Community Mental Health for Central Michigan s2

Community Mental Health for Central Michigan

Provider Network Meeting Minutes

Date: 06/16/2009 Time: 10:00-12:00 Place: Lake Michigan Conference Room Meeting called by: Bryan Krogman Type of meeting: Regular Note taker: Dianne Ward Attendees: Provider Network, Linda Kaufmann, Bryan Krogman, Ruth Moeggenberg, Deb Andrews, Kathie Swan, Tom Rojeski, Barb Mund, Marilyn Thornton, Ann Silker, Frank Keesecker, John Obermesik, Kris Stableford, Karen Bressette. Agenda Topic: Welcome/Sign In Presenter: Bryan Krogman Welcome and introductions were done.

Agenda Topic: Announcements Presenter: Bryan Krogman Bryan stated CMH received notification regarding the adult home health rate from DHS. Clare and Isabella counties rate going up to $13.00 per hour, was $12.75 per hour. Mecosta and Osceola counties staying at $12.75, not sure why, Tom Rojeski will be checking on this. Will be doing some amendments to contracts as this will affect the community living support rate.

Don Schuster from Crisis Center stated they received a grant to work with children that have been or may have been sexually abused, and a grant for assisting homeless or potentially homeless persons 18-22 years old.

Agenda Topic: State and Agency Update Presenter: Linda Kaufmann Linda talked about the current state of the economy and Michigans budget. CMH has received a cut in the General Fund monies and elimination of non-Medicaid respite dollars as part of the May 5th Governors executive order. This reduction is expected to continue into next year. The Governors reduction is $40 million while the Senate has brought to the floor a reduction of $62 million to the general fund. We were on the low end of the cuts because of funding inequities compared with other CMH agencies in the state. Linda stated that CMH won’t be able to increase provider rates or staff salaries at this time but also doesn’t believe CMH will need to cut most contracts either.

CMH has a number of initiatives it is taking on and is making very good progress. The implementation of a Crisis Intervention Team: An experienced working supervisor has been hired, Kent Hubbard, and additional staff is in the process of being hired. Kent and Liz Kline are enrolled in a weeks training in Maine.

Centralized Access: The targeted date for implementation is July. This will provide a prompt response to requests for services. The calls will transfer to other counties so there is a response if the local access worker is on the phone.

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Use of Level of Care Utilization System (LOCUS and Supports Intensity Scale (SIS): These are tools to help evaluate a persons needs. The LOCUS and SIS will be keys to assisting in equitable services throughout our agency. Telecommuting: We are in the final days of the technical needs to begin this. Case Managers and Supports Coordinators will be starting this as well. The expectation is that this will be fully implemented by the end of the calendar year. This initiative promises increased availability of staff for services, and increased consumer and staff satisfaction. Telepsychiatry: We have the equipment in place and are beginning initial pilot use. Right now we are paying for Psychiatrists driving time. There are several Psychiatrists interested in telepsychiatry. Integration with physical healthcare: Individuals with mental illness are dying 25 years younger than the general population. We have embraced this national initiative in order to assure better health care for individuals with mental illness. This includes stressing the importance of wellness in contacts with consumers, assisting consumers in accessing primary healthcare and teaching self-management techniques. Supported Employment: The Employment Specialist in Isabella County has placed eight people in employment situations and has another twenty people that he is working with. Electronic Health Record: We are very close to full implementation of new files. Scanning of existing files will begin in the near future. Electronic prescriptions (InfoScriber): should be implemented during July also.

We have applied for a grant to assist in implementation of Brief Strategic Family Therapy which focuses on family systems approach for children and youth age 6-17. We have increased the use of Peer Support Staff and now employ 26 people. There is 9 additional staff in training for Parent Management Training. Consumer Action Committee has made great strides. They were active in reviewing our Application for Renewal and Recommitment to MDCH and are active in the Anti-Stigma campaign. They have done some television spots on Charter stations and are preparing a speakers bureau.

