Cuyahoga County Community Mental Health Board Fiscal Year 2003 Report to the Community
Bonita W. Caplan Board Chair
William M. Denihan Chief Executive Officer
Message from the Board Chair: Bonita W. Caplan There is a public mental health crisis right here in Cuyahoga County, and if unchecked, it could reach epic proportions within the next few years. This crisis is fueled by the demand for mental health services colliding with the diminishing available supply. Each year, fewer public dollars are accessible, causing a growing number of citizens to either be underserved or not served at all. In addition, within the next five to ten years, we expect that the two ends of the generational spectrum will demand more out of our system as consumers require services at an earlier age and additional services are needed as people live longer.
Confronting this crisis, the Cuyahoga County Community Mental Health Board (CCCMHB) joined forces with all of its stakeholders and completed a planning process that yielded a Five-Year Strategic Plan (2004 - 2009). This plan outlines a vision and an achievable action strategy for the community mental health system. It focuses on three areas: System of Care, Funding, and Leadership.
System of Care: We know that accessing mental health services today is often complicated and bureaucratic. Therefore, the CCCMHB will focus on consumers – supporting the services they need, embracing holistic treatment to promote recovery, and streamlining access to services. This focus will generate a system of care that provides for prevention and timely intervention, reestablishes research and development, utilizes collaboration with other systems to provide more efficient and effective services, and invests in recruiting, training and retaining professional staff knowledgeable in “best practices” service delivery.
Funding: Inadequate funding diminishes the ability of the CCCMHB to provide services to all citizens who are in need. The growing demand for Medicaid match continues to threaten the availability of Non-Medicaid services. In order to provide the required Medicaid match, the CCCMHB is forced to use discretionary funds that have traditionally been used to provide Non-Medicaid services. This leaves potentially no dollars for services to the working poor, uninsured or underinsured citizens of our community. Over the next few years, the CCCMHB is committed to working more creatively with our traditional government partners and developing a stream of nontraditional dollars so we can establish a stable and reliable source of funds that will sustain a system of mental health care that will provide both Medicaid and Non-Medicaid services.
Leadership: Successfully surmounting this mental health crisis requires vision, commitment and leadership. Coordinating, funding and regulating publicly financed mental health services is the core role of the CCCMHB and we are now prepared to provide the leadership that will enable our community to find innovative answers to persistent problems. We have a dedicated Board of Governors and an excellent, hard-working staff. Working in cooperation with our consumers, family members, providers, legislators and community partners we will find the solutions to develop the ideal system of care.
Together, we will find ways to increase funding; improve access to quality mental health services; become a stronger advocate for consumers; educate the public for a deeper understanding of mental illness thereby reducing stigma; and promote public policy that supports parity and the concept of recovery.
We have a responsibility to the residents of Cuyahoga County to provide quality, accessible Medicaid and Non- Medicaid mental health services. Together, we can meet the challenges before us and effectively achieve our mission and our vision of creating, developing, managing and sustaining a superior, evolving system of community mental health care in Cuyahoga County. 1 Message from the Chief Executive Officer: William M. Denihan
A sturdy foundation helped the Cuyahoga County Community Mental Health Board (CCCMHB) overcome funding reductions and continue to move the community mental health system forward in FY03. A rock solid leadership team and strong support from providers and consumers made it possible for the CCCMHB to ensure mental health services even after the system was shaken by $5.4 million in reductions. This was not easy as the CCCMHB and providers had to make difficult decisions to reduce staff and Non-Medicaid services.
An analysis of available funding from the county, state and federal government, as well as our own funding trends, illustrates a shift in the way we fund services. The CCCMHB is mandated by law to fund Medicaid services. As the demand for Medicaid services continues to rise, more and more of our dollars are being earmarked for these services. The result is less discretionary dollars available for much needed Non-Medicaid services, such as vocational/employment services and housing. In fact, we are reaching a point where funding for Non-Medicaid services will be severely reduced to the point of elimination. The entire mental health system is being asked to provide greater program efficiency to serve more with less. To combat this trend, we are working with our Non-Traditional Revenue Generating Committee, providers, the State of Ohio and the County Commissioners to ensure funding for all services to meet the needs of our residents.
Not all news on funding was challenging over the past year. In fact, we have been given an extraordinary opportunity to enhance our system of care for children with severe emotional disturbances and their families through a six-year matching grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) that will generate $18 million. This grant was awarded in October 2003 and will fund Tapestry, a collaborative program involving other systems that will increase access to mental health services for children, adolescents and transitional youth ages 0-21.
