RRCS’s Privacy Notice.

2. Related Policies See the following policies which are referenced in this policy: • #1410 Accounting of Disclosures • #1417 Subpoenas & Search Warrants • #1420 Minimum Necessary Use of Protected Health Information • #1422 Electronic Communication • #1432 Verification of Identity

3. Consent Upon intake to the Agency, a general consent is obtained from the client. See the RRCS “Consent to Treatment” form. This form authorizes Agency staff to provide routine care, emergency intervention, includes payment agreements, and a general consent for the use of health information for treatment, payment, and healthcare operations. This form also includes the client’s acknowledgment of receipt of our Privacy Notice.

Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 3 of 9 Date Revised: 4/04, 3/15, 6/17

4. Requesting Information from Others When requesting PHI from other covered entities, the request is limited to that which is reasonably necessary to accomplish the purpose for which the request is made. See Policy #1420 Minimum Necessary Use of Protected Health Information.

Procedures are developed by program for routine requests, listing requester, purpose of the request, and routine documents disclosed. This limits the PHI requested to the amount reasonably necessary to accomplish the purpose for which the request is made.

Authorization is completed and signed by the client or authorized representative using the agency’s Release of Information form.

ROIs obtained from outside agency will be scanned to the ROI – External folder of the EHR.

5. Responding to Requests Prior to any disclosure of information, RRCS staff will determine if the client has authorized the requestor to receive information. This determination will be made by reviewing the record.

No information will be disclosed without the client’s written authorization. This includes information identifying an individual as a client of RRCS.

a. Procedure for Answering Requests 1) A request for information is processed by the Credible Case Manager. 2) All requests must be answered promptly, within 15 working days of receipt. This is an outer limit and staff are expected to respond as soon as possible. 3) Documentation of release is recorded in a Progress Note or Documentation Note form. See “Accounting of Disclosures” policy. 4) Determine the preferred format for the record (e.g., paper, electronic on CD or memory stick, electronic uploaded to a secure website, etc.)

b. Other Organization’s ROI forms - Authorization Requirements For each use or disclosure requiring an authorization, the content of the authorization will be verified before use or disclosure by RRCS staff. Questions are referred to the Privacy Officer.

In order to be valid, an authorization must contain the following: • description of the information to be used or disclosed • name of the person or function and entity authorized to make the disclosure • name of the person or function and entity to whom disclosure may be made • description of the purpose of the requested disclosure • expiration date • statement of individual’s right to revoke o statement about exceptions to the right to revoke o statement about how the individual may revoke the authorization Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 4 of 9 Date Revised: 4/04, 3/15, 6/17

• statement about redisclosure and loss of protection • signature of individual and date • if the authorization is signed by individual’s representative, a description of that person’s authority

Requesters of information without a valid authorization will be called or the request returned by mail. RRCS’ ROI form can be faxed or mailed as an option to meet required elements. c. Redisclosure Definition: Redisclosure is the process of releasing records that were provided to the facility from a previous facility for continuity of care purposes.

Redisclosure is permitted in the following circumstances: 1) to other health care providers when necessary to assure the health and safety of the consumer 2) to the client upon request 3) with a valid authorization

Staff must include Form #55 HIPAA Redisclosure Notification when sending records. d. Requests for Any and All Information Requests for any or all information should be discussed with the requesting party to determine specifically what is needed. e. Verbal requests for information RRCS does not accept verbal requests for information. f. Voice Signatures Staff should consult with QA before responding to any request for records that includes a voice signature.

6. Charges for Records RRCS charges fees to cover its expenses related to copying records, creating electronic copies or preparing summaries of records. Charges are based on the cost of photocopying (including supplies and labor of copying) and postage if the individual requests that records be mailed. In situations where a summary or explanation is being provided in lieu of PHI contained in the record, the fee will include the cost of preparing the summary/explanation.

RRCS charges clients for copies of their record.

RRCS charges non service/health provider organizations/agencies for records (e.g., lawyers).

RRCS does not charge other service or health provider organizations/agencies for records needed to conduct treatment, payment and health care operations. These are provided free of charge as a professional courtesy.

Fee s: • Paper Copies - $0.50 each page for the first 50 pages; $0.25 each page thereafter • Postage/Shipping: based on actual cost Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 5 of 9 Date Revised: 4/04, 3/15, 6/17

• Handling/Preparation fee: $10 - This includes the cost of the CD/thumb drive if the requesting party prefers an electronic record.

A handling fee is charged for requests made by parties other than a client or someone authorized to act as his/her authorized representative. The handling fee covers the cost of preparing the record, photocopying or copying it to an electronic device (e.g., CD) and preparing the record for mailing/faxing.

Requests/Fee Procedures – For clients requesting records 1) All requesters must put their request in writing using form #501 Request for Records. Staff will assist requesters, if necessary, to help them complete this form.

2) RRCS will honor photocopies, fax or other copies of original documents signed by the requester as if it were an original, provided it contains all the required elements needed to process the request.

3) All requesters will be provided with information about charges at the time the request is made.

4) Requesters will be given an estimate of the cost of reproducing the record or preparing the summary prior to processing the request.

5) Upon confirmation that the requester accepts the charges, the request will be processed.

6) The client’s Credible case manager is responsible for photocopying the requested documents or preparing the summary (if a summary is being provided).

7) Copies of the documents or summary materials are provided to the requester either by mail or pick-up at an agency site.

8) The staff member processing the record request will complete form #510 Record Request Invoice. The Record Request Invoice form will be included with the copied materials when it is provided to requester.

7. Communication with Families, Relatives and Friends Clients may have individuals involved in their treatment that are not expressly authorized to act as an authorized representative. Though not legally authorized to act for the client, these individuals may be involved in the client’s care or the client’s payment related to services. Examples of these individuals include family members, other relatives, close friends or some other individual the client identifies.

Communication of PHI with family, friends and others the client identifies is allowable if an ROI has been obtained from the client.

8. Authorized Representatives General Due to age or disability, some clients may not be able to make health care decisions themselves. In these situations, a person authorized under law to act on a client’s behalf is considered an “authorized representative”. A variety of legal designations are categorized as “authorized representatives”. Examples include: guardian, parent of minors, health care power of attorney, executor of estate, and legally authorized representatives (AR Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 6 of 9 Date Revised: 4/04, 3/15, 6/17

as defined by DBHDS).

The scope of the authorized representative’s authority to act on behalf of the client is based on the applicable law granting the individual authority. RRCS requires verification to establish the authorized representative’s identity (see policy #1432 Verification of Identity). The verification process also establishes the scope of the authorized representative’s authority in relation to RRCS’s services.

RRCS will recognize the authority of the authorized representative to act on behalf of the client in accordance with the authorized representative’s authority under law.

RRCS will treat the authorized representative as the client unless an abuse, neglect or endangerment situation exists. See Abuse, Neglect and Endangerment Situations, below.

The Credible Case Manager will ensure that all members of the client’s team are notified of the existence of the authorized representative and informed of the authorized representative’s authorities.

Abuse, Neglect and Endangerment Situations When there is reason to believe that the client has been or may be subject to domestic violence, abuse or neglect by the authorized representative, RRCS may choose not to treat the individual as the client’s authorized representative.