Agenda Topic: Behavior Treatment Interventions Presenter: Marilyn Thornton Discussion & Marilyn is the Chairperson of the Behavior Treatment Committee. Marilyn stated that Conclusions: with the new fiscal year beginning last October brought with it renewed commitments between Community Mental Health for Central Michigan and the Michigan Department of Community Health to improve mental health services. You as providers have probably noticed that there is an emphasis on positive approaches to helping our consumers who sometimes behave in ways that put themselves or others at risk of harm. While positive support is not new, we are recommitting to it in response to direction coming from MDCH in a Concept Paper and in a Technical Requirement for Behavior Treatment Plan Review Committees. The Concept Paper urges us to foster a “culture of gentleness” “wherein force is not used”. This is possible as we identify what has led to a challenging behavior, what might be reasons for a behavior and what that behavior may be communicating. In order to do this it is essential that we have involvement from our providers who interact with and observe the consumers, often on a daily basis.

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The Technical Requirement outlines procedures to follow as we address consumer behavioral issues. Specifically, it requires among other things that we always use the least intrusive and least restrictive intervention possible and that we always first use positive behavior supports with interventions designed to develop the consumer’s functional abilities.

Marilyn handed out the Behavior Treatment Data Form for review (see attachment) and is available on the CMHCM website at http://www.cmhcm.org/provider/behavior.pdf. The Data will be reviewed by the Behavior Treatment Committee which will give recommendations and identify trends that suggest training opportunities, then it will be reported to CMHCM Performance Improvement Committee and to MDCH. Anytime intervention is used the provider will need to fill out the form and turn it in to the Supports Coordinator.

The group asked for definitions of intrusive techniques and restrictive techniques:

Intrusive Techniques: Those techniques that encroach upon the bodily integrity or the personal space of the individual for the purpose of achieving management or control of a seriously aggressive, self-injurious or other behavior that places the individual or others at risk of physical harm. Examples of such techniques include the use of a medication or drug that is not a standard treatment or dosage for the individual’s condition.

Restrictive Techniques: Those techniques which, when implemented, will result in the limitation of the individual’s rights as specified in the Michigan Mental Health Code and the federal Balanced Budget Act. Examples of such techniques used for the purposes of management, control or extinction of seriously aggressive, self-injurious or other behaviors that place the individual or others at risk of physical harm, include prohibiting communication with others to achieve therapeutic objectives, prohibiting ordinary access to meals, using the Craig (or veiled) bed, or any other limitation of the freedom of movement of an individual. Restrictive techniques include the use of a drug or medication when it is used as a restriction to manage, control or extinguish an individual’s behavior or restrict the individual’s freedom of movement and is not a standard treatment or dosage for the individual’s condition

Agenda Topic: Person Centered Planning and Self Determination Presenter: Bryan Krogman Discussion & Part of the ARR involves how we assure consumers have meaningful participation in the Conclusions: community. 1. What makes person centered planning meaningful? a. The individuals knowledge and understanding of pcp b. Informed choice among providers and service delivery options c. Support throughout the system Independent Facilitation: In the pcp process it is offered as an independent facilitation of the process. Consumer selects the individual that they want to facilitate the pcp meeting process. We really want to put it in the hands of the consumer so the Supports Coordinator can focus on consumer needs rather than setting up the pcp meeting. The goal is to have 2 providers of independent facilitation in each county.

2. Self Determination: Self determination is an overall philosophy about personal independence and control. It is also a method of how a consumer controls their services (using a choice voucher). Currently there are over a hundred consumers that are receiving services through a choice voucher arrangement. It gives the consumer more

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control over their individual budget and services. Consumers use a Fiscal Intermediary as their paying agent to ensure that things are paid timely. The fiscal intermediary also handles all payroll related payments and reporting.

A question was asked: how does Self Determination work for severely DD? Answer was we will get input from guardian or person that knows consumer best, will depend on the people that love that person and knows them best.

Question asked: what kind of requirements and training does staff have on choice voucher and who monitors it? Answer: Training is first aid, infection control/blood borne pathogens, safety and fire prevention, HIPAA, false claims act and whistleblowers act. A fiscal intermediary monitors training compliance and also conducts the criminal background check.

Question asked: Most consumers don’t know what independent facilitation is, how do we get the word out and train them? Answer: the Arc does presentations and has a book at the Big Rapids and Reed City offices that tells about it. They are willing to schedule and meet with consumers to discuss it. CMHCM staff training is also being looked at.