As we begin to implement our Five-Year Strategic Plan and face the challenges of the future – we are building opportunities. Opportunities to better serve our consumers and ensure that quality mental health services remain available. Opportunities to move our headquarters to a new location; develop a Crisis Intervention Team with local police officers; further discuss Central Intake with our providers; inform the community about mental health through our newly formed Speakers Bureau; advocate for changes in public policy through implementation of our Advocacy Action Agenda; and further engage our consumers and family members in our planning efforts for the system. We look forward to building opportunities and hope that you will continue to be our partner.
2 FY 2003 Accomplishments: Board of Governors: Funding: Bonita W. Caplan Chair Managing Funding Reductions: Mieko K. Smith, Ph.D. First Vice Chair Services to consumers were protected as the Cuyahoga County Community Mental Health Board John Bazyk (CCCMHB) successfully absorbed $1.4 million of $5.4 million in funding reductions. The table of Vice Chair organization was “downsized,” which lead to eliminating 21 positions and the layoff of eight valued employees; space and operations were consolidated from three to two floors to save on costs; and rent Eugenia Cash paying tenants were obtained for a portion of the fourth floor.
Rev. Benjamin F. Gohlstin Bed Day Refund: Ronald E. Henderson, Esq.
Ann F. Hull $2,208,368 was refunded to the CCCMHB from the Ohio Department of Mental Health for using 6,731 Joan P. Leeb less bed days than the 45,252 projected for FY03. The refund was added to the CCCMHB’s FY04 Flex allocation and was made possible through the continued commitment of our mental health providers. L. Douglas Lenkoski, M.D. George X. Mechir Health & Human Services Supported: Joan A. Schmetzer Voters showed their support of mental health and other social services by William N. Sheehan successfully passing Issue 15 - the Health and Human Services Levy on May 6, Ericka L. Thoms 2003. The CCCMHB played a major role in fundraising, provided space for campaign headquarters and coordinated hours of volunteer support. Jesse N. Waller Mary R. Warr County Commissioners Reserve Fund:
FY 2003 $1.5 million was drawn down from a reserve fund set aside for mental health Former Governors: established by the Board of County Commissioners. David J. Blank, M.D.
Mohan J. Durve, M.D. Byrne Memorial Court Project:
Al Kay Mental health outreach services continued to be provided to the municipal court systems in Cleveland, Ella Patterson Shaker Heights, Lakewood, Rocky River, Garfield Heights and Euclid, with continued funding from the Byrne Memorial Grant.
3 Board Staff: Planning: William M. Denihan Chief Executive Officer
Valeria A. Harper-Bledsoe Chief Operating Officer Five-Year Strategic Plan:
Kathryn A. Burns, M.D., M.P.H. In partnership with consumers, family members, providers, other systems Chief Clinical Officer and involved community stakeholders, the CCCMHB began the process of Cassandra Richardson formulating its Five-Year Strategic Plan. Chief Financial Officer
Loyall Abdul-Majid Headquarter Location Project:
Maryam Akram The Headquarter Location Project was initiated with community partners to begin exploring the possibility of Lois Anderson the CCCMHB moving to a new location. A three sub-committee structure to manage the task was developed to address model/design, location and funding. Paulette Baglyos Carole Ballard Central Intake: Ada Cancel In partnership with providers, the CCCMHB initiated discussion and exploration around designing and John Coleman implementing a Central Intake system. Other County Boards were visited to discuss their experiences of implementing similar systems. Tyshon Coleman Curtis Couch Pilot Parole Project: Michael Doud Intensive mental health services were provided to people being released on parole or post release control Linda Duncan through the Pilot Parole Project. The Project, which started in August 2002, is funded with a grant from the Ohio Department of Rehabilitation and Correction. Hayne Dyches Craig Fallon Web Site: Rose Fini www.cccmhb.org was launched during Mental Illness Awareness Week in October 2002. This site continues Tami Fischer to provide much needed information to the community including finding a mental health provider, facts about mental health, legislative updates, Board publications, Board meeting schedules and other general Cheryl Fratalonie information about the Board and related topics. Karen Frena
Ben Gore 4 Board Staff Consumer & Provider Work Program: Continued: To increase the number of consumers employed by our provider agencies, the Consumer & Provider Myra Henderson Work Incentive Program was developed to provide employment opportunities for consumers throughout Jui Wui Huang the mental health system. This program has been praised by Dr. Michael Hogan, Director of ODMH, as an idea worthy of being replicated throughout the state. Pat Ilavsky Judy Jackson-Winston Transitional Employment: Jeff Johnsen Realizing the importance that employment has on the recovery process, Harriett Jones the Transitional Employment Program position was developed at the Mark Jones CCCMHB in March 2003. The position is held by consumers for a period of six months. Duties include various clerical and receptionist tasks. Since its Carol Krajewski inception, two consumers from Magnolia Clubhouse have held this position.