If there is reason to believe that treating the person as the client’s authorized representative could endanger the client, RRCS may choose not to treat that person as the authorized representative.

The decision not treat an individual as the client’s authorized representative will be made on a case by case basis, based on the staff member’s professional judgement and the best interest of the client. Supervisory staff will be consulted to review these cases when these situations are identified.

A notation will be will be made in the chart indicating the basis of the determination to not treat an individual as the authorized representative.

Adults and Emancipated Minors Adults and emancipated minors control the use and disclosure of their own PHI, unless there has been a legal determination appointing someone else to act as their authorized representative.

Deceased Clients A person with the authority to act on behalf of a deceased individual or his/her estate will be considered the authorized representative (e.g., executor). If there is no executor, individuals will be assigned as the deceased client’s authorized representative in the following order of priority: spouse, adult son or daughter, either parent, an adult brother or sister or any other relative of the deceased client in order of blood relationship.

Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 7 of 9 Date Revised: 4/04, 3/15, 6/17

9. Minors Minors (clients under the age of 18) A custodial parent is the authorized representative for a minor child and can exercise the minor’s rights regarding the use and disclosure of PHI, unless one of the following exceptions exists:

• When a court authorizes someone other than the parent to make treatment decisions for the client (e.g., a court awards guardianship to someone other than the parent), that individual will be considered the authorized representative of the minor child.

• When a parent agrees to a confidential relationship between the minor and the RRCS staff member, the minor can act as his/her own authorized representative in regard to the use and disclosure of PHI. Documentation of the parent’s agreement to this confidential relationship will be placed in the client record.

• For outpatient mental health records of minors over 13, the minor can consent to treatment. Under HIPAA, the minor has rights over their own information, which pre-empts Virginia law. This includes the authority to release their own records.

• A non-custodial parent has access to the minor’s record unless parental rights have been terminated.

• Substance abuse treatment records:

A. Outpatient records - Minors are permitted to authorize the release of outpatient substance abuse treatment records. Parent consent is not required in this situation; the minor acts as his/her own authorized representative.

B. Inpatient records - Authorization is needed from both the custodial parent and the minor in order to use/disclose inpatient substance abuse records. The minor may not act as the authorized representative in this situation.

10. Authorization Not Required & Emergencies The following are exceptions to the requirement for authorization to disclose protected health information: • Communications within RRCS. Limit disclosure to minimum necessary to provide services Follow the Minimum necessary policy regarding information access for specific staff • Communication with a business associate. Limit disclosure to minimum necessary to provide service for client • Communications for the purposes of billing • Communication with the Department of Behavioral Health & Developmental Services (DBHDS), DBHDS contractors or disAbility Law Center • When communicating with our agency attorney • Reporting suspected child abuse or neglect • Reporting suspected abuse of adults to adult protective services. We cannot identify substance abuse clients as such when doing this • Properly executed court order or subpoena (substance abuse records require both) Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 8 of 9 Date Revised: 4/04, 3/15, 6/17

• If in a court proceeding, the individual or someone acting on behalf of the individual, introduces any aspect of the individual’s mental condition or services as an issue before a court, administrative agency or medical malpractice review panel, the provider may disclose any information relevant to that issue. • Health oversight activities • To meet public health reporting requirements (may not be allowed for substance abuse records) • To report a crime committed on agency property or against agency staff. Report minimum information necessary • To the local or state Human Rights Committee in order for these committees to carry out their mandated duties • Any information required to secure a Authorized Representative or Guardian • As otherwise required by law • Research

Emergencies In emergency situations, RRCS may disclose protected health information directly relevant to the person’s involvement with the client’s care. RRCS staff will exercise professional judgment, act in the client’s best interest and disclose only information needed to alleviate the emergency.

Documentation of this disclosure will be entered into the client record. After the emergency, the Credible Case Manager will consult with the client to determine the likelihood of the situation reoccurring. Written authorizations will be obtained, if necessary, to prepare for future situations.

• Medical (including psychiatric) emergencies: Disclose only to those who can treat the emergency situation. Disclose only that information necessary to treat the emergency situation. When a client has been hospitalized (TDO or voluntary) contact can be made with the psychiatric hospitals/units, state hospitals, and nursing homes without an ROI for coordination of treatment, aftercare and discharge planning. Staff should still attempt to get an ROI signed as soon as possible. • Disclosures necessary to warn a potential victim of a credible threat against them. In substance abuse cases you may not disclose that the individual is an SA client. Disclose only to someone who can alleviate the threat (including intended victim). Disclose only that which is necessary to alleviate the potential threat • Disclosure necessary to prevent a credible threat against the public. In substance abuse cases you may not disclose that the individual is an SA client. Disclose only to someone who can alleviate the threat. Disclose only that which is necessary to alleviate the potential threat

Disclosure Without Authorization A Disclosure without authorization is a legal disclosure made without prior written authorization under the following circumstances: • An emergency • In response to a subpoena not issued by or on behalf of the individual • In response to a court order

Procedures If a disclosure is made without authorization, the provider must: Prior to the disclosure, or in an emergency as soon as possible after the disclosure, document in the record: Rappahannock Rapidan Community Services

Policy Title: Use and Disclosure of Protected Health Information (PHI) Effective Date: 4/14/03 Policy #: 1416 Date Reviewed: 7/8/03, 3/24/04, 5/17 Page: 9 of 9 Date Revised: 4/04, 3/15, 6/17

• The name of the person to whom the disclosure was made • Nature of the information disclosed • The purpose of the disclosure • The date the disclosure is made

Within fifteen working days after the unauthorized disclosure the provider must notify the individual (or the individual’s Legally Authorized Representative) of the disclosure including to whom the disclosure was made and the nature of the information disclosed unless, in the providers professional judgment, doing so would place the individual at risk. See HIPAA 164.512 (c)(2)(i)&(ii). The notification must be in writing. Either giving the written notification directly to the individual or mailing the written notification to the last known address of the individual is considered a good faith attempt to comply with this policy. The attempt to notify the individual is to be documented in the progress notes section of the record.

11. Disclosures to Business Associates

Policy RRCS has agreements, which are written arrangements with our business associates to ensure that protected health information that the associate receives or creates on our behalf are properly safeguarded. This contract ensures that the business associate’s uses and disclosures of protected health information and other actions are consistent with our privacy policies.

The business associate agreement describes the permitted and required uses of protected health information by the business associate. The business associate cannot use or further disclose the protected health information other than as permitted or required by the contract or as required by law.

Protected health information is disclosed to business associates to carry out health care functions. Information disclosed is limited to the minimum necessary to accomplish the intended purpose of the disclosure.

If a violation of this agreement becomes known, the agency will take reasonable steps to address this violation. If the steps are not successful, the agreement will be terminated if feasible. Otherwise the problem will be reported to the Department of Health and Human Services Office for Civil Rights.

12. Leaving Messages Care is taken to limit the amount of information to a family member, answering machine, or voice mail. Information disclosed when leaving a message is limited to agency name, staff name, telephone number, and information necessary to confirm an appointment or ask that the client call back. Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Paula Stone, Laura Wohlford

The meeting started at 9:10am. Item Discussion Action/Follow-up Who Financial and Budget Reimbursement • Permanent Supportive Housing Dawn and Ginger have made the calculations on the first (PSH) Funds – program start-up drawn of funds. The funding will be done monthly, not lump- Reports sum. The MOA with People, Inc. has not been signed; it should be signed soon.