Agenda Topic: Fire Drills Presenter: Kris Stableford Discussion & On June 4 John Sanford forwarded a memo to all CMHSP Rights Officers regarding the Conclusions: Department’s commitment to provide public mental health services within a culture of gentleness. John Sanford stated that the department’s position is that refusal to participate in a practice fire evacuation from a home, either licensed, supported- independent or through a self-determination arrangement, is a serious safety issue that needs to be addressed in the individual plan of services and a positive behavioral support plan developed to gain the cooperation of the recipient WITHOUT resort to physical management. Physical management, according to Rule 330.1723, may only be used when a recipient is presenting an imminent risk of harm to himself, herself or others and lesser restrictive techniques have been unsuccessful in reducing or eliminating the imminent risk of harm. A practice fire drill does not present an imminent risk of harm and the recipient’s refusal to participate in the practice provides only identification as to the safety issue and/or data for purposes of determining the efficacy of the behavioral support plan. Of course, if there is an actual fire requiring evacuation and the recipient refuses to leave the premises voluntarily despite implementation of the behavioral support plan, staff must use the least restrictive emergency intervention to safely remove him or her. The department’s new position follows the guidelines set forth by CMHCM in the CenTrain manual materials.

Also noted by Kris: On behalf of the Recipients Rights office if a consumer chokes, can’t breath, cough or speak please document with an incident report.

Agenda Topic: HIPAA and the HI Tech Act Presenter: Bryan Krogman Discussion & The HI Tech Act advances the use of health information technology such as health Conclusions: records by: requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information, Investing 20 Billion in health information technology infrastructure and Medicare and Medicaid incentives, Saving the government 10 billion, and strengthening federal privacy and security law to protect identifiable health information from misuse. The Hi Tech Act takes it a step further than HIPAA. It requires that we notify the consumer if

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confidentiality is breached and provides transparency to consumers to show what disclosures have been made. When emailing do not use consumer names, what is helpful is the persons 1st name and case number or just a case number.

Agenda Topic: Electronic Access to Contract Documentation Presenter: Bryan Krogman Discussion & We recognize the benefit of electronic health records. Most providers already access our Conclusions: computer server through a login id and password for billing purposes. We are working to put client rate sheets and service authorization request (SAR) forms in PDF format for providers to access. We are looking into email notification and then provider can log on to the server to get service authorization information. We will be phasing this in over the next fiscal year.

Contract renewal process: We have started to review contracts, will the summary list to the the board in August and the new contracts should go out in September. We have 295 amendments so far this fiscal year and we are looking at ways we can structure the contracts to reduce the number of amendments necessary.

Agenda Topic: Provider Topics Presenter: Bryan Krogman Discussion & Country Place brought up a concern about the person centered plan. It is months before Conclusions: it gets back to them for their file. Bryan stated the timeline is 15 days and Kris Stableford recommended that if providers are not receiving the PCP timely to contact the Recipient Rights office.

The meeting adjourned and went into the CenTrain Forum.

CenTrain Forum Minutes

Karen asked if there are any problems or concerns? Any trouble accessing over the internet? No problems or concerns mentioned.

Karen stated that other CMH’s in the state are now looking to adopt the CenTrain curriculum or using it.

The Direct Support Professionals Conference, we have people interested in partnering this year, some of them are Women’s Aid Society and Arc of Central Michigan. This is the 10th year of the conference. If there are any recommendations or if anyone is interested in being on the planning team please contact Karen. We are considering Dave Hansberger this year.

There are consumer training opportunities. Public speaking opportunities; we are partnering with MMI, the first training will be here on July 14th 1:30 to 3:30 and the trainings will go for about 8 weeks.

Healthy Relationship classes are beginning again next week. Still have room for more attendees.

Reciprocity of training records, came up in the last forum, Karen has come up with a draft release form and passed out to the group.

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Recommendation for additional information in CenTrain. More information on incident reports and how to do a doctor appointment, how to be descriptive on how to write and incident report, what and where things go. Group thinks an example of an incident report and where information goes might be helpful.

Group stated that breathing treatments needs to be added to medicine admin policies.

Karen stated there are public service announcements opportunities for consumers or anyone interested in raising awareness on mental health

Meeting adjourned at: 12:00 Next meeting date: Next January, specific date to be determined Observers: Resource Persons: Special Notes:

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