June Krupinski Consumer Art Program: William Kunchik
Linda Lamp To acknowledge the therapeutic benefits that art has on personal recovery and to showcase the many talents of our consumers, as well as highlight Terry Lester the uniqueness of each provider agency, the Consumer Artwork Display Program was started in Kathleen LoPresti December 2002. The artists and agencies are recognized at monthly General Board Meetings.
Medeanah Miles Employee Recognition: Michelle Myers Esmat Nasr Dedication and hard work of CCCMHB staff and provider agency employees were recognized through the Employee Recognition Program and the Provider Employee Recognition Program. CCCMHB staff DeAnne NiBlack are honored on a monthly basis, while provider employees are acknowledged quarterly at General Board Meetings. Terri Oldham
Scott Osiecki Staff Generosity:
Margaret Perpar Nearly $9,000 was collected by CCCMHB staff to support local charities through participation in Ralph Piatak the Cuyahoga County Charity Choice Campaign, the Harvest for Hunger Campaign and Dress Down Days for Charity. Judy Reilly
Dale Russell 5 Board Staff Monitoring: Continued: Successful Transition: Laura Simmons
Starlette Sizemore Five hundred consumers served on an interim basis by the Center for Families and Children were successfully transitioned to Murtis H. Taylor Multi-Service Center and North East Ohio Health Services. The Michael Sosnick CCCMHB conducted two community meetings to discuss the transition process and the mental health Maggie Tolbert needs of the East Side communities. David Wesner HIPAA Compliance: Shonye Williams All Federal Health Insurance Portability and Accountability Act (HIPAA) regulations were met by the CCCMHB Leshia Yarbrough- Franklin to ensure the privacy of all consumers served by the community mental health system. Privacy Practices were developed and mailed to approximately 35,000 MACSIS enrollees. These Privacy Practices, posted on www.cccmhb.org, are on display in the Board offices and continue to be mailed to new enrollees.
Adult Consumer Advisory Council:
Understanding the importance of consumer input, the Adult Consumer Advisory Council was formed to provide assistance to the CCCMHB in planning for the community mental health system.
OACBHA:
Executive team members work closely with the Ohio Association of County Behavioral Health Authorities (OACBHA) and provide guidance by serving as members of the Executive Policy Management Committee, Governance Committee, Children’s Committee and other statewide policy committees.
MHAC:
William M. Denihan, CCCMHB CEO, serves as the Co-Chair of the Mental Health Advocacy Coalition (MHAC) that helps to influence public policy and secure funding to improve Cuyahoga County’s mental health services. Community Image: Positive media coverage enhanced the CCCMHB’s image in the community. Over 55 positive media mentions reached the public in FY03 through newspapers, radio and television. 6 FY 2003 Photo Album:
(L-R) Board Chair Bonita W. Caplan with State Repre- sentative Annie L. Key, and Keynote Speaker Doug DeVoe, Executive Director of the Ohio Advocates for William M. Denihan, CEO, (R) congratulates Mental Health at the CCCMHB Annual Meeting held on James Poole for receiving the CCCMHB June 2, 2003. Kathleen Burton Memorial Award for outstand- ing mental health professional.