• Virginia Opioid Prevention, The contract is ready for Dr. DeRoo’s signature. Deanne has Treatment-Recovery (OPT-R) funds submitted the credentialing information. All the pieces just updates need to be fine-tuned to get the service ready – probably early August. Genoa is ready to assist in issuing medication. Dr. DeRoo will report to Jane Spivey.

• Final budget meeting with Aging Not discussed. Division later today

• Other Brian will follow-up with the department regarding funding Brian for FTEs at Liberty House. Confirmation of funding is required before we hire anyone.

Young Adult Coordinated Care Substance Abuse: We are hiring a new counselor and one case manager. They may be located in Orange. We have not received information regarding the final funding. This is not scheduled to start until the fall. This is supported through federal funding.

Reimbursement • Updates / discussion Not discussed.

Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am • June report (see below) This report may not be completely accurate due to the number of changes that occurred in Community Services this year, but the ending numbers look good overall.

Board Committee Program Committee Support • August: QA plus other updates Not discussed.

Administrative Services Committee • Aug: To be determined Most likely this meeting will focus on various HR items.

Other Committees: • Development Committee Not discussed. (September)

• Search Committee – updates from Robert was elected chair; the advertisements and job first meeting held on 7/25 description were approved.

HR Recruitment Report The recruitment report was distributed.

Policy: Contractors/Interns/Volunteers, The Recognition Policy has been completed. The Contractors Anna Recognition Program - pending / Intern / Volunteer policy will go to the Board. Anna will review some of the procedures for licensing and credentialing.

Evaluations – 2017 Katia has already made the revisions; Anna will review the Anna changes and forward to SMT. Updates will be available for the next evaluation period.

Other HR Updates Not discussed.

DBHDS Licensing Updates as needed – Licensing may look at Culpeper Clinic as well as Bridges on New Bridges – 8/15 8/15.

Credible Updates as needed Sara, Wanda, Barbara, and Anna are requesting consulting assistance from Credible to develop a method to transfer financial information from Credible to Munis. Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am Munis Updates as needed We are making journal entries and paying bills out of Munis. We have cancelled all the requisition training. We will stay with paper requisitions and then slowly train individuals on the new process. The procurement process has never been automated, so it was too large of a transition. F & A is keying the requisition information into Munis. We have done the kick-off for HR & Payroll.

Other Bridges Project – We should have our final inspection next week. Furniture and fixtures will be arriving soon. Everything seems to be on track. We don’t have a date for the open house yet, but it will be after we open – sometime mid- to late-August.

Guinn Lane renovation – There will be another meeting at the site tomorrow to determine if we need to hire a general contractor or do the work ourselves.

CCC+ - and VAAAC Brian is reviewing the VAAAC contract. Ray has scheduled a meeting for early August to make sure everyone is caught-up with the program. The go-live expectation is October 1 for Orange and Madison and December 1 for the other counties.

Bradford Road back door / key pad code? Staff has requested that this be changed on a regular basis. Anna Anna will follow-up.

Divisional Reports Clinical Division: Genoa is doing well and is pleased with the traffic they are seeing. We will be doing an open house in mid- and September for the clinic and Genoa. They are supposed to provide flyers and brochures to support coordinators. ● Boxwood - Jim and Courtney are doing some research about allowing individuals who are on Suboxone to use Boxwood services. We don’t Announcements have a license to dispense Suboxone. They are looking at a way to maintain existing prescriptions without issuing new prescriptions. We don’t have a license to prescribe Suboxone. ● Children’s Services is getting ready for Parent Café to start right after school starts; they are also starting up Too Good for Drugs. They will be doing an open house for providers, etc. in August at the Orange offices. ● Kristi has been working with the Health Department to schedule a REVIVE training. This will be open to the public and is free of charge. ● We are developing our intensive outpatient program (IOP) to include 20+ groups between the two clinics. We are working on licensing and credentialing now. The credentials are pending the licensing. There is not a firm start date – this is pending more staff being hired. We are also doing partial hospitalization with IOP. ● We are still struggling with staffing Crisis Services. Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am

Finance and Admin Services: Brian will follow-up on the emergency procedures. ● Deanne will be focusing on credentialing; Laura will take over some of the processes Deanne provided for Anna; Elaine will be taking over the events planning and front desk coverage. Deanne will be working from home every other Friday to work on credentialing.

Community Support: We will be hosting Peer Recovery Training in August. ● We extended one of the DD contracts for three months. ● We will implement a secure email service within a month.

Aging and Transportation Services: We posted a notice for a Chronic Disease Self-Management Education (CDSME) regional coordinator contract. The prior regional coordinator will stay on as a volunteer. ● The regional commission would like to allow the call center staff to have access to social media to interact with clients in real time. We need something more from the Regional commission as to their needs and requirements. ● We are working on a couple of grant applications due soon – Northern Piedmont Foundation for seed funding for our housing program and National Lutheran Community & Services for CDSME.

Next meeting: August 8, 2017 – 9AM Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report QA is sending out human rights reports to support coordinators on a weekly basis. Human Rights Problem Resolution 4th quarter Human Rights report (attached) Paula may want to be added to that list; she will confirm. This is for all licensed programs. Stakeholder Communications – The newsletter will go out around the 3rd Updates as needed Newsletter week in August. No meeting until August.

Workforce Development Updates Golf Tournament: This was very successful. Players thought it was well organized. Preliminary numbers are Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am $17,000 gross; we still have some outstanding commitments. If these come through, the gross would be over $20,000. Expenses were under our budget of $10,000. Planning and Development No report Risk Management

QA Policy Reviews / Updates No report

The meeting ended at 11:35am.

Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am

June Fee Reports – Year End

Combined YTD Units Community Support YTD JUL - JUN YTD JUL - JUN YTD JUL - JUN Budgeted Units Monthly units Variance %

DD/ID CMAdult 2500 3039 539 122% DD/ID CMCHILD 850 801 -49 94% MH LIBERTY (Old Guinn 1800 1785 -15 99% MH SMI CM 1415 1696 281 120% MHSS (ORANGE APTS) 1600 2159 559 135% MH VISIONS 9300 10625 1325 114%

Combined YTD Units Clinical Services YTD JUL - JUN YTD JUL - JUN YTD JUL - JUN YTD Budgeted Units Monthly units Variance %

ID CM ITC 700 1119 419 160% MH SED CM ( 1150 1078 -72 94% SA BOXWOO 5930 6604 674 111% SA BX DETX ( 1270 1332 62 105%

Rappahannock Rapidan Community Services Senior Management Team Meeting July 26, 2017 – 9:00 am

Combined YTD Units Waiver Redesign YTD (Sep - YTD (Sep - YTD (Sep - June) June) June) YTD Budgeted Units Monthly units Variance % ID F-BRIDG 32170 33178 1008 103% ID GH AIRL 600 547 -53 91% ID GH ASTER 1200 1090 -110 91% ID GH CANT 1200 1078 -122 90% ID GH EVER 1200 1074 -126 90% ID GH FOXC 1050 810 -240 77% ID GH HIGH 1050 830 -220 79% ID GH LOCU 1650 1305 -345 79% ID GH MILL 1200 1067 -133 89% ID GH ORAN 1200 1020 -180 85% ID GH REMI 1800 1637 -163 91% ID O-Bridg 45415 40988 -4427 90%

Rappahannock Rapidan Community Services Senior Management Team Meeting August 8, 2017 – 9:00 am

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Paula Stone, Laura Wohlford

The meeting started at 9:05am. Item Discussion Action/Follow-up Who Financial and Budget Reimbursement • Virginia Opioid Prevention, Dr. DeRoo will begin services soon; she is completing her Treatment-Recovery (OPT-R) funds credentialing paperwork. We will follow our existing fee Reports updates scale for profession services; we are coordinating with Genoa for the prescriptions.

• Prevention funds plans – discuss We have committed some of the funds to an upcoming convention. Ryan will move forward on the mini-grants under this program. These funds need to be spent by Sept. 30.

• VAAAC start-up and projections We have the rates now and Ray has worked on the needed projections, but they still needs to be “Dawned”. We can use the existing position classifications for new full-time positions once the program begins and funds are received. Susie Walker will be the supervisor for these new positions.

• Other Not discussed.

Reimbursement • Updates / discussion Not discussed.

• ARTS / Boxwood – updates and Brian is working on the revised MOAs. The MOAs will revised MOAs. formalize the current practice. Anna, Ryan, and Jim will review the MOAs before they go out to the regions. Wanda, Ryan, and Jim will review the requirements for authorization of client fee payments. We can’t pre-authorize.

Rappahannock Rapidan Community Services Senior Management Team Meeting August 8, 2017 – 9:00 am Board Committee Program Committee Support • August: QA plus other updates No changes to the agenda. • September: Discuss Maybe discuss the pharmacy.

Administrative Services Committee • August: Focused on HR items Anna will discuss four position classifications being changed based upon market analysis. We are considering a COLA, if funds are available, effective the first pay period in 2018.

• September: Discuss Not discussed.

Other Committees: • Development Committee Not discussed. (September)

th • Search Committee – updates as The next meeting will be August 15 and include the search needed committee meeting with Ryan and Anna

HR Recruitment Report Anna distributed the recruitment report.

Evaluations – 2017 – revised evaluation Are there other changes to the soft factors (the same for all instrument : Discuss employees) before the evaluation period starts? The rating period ends September 30. SMT asked for the opportunity to review the document again.

Other HR Updates Access to Credible while not at work: The requirement is Anna that you do all your work in Credible by the end of your shift. Staff are not supposed to be accessing Credible when they are not working. If someone is in Credible, that person is considered to be working. Because the system is web-based, we can’t keep staff from accessing Credible during their off- hours – we can only correct the individual after the work has been done. Anna will research the explicit reference. This information has been disseminated – initially by Brian when EHR was first implemented. The issue is that the employee must put the time spent updating Credible during non-work Rappahannock Rapidan Community Services Senior Management Team Meeting August 8, 2017 – 9:00 am hours on their timesheet, with prior approval of their supervisor for the additional time. This would not apply to exempt employees. Anna will prepare a reminder for SMT review that can be distributed to staff.

DBHDS Licensing Updates as needed – New Bridges – 8/15 Licensing will be visiting shortly. Family members and providers will visit the site on 8/17; the general open house

will be on 8/21 for the public. Credible Updates as needed No updates.

Munis Updates as needed No updates.

Other Bridges Open House and transition Discussed above.

Guinn Lane renovation Brian is working with Charlene regarding the renovations.

Federal Block Grant Review – DBHDS This will be held on 9/18 – 19. There will be one or two individuals conducting the review. They are covering the MH and substance abuse block grants. The review is not based upon the flow of dollars; all programs are reviewable. Valerie has been very helpful in preparing for the review.

FTA Review – Aging Ray has this in hand – they are visiting this Thursday. FTA will review maintenance records and inspect vans. One individual wants to visit the FAMS Call Center.

Divisional Reports Clinical Division: Crisis services, as of 9/1, will no longer be doing voluntary evaluations in the ERs in the two regional hospitals. ● The CITAC still has some challenges; Fauquier law enforcement is still using the hospital ER. ● Parent Café will start in and Fauquier on 9/25. It will meet once a month in the evening in the Fauquier Hospital. There is no charge; child care is provided. Announcements This is for parent support/education. They cover difficult behaviors, etc. It benefits parents of children with behavioral issues. ● Children’s Services will have an open house the end of summer/end of fall. ●The Genoa Pharmacy grand opening will be 10/17.

Finance and Admin Services: Discussed above. Rappahannock Rapidan Community Services Senior Management Team Meeting August 8, 2017 – 9:00 am Community Support: Clinical and Community Support are working out the process for making referrals from clinical assessments. ● VACSB is coming up the first week of October. This is the policy conference and is being held in Williamsburg. ● Paula will be on vacation starting Friday through the 21st.

Aging and Transportation Services: Ray has 10 vouchers from Noah’s Ark (we can get 10 a month) to address furniture and clothing needs of our clients. This would work well with the PSH clients. Staff will connect some with these clients – when they get a housing voucher, they will also get a Noah’s Ark voucher. Paula will also discuss this with her staff. ● There is a webinar tomorrow to discuss the permanent supportive housing program roll-out and procedures. Ray will forward the information to Paula for her staff. ● Ray will be attending a conference from Monday through Wednesday.

Next meeting: August 23, 2017 – 9AM Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report

Human Rights Problem Resolution No report

Stakeholder Communications – Updates as needed Newsletter

Workforce Development Updates – Step Challenges No meeting until August

Planning and Development No report Risk Management

QA Policy Reviews / Updates No report

The meeting ended at 11:30am.

Rappahannock Rapidan Community Services Senior Management Team Meeting August 23, 2017 – 9:00 am

MINUTES

Staff Present: Brian Duncan, Ryan Banks, Anna McFalls, Ray Parks, Paula Stone, Laura Wohlford

The meeting began at 9:08am. Item Discussion Action/Follow-up Who Financial and Budget Reimbursement • Virginia Opioid Prevention, The report is due on Friday. It is almost complete. Treatment-Recovery (OPT-R) funds Reports updates – submission of detailed budget status.

• Prevention funds plans – grants for This has not been completed, but the information has been coalitions document completed distributed.

• VAAAC updates There is a conference call today; they do one every Wednesday. There is still is much uncertainty around this program. The training is still pending. Our open positions

are posted; but much of the program is still in flux. There is town hall in Charlottesville for CCC+. United HealthCare is

doing a meeting as well and we will have several staff attending.

Money has begun to flow for case management services. • PSH Program / Aging and Have we received the fully executed agreement yet? Community Support Housing is planning a community event on September 8 for stakeholders and landlords. There is a lot of interest in this in the community. Ginger and Lindsay are working well

together. There is training in Virginia Beach. Ginger and Bobbie want to visit another location with an active program

to study their policies and procedures.