Dr. June Gutterman, Director of the Bureau of Vocational Rehabilitation for ORSC, expressed Andrea Taylor poses with one of her many that employment for people with severe and per- paintings entitled “Soaring Out of Dark- sistent mental illness is a solution not a problem. ness into the Splendid Light.” 7 Number of People by City in Cuyahoga County Who Received Mental Health Services Funded By or Through the Cuyahoga County Community Mental Health Board in Fiscal Year 2003*
City Under 18 18 - 64 65 & Over Total Bay Village 22 36 2 60 Beachwood 107 205 44 356 Bedford 162 184 5 351 Berea 80 88 7 175 Brecksville 10 20 2 32 Broadview Heights 17 41 0 58 Brookpark 66 87 3 156 Chagrin Falls 14 25 0 39 Cleveland 6,716 10,105 594 17,415 Cleveland Heights 263 387 39 689 East Cleveland 384 792 137 1,313 Euclid 149 272 15 436 Fairview Park 37 95 4 136 Garfield Heights 125 222 10 357 Gates Mills 2 4 0 6 Independence 20 41 2 63 Lakewood 345 680 28 1,053 Lyndhurst/Mayfield 79 121 32 232 Maple Heights 177 186 5 368 North Olmsted 76 166 2 244 North Royalton 42 55 5 102 Olmsted Falls 43 58 1 102 Parma 92 204 8 304 Richmond Heights 74 105 28 207 * All numbers in the chart are based on paid claims Rocky River 28 107 13 148 through MACSIS. Shaker Heights 516 759 42 1,317 Solon 24 38 1 63 **The Total Served includes consumers that are South Euclid 192 246 26 464 counted in missing zip codes or are Cuyahoga Strongsville 37 65 5 107 County residents being served out-of-county. Westlake 35 104 5 144 TOTAL 9,934 15,498 1,065 26,497 TOTAL SERVED** 10,976 16,089 1,107 28,172 8 Cuyahoga County Community Mental Health Board FY 2003* Financial Summary
Revenue State Funds $38,577,406 Medicaid (Title XIX) $35,261,881 County Health & Human Services Levy $15,730,162 Federal Funds (Title XX) $ 1,196,192 Grants/Other $ 3,620,431
TOTAL BOARD REVENUE $94,386,072
Expenses Board Operating Budget $ 4,212,524** (Including Board Services to Agencies.)
Disbursements to Provider Agencies $90,173,548
TOTAL BOARD EXPENDITURES $94,386,072
* FY 2003 began on July 1, 2002 and ended on June 30, 2003.
** Includes Board services to agencies and designated agency expenses under Ohio Substitute State Senate Bill 156.
9 Cuyahoga County Community Mental Health Board FY 2003 Revenue & Expenses at a Glance
CCCMHB Revenues CCCMHB Expenditures by Service Category Federal (Title XX) Board Administration County Health & Human $1,196,192 Grants/Other Services Levy Voc/Emp $4,212,524 1% $3,620,431 Other Mental Health CSP $15,730,162 $901,089 4% 4% $11,750,588 $33,812,770 17% 1% 12% 36% Residential $5,320,025 6% Crisis $2,404,728 3%
Counseling $7,867,935 8% State Diagnostic Assessment Medicaid (Title XIX) $38,577,406 Med/Som Partial Hospitalization $2,986,335 $35,261,881 41% $11,256,741 $13,873,337 37% 3% 12% 15% FY 2003 Provider Agencies: Thank you to the following provider agencies that were under contract with the CCCMHB during FY03 to provide mental health and related services. Achievement Centers for Children Community Behavioral Health Center NAMI - Cuyahoga County Applewood Centers, Inc. Consumer Protection Association NAMI- Metro Cleveland Beech Brook Cuyahoga County Court Psychiatric Clinic Northcoast Behavioral Healthcare System Bellefaire Jewish Children’s Bureau Emerald Development and Economic Network, Inc. (EDEN) North East Ohio Health Services Bellflower Center Epilepsy Foundation of Northeast Ohio Positive Education Program (CONNECTIONS) Benjamin Rose Institute Far West Center Psychobiology Clinic of Cleveland, Inc. Berea Children’s Home and Family Services Jewish Family Service Association Recovery Resources Bridgeway, Inc. Laurelwood Hospital St. Vincent Charity Hospital Catholic Charities Services of Cuyahoga County Lutheran Metropolitan Ministry SPECTRUM of Supportive Services Center for Families & Children Mental Health Services, Inc. University Psychiatrists of Cleveland, Inc. Children’s Aid Society MetroHealth Medical Center V. Beacon, Inc. Cleveland Christian Home for Children Murtis H. Taylor Multi-Service Center Visiting Nurse Association West Side Ecumenical Ministry 10 About The Artwork:
Sketch Burning Sun Michael’s House Best Foot Forward
The CCCMHB thanks the consumers of mental health services who created the original artwork contained in this annual report. Each piece was displayed in the CCCMHB offices as part of the Consumer Artwork Display Program.
Sketch and Michael’s House were created by children from Applewood Centers and the Eleanor Gerson School. Burning Sun was painted by an adult from Recovery Resources and Best Foot Forward is a digital photo from a teen recovering from depression. We thank them for sharing their creativity. The artists have expressed that art helps them through recovery, as well as to relax, focus and feel good about themselves. Cuyahoga County Community Mental Health Board 1400 West 25th Street, 3rd Floor Cleveland Ohio 44113-3199 TEL: 216-241-3400 • TDD/TTY 216-241-3983 WEB: www.cccmhb.org
Vision Mission Create a model system Develop, manage and sustain an evolving of mental health care. system of community mental health care.