• Other Not discussed

Rappahannock Rapidan Community Services Senior Management Team Meeting August 23, 2017 – 9:00 am Reimbursement • Updates / discussion Not discussed

Board Committee Program Committee Support • August: Outcomes This went well. • September: Discuss Site visit to Bridges in operation?

Administrative Services Committee • August: Outcomes This went well. • September: Discuss Not discussed

Other Committees: • Development Committee Not discussed (September)

• Search Committee – updates as The next meeting will be Sept. 5, when they will receive needed copies of the pre-screened applications. HR Recruitment Report Anna distributed the recruitment report.

Evaluations – 2017 – revised evaluation This has been revised by Katia based upon feedback received. instrument : Finalize comments SMT agreed to this version. Ryan will do some training on this form at her Leadership meeting on 9/11. Anna will discuss the evaluation roll-out with Katia.

Other HR Updates Not discussed

Use / Lose Leave Report Please review this with your staff. Any excess leave will be lost on 12/31 if it is not used before then. Make sure to manage requests for time off, so there is sufficient staff available during the holidays.

DBHDS Licensing Updates as needed – There are no pending licensing actions in any of our programs New Bridges – Done right now. Culpeper Clinic - Done

Rappahannock Rapidan Community Services Senior Management Team Meeting August 23, 2017 – 9:00 am Credible Updates as needed We are continuing form revision and clarifying workflows.

Munis Updates as needed HR and payroll kicked off last week. Next week, we will work on the financial module – closing the month and reconciling financial statements. Staff will attend the state Munis conference.

Other Bridges Open House and transition – This was an excellent event with a good turn-out. Brian will excellent event visit both of the old locations on Friday. He has alerted the landlord that we will be vacating the existing facilities by the end of the month.

Guinn Lane renovation The specs are finished; Charlene and Brian are working on getting the construction contract out for bid.

Federal Block Grant Review – DBHDS This is scheduled for Sept. 18-19 and they have provided some additional information about what they will be reviewing.

All Staff Email Instructions It is requested that the bcc: be used for all staff emails and include “To All Staff” in the email.

WaMS Demographic Updates Staff are revising the Credible form to collect this information the Waiver Access Management System (WaMS).

Divisional Reports Clinical Division: The Revive training was held last night. There were 12 people in attendance, including 3 board members. ● The Children’s Services open house is scheduled for September 27. ● Parent Cafe will be in Fauquier on the 4th Monday of the and month. Announcements Finance and Admin Services: We are preparing the Community Automated Reporting System (CARS) report for year end. ● The Munis workgroup is reviewing the procurement to streamline the process. ● We need to come up with a better solution for handling maintenance requests and facilities supplies.

Community Support: What should be done with the paper records from the current Bridges buildings? There is insufficient space in the current archives building. Airlie may be a good option until space can be made in the archives building. Brian will Rappahannock Rapidan Community Services Senior Management Team Meeting August 23, 2017 – 9:00 am discuss the work needs to be completed by the end of August with Steve.

Aging and Transportation Services: We got a good report from the Federal Transportation Administration’s (FTA) inspection on August 10. We were the chosen site in the state for this inspection. ● We are going to have a volunteer driver appreciation event on September 10. This is organized by FAMS and will include our drivers, plus drivers from other areas.

Other: Brian will be requesting annual report information from each division soon. We need to get the report done around Thanksgiving. Next meeting: September 12, 2017 – 9AM Reports to Senior Management Discussion Action/follow-up Who

Health/Safety No report

Accessibility No report

Human Rights Problem Resolution No report

Stakeholder Communications – Updates as needed – Newsletter just published Newsletter

Workforce Development Updates –

Planning and Development No report Risk Management

QA Policy Reviews / Updates No report

The meeting ended at 11:15am.

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES BOARD OF DIRECTORS 2017

OFFICERS OF THE BOARD

Mr. Robert Legge, Chair (Madison) Ms. Elizabeth Davis, Vice-Chair (Culpeper) Ms. Marcia Brose, Secretary (Orange)

MEMBERS OF THE BOARD

Culpeper County (Term) Fauquier County (Term)

Mr. Edward Alan Anstine (1/13 – 12/18) Ms. Pat Balasco-Barr (1/15 – 12/17) Ms. Elizabeth Davis (1/14 – 12/19) Mr. Matthew Parker (7/16 – 12/18) Ms. Dawn Lovelace Klemann, Ph.D. (1/17 – 12/19) Mr. Robert Weigel (1/17 – 12/19)

Madison County (Term) Orange County (Term)

Ms. Bonita Burr (1/15 – 12/17) Ms. Marcia Brose (1/11 – 12/18) Mr. Robert Legge (1/15 – 12/17) Mr. William Hepler (1/17 – 12/19 Ms. Clare Lillard (1/15 – 12/17) Ms. Donalda Lovelace (9/16 – 12/19)

Rappahannock County (Term)

Ms. Ann Baumgardner. Ph.D. (9/17 – 12/19) Ms. Paula Howland, Ph.D. (1/16 – 12/18) Ms. Demaris Miller, Ph.D. (1/15 – 12/17)

August 29, 2017

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES SENIOR MANAGEMENT TEAM ROSTER 2016

Brian D. Duncan 825-3100, ext. 3145 Executive Director email: [email protected]

Anna B. McFalls 825-3100, ext. 3144 Director, Finance and Administrative Services email: [email protected]

Paula Stone 825-3100, ext. 3437 Director, Community Support Services email: [email protected]

Ray Parks 825-3100, ext. 3331 Director, Aging and Transportation Services email: [email protected]

Ryan Banks 825-3100, ext. 3008 Director, Clinical Services email: [email protected]

USEFUL WEBSITES

Virginia Association of Community Services Boards www.vacsb.org

Department of Behavioral Health and Developmental Services (DBHDS) www.dbhds.virginia.gov

Virginia Division for the Aging (VDA) www.vda.virginia.gov

National Association of Behavioral Health and Developmental Disabilities Directors http://nacbhdd.org/

National Association of Area Agencies on Aging http://www.n4a.org/

Virginia Association of Area Agencies on Aging http://vaaaa.org/

The mission of RRCS is to improve the quality of life of the citizens of Planning District 9 by providing comprehensive behavioral health, intellectual disability, substance use disorder, and aging services. Vision Statement: To have quality define our services, our practices, our behaviors and our outcomes. Supplement

August 2017 Vol. 33, No. 12 Editor: Jeff Stratton Beware potential pitfalls of dual roles for board member attorneys The wealth of knowledge and expertise that at- nonprofit, communications might lose critical torneys have to offer makes them prized as non- attorney-client privilege if they are not handled profit board members. But for the board member properly, the firm says. attorneys and the nonprofits alike, such situa- • Questions of competence. Board member at- tions present a slew of complications, and it’s best torneys should also examine whether they truly have to understand how they will be addressed before the knowledge and competency to advise the orga- nonprofits avail themselves of this valuable re- nization, given their background and practice areas. source, according to Michele Berger, an attorney at They should be careful when asked to provide advice San Francisco–based NEO Law Group. in areas in which they possess some knowledge but In presentations on this topic given in venues don’t have a deep enough understanding of the intri- such as the Bar Association of San Francisco, cacies of nonprofit law, Berger says. Berger’s firm has laid out some of the most signifi- To address these and other issues, Berger’s firm cant considerations for board members who are offers the following tips for nonprofit board mem- practicing attorneys and thinking of serving in a bers also providing legal services to the organiza- legal capacity for their organizations. They include: tions they are serving: • Role confusion. According to Berger, a board • Inform management and the board about member attorney who offers an opinion on some- your role and the issues regarding attorney-client thing during a board meeting has to establish privilege up front. whether he’s communicating as a board member • Identify in what capacity you are communicat- or as a lawyer for the nonprofit. There are two ing to ensure it’s accurately reflected in the minutes. main concerns here: The opinions offered as a • Refrain from voting on material financial board member may be received with unwarranted transactions with your law firm. and unspoken deference if the rest of the board • Identify potential gaps in coverage between considers it legal advice, and your legal advice your professional liability insurance and the non- offered as a lawyer may be received without ap- profit’s directors and officers insurance. propriate consideration if the rest of the board • At all times when rendering legal advice, considers it the opinion of a board member. exercise the independent professional judgment • Conflicts of interest.Another complication required of a lawyer. arises when the board member attorney’s firm, • Diligently perform your duties as counsel, or one of its clients, gets in a dispute with the within the limits of applicable law, once an ac- nonprofit. Which role does the member play, and tion has been approved by the board, even if you which party does he represent? disagreed with the action as a board member. • Loss of attorney-client privilege. When a For more information, visit http://www.neolaw board member also serves as an attorney for the group.com. ■

© 2017 Wiley Periodicals, Inc., A Wiley Company • All rights reserved View this newsletter online at wileyonlinelibrary.com • DOI: 10.1002/ban B&A For Board Members Take time to develop collegial rapport with nonprofit staff Nonprofit leaders aren’t giving enough thought who will impact my position in the organization? to the relationships between their boards and the • Will board-directed changes cause us to lose organization’s staff, leading to unnecessary friction staff collegiality or interfere with the organiza- between the two groups, according to Eugene Fram, tion’s sense of caring? professor emeritus in the Saunders College of Busi- Fram suggests board members help alleviate ness at the Rochester Institute of Technology. these concerns by nurturing collegial relationships In “Nonprofit Board/Staff Relationships: An Un- with staff members that show sensitivity to their comfortable Partnership?” Fram says the problem concerns. Some tips for doing this include: lies with the nature of the roles of each side. While • Establishing a board procedure that encour- the board might be responsible for oversight, plan- ages directors, on occasion, to interact with key ning and the overall strategic direction of the or- staff persons below the management level. ganization, the staff are in charge of making sure • Respecting and celebrating staff accomplish- the nonprofit actually makes progress toward its ments, both individually and as a group, and at- mission—its reason for being. tending staff celebrations where appropriate. For staff, this disconnect surfaces in concerns • Meeting with staff in small groups and on such as: problem-solving committee assignments. • Do the directors have a robust understand- • Developing an interest in and understanding ing of our mission? Are they truly qualified to of the work staff do, and the challenges they face. judge our work? This may include encouraging staff to provide • How well does the board understand the brief informational updates and/or reports at challenges we face daily? Do they really under- board meetings, or even attending some of their stand the difficulties of daily contact, for example, professional conferences. with disadvantaged families? “As much as possible, try to develop a collegial, • When a new CEO is about to be engaged, will not authoritarian, relationship with staff. They staff concerns be considered? are well aware that the board has final authority,” • How secure is my position if the board sees sub- Fram writes. stantial turnover? Will a new director be appointed For more information, visit http://bit.ly/2sWj0pR.■

Ask questions to stay abreast of annual giving While not all board members are as involved ing? Are we doing anything differently this year to in the “nitty-gritty” work of fundraising as the try to increase giving from any constituency? Development Committee, everyone should stay • How are we doing this year compared to the last up to speed on the organization’s annual giving two years? Did we meet our goals the last two years? programs and plans for the coming year. That • Is our annual giving overall on an upward doesn’t have to be a daunting task—just a few trajectory? questions should guide the discovery process and • How many years do you project it might take ensure the whole board is sufficiently informed, to double our income from these recurring giving according to consultants at the Alford Group. The programs? firm suggests the following questions for board • How many individual donors do we have cur- members to ask: rently? • What are our goals for this year by constitu- • What are we not doing that we might consider? ency (i.e., individuals, foundations, corporations, • How much has the board given this year? government, organizations, etc.)? What is the participation rate of the board? • What are our key strategies for annual giv- For more information, visit http://alford.com/. ■

DOI 10.1002/ban © 2017 Wiley Periodicals, Inc., A Wiley Company • All rights reserved Supplement

September 2017 Vol. 34, No. 1 Editor: Jeff Stratton Invest in your own education I recently heard from a long-time subscriber to The new chair believed it was his job to manage Board & Administrator who told me controversy the CEO. This even reached the point where the erupted at the nonprofit when the CEO terminated chair managed the CEO’s work schedule. “I can an employee. no longer attend my monthly association meetings Because the board didn’t understand its rela- because he thinks I should be here working,” she tionship to staff and the board’s role in personnel said. matters, it agreed to meet with the terminated The executive had to drop the local Kiwanis staff member after he demanded a meeting with Club membership to concentrate on work and is the board. under fire to drop the nonprofit’s chamber mem- “This opened a real can of worms that took bership because the chair believes one-and-a-half- me months to resolve,” the administrator said. hour lunch meetings “are a waste of time,” she “Working through this mess also soured my re- said. lationship with several new board members who There are far too many ways to provide the could not keep their hands out of the personnel board with regular education that don’t have to be issue.” time-consuming: This is one example of why boards need regular • Slip the For Board Members section of B&A training: When board veterans leave, the organi- into your board meeting packets. zation needs to be able to rely on a core group of • Find low-cost or free webinars for the board board members who understand the board mem- to learn from. ber’s job. This requires regular role education. • Ask your governance committee to survey the It got worse for the CEO when the board elected board on the topics it wants to learn about. a bullheaded chair and this individual decided • Improve the quality of your nonprofit’s new “things had not been run right here.” board member orientation program. ■

Job description review: Set policy and establish goals for your executive to achieve When the board knows its role at the organiza- why boards employ a CEO. Let this person carry tion, it will have a much stronger relationship with out board decisions. its executive. It’s important to understand that board mem- In a nutshell, board members acting as a group bers do not take action as individuals, but as a set goals and make policies for the executive to team through votes at meetings. Board members implement and achieve. who take action without approval of the full board Board members do not carry out policy. That’s can damage their organizations. ■

© 2017 Wiley Periodicals, Inc., A Wiley Company • All rights reserved View this newsletter online at wileyonlinelibrary.com • DOI: 10.1002/ban B&A For Board Members Might I serve as a volunteer too? Board members can serve their organizations in bility for the organization. two roles: as policymakers and as volunteer con- • Hat 2. The volunteer consultant hat. This sec- sultants to the CEO. ond hat is the one you wear when you volunteer for But be careful not to mix these roles. To sepa- staff-level duties. While wearing your volunteer hat, rate them, keep the two hats principle in mind. you have no more authority than any staff member • Hat 1. Your policymaker hat. You wear this and, in fact, report to the executive director. when you meet as a full board to set direction And remember, when volunteering your skills to and policy for the organization. Wearing this hat the organization, you will also have a temporary as a member of the board, you have full responsi- boss in the executive director. ■

Tip sheet for board members: Prevent board role mistakes • Avoid pop-in visits to the offices. Surprise Instead, when an employee approaches you, hear “pop-in” visits by board members serve no good the employee’s problem for full understanding of purpose, and in fact can be unsettling to the persons involved, date and place. Then remind organization’s staff. The board member who visits the employee of the chain of command. Refer the the office and then offers advice on how a recep- employee to the appropriate person. tionist should answer the telephone really needs • Limit board requests for staff work. Use to reassess his priorities as a board member. a simple technique for how board members can • Respect the chain of command. Board make requests of staff. members best help constituents resolve their is- • The request should be channeled through the sues by directing them to the proper channel. For administrator. example, if a parent has a complaint about how a • The request should have a connection to the child is being treated in a program, refer the mat- organization’s goals. ter to the supervisor. • The request should not take more than one • Don’t try to “solve” employee problems. hour of an employee’s time. ■

Improve board self-evaluation If the board’s self-evaluation has become stag- • Set achievable goals based on the results. nant, consider these strategies to freshen it up: This is vital to getting effective results from a • Discuss the purpose and goals of the board self-evaluation. self-evaluation with the full board. If board • Commit to a follow-up mechanism. As- inactivity, for example, is the problem you are sign the responsibility for meeting these goals trying to resolve, state this at the beginning of to a board committee. The committee that the evaluation process and emphasize it on your works on board governance issues is a good evaluation tool. choice. • Select a new evaluation tool. Design one • Consider a post-evaluation board-and- that addresses key board obligations, including: administrator retreat. This is a good opportu- meeting attendance and participation, support for nity to discuss the board’s role, and may include nonprofit events and activities, and support for a conversation about what the board should be fundraising. doing. ■

DOI 10.1002/ban © 2017 Wiley Periodicals, Inc., A Wiley Company • All rights reserved ACRONYMS USED AT RRCS

AA Alcohol Anonymous AAA Area Agency on Aging (25 organizations in Virginia) ABS Adaptive Behavior Scale (ID) ACL Administration on Community Living ACT Assertive Community Treatment ADA Americans with Disabilities Act (Federal) ADC Adult Day Care (RRCS Aging Services - Warrenton location) ADI Autism Diagnostic Interview ADOS Autism Diagnostic Observation Scale ADRC Aging and Disability Resource Center AFHMP Affirmative Fair Housing Marketing Plan (Federal - HUD) AGA Association of Government Accounts (RRCS is not a member) ALF Assisted Living Facility (formerly Adult Care Residence) AMR Aging Monthly Report (VDA financial reporting) AR Authorized Representative ARC Association for Retarded Citizens ARTS Addiction, Recovery and Treatment Services (Virginia) ASAM American Society of Addiction Medicine ASD Acute Stress Disorder ASI Addiction Severity Index AT Assistive Technology BH Behavioral Health BTI Boston Technologies, Inc. (RRCS Accounting software system) CAPTA Child Abuse Prevention Treatment Act (Federal) CARS Community Automated Reporting System (DBHDS financial reporting) CBT Cognitive Behavioral Therapy CCBHC Certified Community Behavioral Health Clinics (Virginia) CCC Commonwealth Coordinated Care (Virginia) CCC+ Commonwealth Coordinated Care Plus (Virginia) CCCA Commonwealth Center for Children and Adolescents, Staunton (DBHDS) CCEVP Care Coordination for Elderly Virginians Program (Virginia) CCISC Comprehensive, Continuous, Integrated System of Care Model CCS Community Consumer Submission (DBHDS statistical reporting software used by CSBs) CDC Center for Disease Control (Federal) CDSME Chronic Disease Self-Management Education (NCOA program) CH Catawba Hospital, Salem (DBHDS) CHAP Child Health Assistance Program CHRIS Comprehensive Human Rights Information System (DBHDS and LHRC) CIT Crisis Intervention Team CITAC Crisis Intervention Team Assessment Center CM Case Management CMHS Center for Mental Health Services (Federal)

Last Updated: August 14, 2017 1 of 6 ACRONYMS USED AT RRCS

CMS Center for Medicare and Medicaid Services (Federal) CNS Clinical Nurse Specialist COPN Certificate of Public Need COSIG Congress State Infrastructure Program CPMT Community Policy and Management Team CPP Certified Prevention Professional CQI Continuous Quality Improvement CRC Commitment Review Committee (DBHDS) CRIA Communication, Referral, Information, and Assistance CSA Comprehensive Services Act for Troubled Children & Youth CSB Community Services Board (40 organizations in Virginia) CSH Central State Hospital, Dinwiddie (DBHDS) CTI Care Transitions Initiatives CVTC Central Virginia Training Center, Lynchburg (DBHDS) CVTC Central Virginia Transitions Collaborative DAP Discharge Assistance Project (MH discharge from state training centers) DARS Department of Aging & Rehabilitative Services (Virginia) DBHDS Department of Behavioral Health & Disability Services (Virginia) DBT Dialectical Behavior Therapy DCJS Department of Criminal Justice Services (Virginia) DD Developmentally Disabled DDHH Department for the Deaf and Hard of Hearing (Virginia) DJJ Department of Juvenile Justice (Virginia) DLA Daily Living Activities DMAS Department of Medical Assistance Services, Virginia (Medicaid) DOC Department of Corrections (Virginia) DOJ Department of Justice (Federal) DRPT Department of Rail and Public Transportation (Virginia) DRS Department of Rehabilitative Services (Virginia) DSM-IV Diagnostic and Statistical Manual (Mental Disorders), Fourth Edition DSS Department of Social Services (Virginia) EAP Elder Abuse Prevention (VDA) EAP Employee Assistance Program (DBHDS) EBL Extraordinary Barriers List ECO Emergency Custody Order EDI Electronic Data Interface EHR Electronic Health Records (RRCS uses Credible EHR software) EI Early Intervention EMAP Emergency Medical Alert Program (RRCS Aging Division Program) EMHA Excellence in Mental Health Act ESH Eastern State Hospital, Williamsburg (DBHDS) ESR Exceptional Service Rate (Community Support)

Last Updated: August 14, 2017 2 of 6 ACRONYMS USED AT RRCS

FAHASS Fredericksburg Area HIV/AIDS Support Services FAMS Foothills Area Mobility System FAPT Family Assessment & Planning Team FBG Federal Block Grant FFS Fee-for-Service FMLA Family and Medical Leave Act (Federal) FMR Fair Market Rent (Federal) FTA Federal Transit Administration (Federal) GA General Assembly (Virginia) GAP Governor’s Access Plan, Virginia (Medicaid) GOSAP Home and Community-Based (Medicaid ID Waiver) GPTICN The Greater Piedmont Trauma Informed Community Network HAP Housing Assistance Payment (tenant assistance in Federal - HUD projects) HCBS Home and Community Based Services HCVP Housing Choice Voucher Program (tenant assistance in Virginia VHDA projects) HHS Department of Health & Human Services (Federal) HIPAA Health Insurance Portability & Accountability Act (Federal) HPR-1 Health Planning Region-1 (eight CSBs including RRCS) HPSA Health Professional Shortage Area HR Human Resources HR Human Rights HRIS Human Resources Information System (Virginia) HUD Department of Housing & Urban Development (Federal) ICC Intensive Care Coordination ICD International Classification of Diseases ICF Intermediate Care Facility (CMS) ICF/MR Intermediate Care Facility for the Mentally Retarded ICT Intensive Community Treatment ID Intellectual Disability ID Waiver Medicaid Home and Community-Based Waiver, formerly the MR waiver (CMS) ID/MI Intellectual Disability/Mental Illness (co-occurring diagnosis) IDDT Integrated Dual Disorders Treatment IDEA Individuals with Disabilities Education Act (Federal) IEP Individual Education Program (children age 3 and older) IFSP Individual Family Service Plan (children through age 2) IOP Intensive Outpatient Program ISP Individualized Service Plan or Integrated Strategic Plan (DBHDS Plan) IT Information Technology ITC Infant Toddler Connection KOVAR Knights of Virginia Assistance for the Retarded (Catholic grant program) LCP Licensed Clinical Psychologist LCSW Licensed Clinical Social Worker

Last Updated: August 14, 2017 3 of 6 ACRONYMS USED AT RRCS

LEEP Leading through Empowerment, Excellence, and Partnership (DBHDS) LHRC Local Human Rights Committee LIPOS Local Inpatient Purchase of Service (DBHDS Mental Health) LMPH Licensed Mental Health Professional LOF Level of Functioning LON Letter of Notification LPC Licensed Professional Counselor LTC Long-Term Care MAT Medication-Assisted Treatment Mcad Medicaid MCO Managed Care Organization MDR Multidrug-Resistant MH Mental Health MI/ID Mental Illness/Intellectual Disability (co-occurring diagnosis) MI/SUD Mental Illness/Substance Use Disorder (co-occurring diagnosis) MIPPA Medicare Improvements for Patients & Providers Act MLTSS Managed Long Term Services and Supports (Medicaid) MOA Memorandum of Agreement MOT Mandatory Outpatient Treatment MOU Memorandum of Understanding MUA Medically Underserved Area N4A National Association of Area Agencies on Aging NA Narcotics Anonymous NAMI National Alliance on Mental Illness NAPIS National Aging Program Information System (VDA statistical information) NCOA National Council on Aging NGRI Not Guilty by Reason of Insanity NHSC National Health Service Corps (Federal) NIMH National Institute of Mental Health NP Nurse Practitioner NVTC Northern Virginia Training Center, Fairfax (DBHDS) NWD No Wrong Door (Virginia Initiative) OAA Older American’s Act (Federal) OBOT Office-based Opioid Treatment OBS Organic Brain Syndrome OPT-R Opioid Prevention Treatment –Recovery (Virginia DBHDS) OT Occupational Therapy PACT Programs for Assertive Community Treatment Part C Part of the IDEA program – funds for early childhood intervention (Federal) PAS Psychiatric Assessment & Support PATH Piedmont Action to Health Foundation (formerly Fauquier Health Foundation) PATH Projects for Assistance in Transition from Homelessness Grant (Federal)

Last Updated: August 14, 2017 4 of 6 ACRONYMS USED AT RRCS

PBPS Performance-Based Prevention System PBS Positive Behavioral Supports PCP Person Centered Planning PD9 Planning District 9 (Culpeper, Fauquier, Madison, Orange, & Rappahannock counties) PEEP Professional Enrichment and Enhancement Program (RRCS) PeerPlace VDA statistical reporting software used by AAAs PMMP Protective Money Management Program (RRCS) POIS Purchase of Individualized Services POS Purchase of Services PPHF Prevention and Public Health Fund (Federal/CDC) PPS Prospective Payment System PRAC Project Rental Assistance Contract (Federal) PSH Permanent Supportive Housing PTSD Post Traumatic Stress Disorder QA Quality Assurance QI Quality Improvement QMHP Qualified Mental Health Professional QMRP Qualified Mental Retardation Professional RACSB Rappahannock Area Community Services Board (Fredericksburg, VA) Rapp-Rap Rappahannock Rapidan Community Services (informal nickname) RCCT Rapid Cycle Change Team RCSC Regional Community Support Center RD Rural Development (program of USDA) REAC Real Estate Assessment Center (Federal) REACH Recovery, Education, and Creative Healing REACH Regional Educational Assessment Crisis Response and Habilitation (DD/ID Crisis Program) RIC Resident-in-Counseling RN Registered Nurse ROAP Regional Operation Administered Program (RRCS Visions lunch funds) RRCS Rappahannock Rapidan Community Services (current name) RRCSB Rappahannock-Rapidan Community Service Board (historical name) RRRC Rappahannock-Rapidan Regional Commission RSVP Retired Senior Volunteer Program SA Substance Abuse SAFE Services to Abused Families SAMHSA Substance Abuse and Mental Health Services Administration (Federal) SAPT Substance Abuse Prevention & Treatment (DBHDS federal block grant) SARPOS Substance Abuse Residential Point of Service (DBHDS) SE Supported Employment SED Seriously Emotionally Disturbed SGF State General Funds SHRC State Human Rights Committee

Last Updated: August 14, 2017 5 of 6 ACRONYMS USED AT RRCS

SIS Supports Intensity Scale SMHA State Mental Health Authority SMI Serious Mental Illness SMP Senior Medicare Patrol (Virginia) SNAP Supplemental Nutrition Assistance Program (previously called Food Stamps) SNF Skilled Nursing Facility (CMS) SPMI Serious and Persistent Mental Illness SPO State Plan Option (type of Medicaid) SSDI Social Security Disability Insurance (Federal) SSI Supplemental Security Income (Federal) STEP-VA System Transformation, Excellence and Performance (Virginia) SUD Substance Use Disorder SVTC Southside Virginia Training Center, Dinwiddie (DBHDS) SWVTC Southwestern Virginia Training Center, Hillsville (DBHDS) TANF Temporary Assistance for Needy Families (Federal) TBI Traumatic Brian Injury TDO Temporary Detention Order TDT Therapeutic Day Treatment TEDS Treatment Episode Data Set TEP Transitional Employment Program TIP Treatment Improvement Protocols TOVA Therapeutic Options of Virginia USDA U.S. Department of Agriculture (Federal) V4A Virginia Association of Area Agencies on Aging VAAAC Virginia Area Agencies on Aging Cares VACSB Virginia Association of Community Service Boards VARO Virginia Association of Reimbursement Officers VASIP Virginia Service Integration Program VDA Virginia Division for the Aging VHDA Virginia Housing Development Authority VICAP Virginia Independent Clinical Assessment Program (Children MH – no longer offered by RRCS) VICAP Virginia Insurance Counseling Assistance Program (Aging Division - VDA) VIDES Virginia Individual Developmental Disability Eligibility Survey VTCLI Veterans Transportation & Community Living Initiative (Federal) WSH Western State Hospital, Staunton (DBHDS) YACC Young Adult Coordinated Care (RRCS)

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