HomeMy WebLinkAbout2017 MH/SA Advisory Committee Retreat Summary 9-12-20171
JEFFERSON COUNTY MENTAL HEALTH/SUBSTANCE ABUSE ADVISORY COMMITTEE
September 12, 2017 Retreat: Draft Meeting Summary
Camp Beausite, 510 Beausite Lake Rd, Chimacum, WA 98325
(v. 9-29-17)
MH/SA Member, Staff, and Facilitator Introductions
Sophie Glass, facilitator from Triangle Associates, welcomed participants to the Jefferson County Mental
Health/Substance Abuse Advisory Committee (MH/SA) retreat. See Attachment A for a list of
participants in attendance.
Review of Assessment Interviews
Sophie reported out on the findings from the assessment interviews she conducted with each of the
MH/SA members and staff. She shared the common themes she heard regarding MH/SA’ strength,
structure, funding allocation process, membership, funding priorities, and the role of the Jefferson
County Substance Abuse Advisory Board (SAAB) vis-à-vis MH/SA. See Attachment B for the full
assessment. MH/SA Retreat participants concurred with the findings of this assessment.
Review MH/SA’s Decision-Making Authority
Commissioner Kler and Vicki Kirkpatrick provided an overview of the types of issues and topics that are
within the discretion of MH/SA, and those that fall outside it. They explained that MH/SA is responsible
for providing recommendations to the Board of County Commissioners (BOCC) on how the 1/10th of 1%
sales tax money (“Hargrove funds”) should be allocated. They also shared that the prosecuting attorney
is responsible for approving all contracts for recipients of Hargrove funds. If MH/SA wanted to create a
governing structure (i.e. bylaws), it would have to be approved by the BOCC.
Set Context
Mark Freedman, Thurston/Mason BHO Administrator, shared information about the larger funding and
political landscape related to Hargrove funds. Below is a summary of Mark Freedman’s main discussion
items:
The original intent of Hargrove funds was to backfill Medicaid.
The Hargrove funds are very flexible and should not be used for services that already have
dedicated and restricted funding sources.
If MH/SA wants to be the “funder of last resort,” it needs to have a clear understanding of how
local, state, and federal1 mental health policies affect the types of funding that are available to
providers.
Coordinating with Behavior Health Organizations is a key to success.
Thurston County’s Hargrove committee aims to “braid” multiple funding sources together.
(Braiding funding allows one to leverage multiple funding sources and enables targeted,
innovative, and/or evidence-based services that complement or enhance traditional Medicaid
treatment services.)
1 Medicaid funding in particular.
2
Envisioning Success
Sophie posed the following question to MH/SA Retreat participants: “Imagine it’s 2020 and we are all
back in this room, what has happened that shows MH/SA has been successful?” Participants then shared
and grouped examples of success into the following categories:
MH/SA’s values (e.g. group norms and behaviors)
Structures (e.g. bylaws, policies and procedures, conflict of interest protocols, etc.)
Staff Support
Providers (e.g. support for specific groups)
Local Workforce (e.g. investment in local organizations).
Outcomes related to (a) general success, (b) emergency room (ER) visits; (c) jail bookings; (d)
children and youth; (d) the opioid epidemic; and (e) housing.
Collaboration (e.g. understanding the funding landscape, coordination with other health groups)
Evidence based evaluations/measuring the return on investment (i.e. evaluating results)
Please see Attachment C for the full transcription of this exercise. Please note that only MH/SA
members and staff contributed to these lists (and not retreat guests/experts).
Identifying Barriers to Success
MH/SA Retreat participants discussed the potential barriers impeding the successes they identified in
the earlier visioning exercise. The majority of MH/SA participants agreed that structures (i.e. bylaws,
policies, etc.) are needed to achieve the desired public health outcomes. One MH/SA member had
reservations about developing formal structures but shared that she would not stand in the way of
developing such structures.
Participants shared that new partnerships and collaborations would support their desired public health
outcomes as well. They noted that the Community Health Improvement Plan and Olympic Community of
Health are two opportunities for forging partnerships.
Work Plan to Achieve Success
Participants divided into two groups to identify the questions that need to be answered to develop (1)
formal bylaws; and (2) informal policies to guide RFP and decision-making processes.
Bylaws: Breakout Group #1 posed the following questions related to potential MH/SA bylaws:
Mission statement: What should be included in a mission statement? Staff could create draft
mission statement examples for review by MH/SA members.
Membership: Could new members come from cities, legal organizations/agencies, schools,
Education Service District, courts, Olympic Area Agency on Aging, Emergency Medical Services,
BOH, Hospital Commission, consumers, community members, youth serving organizations, the
jail, etc.? Should an Open Public Meeting Act training be provided to members? Should SAAB
members be involved with MH/SA?
Terms: Should there be 3-year staggered terms? Should there be term limits? What should be in
the bylaws regarding quorum, purpose, duties, appointment, termination, resignation, and
removal of members?
Meeting frequency: Should MH/SA meet monthly or bimonthly? Should the meetings be
advertised? Should there be an annual retreat?
3
Conflict of interest language: Should people with conflicts of interest leave the room during
certain discussions? Recuse themselves from voting?
Sub-committees: How should sub-committees internally operate? How should sub-committees
be accountable to the larger MH/SA Committee?
Approval: What should be the process for MH/SA agreeing on recommended bylaws for BOCC
review? Majority rule? Consensus? Other?
Please see Attachment D for the full transcription of this break out group’s notes.
Policies: Breakout Group #2 posed the following questions related to potential MH/SA policies:
Funding Priorities: Should there be an annual or biennial review of priorities? Should the funding
priorities stay the same, be narrowed, or change all together? Should MH/SA provide ongoing
support to certain organizations or should new organizations receive funding? How should
priorities be related to Medicaid funding and Managed Care Organizations (MCO) in the future?
Decision-making processes for regular RFP cycles: Should the full committee or an evaluation
panel review RFPs? Should non-MH/SA members be part of an evaluation panel? Should MH/SA
use a RFQ approach rather than a RFP approach? How can we not duplicate the Salish
Behavioral Health Organization or SBHO? Should we include an increase clause? Should there be
separate pots of money for new/innovative providers? How should BHO reserves be used? What
happens when BHO goes away?
Decision-making processes for supplemental funding: Should the decision-making process for
supplemental funds be the same as the decision-making process for regular funds? Should
supplemental funds be targeted differently than regular funds?
Decision-making processes for emergency funding: Should the process for emergency funds be
the same as the decision-making process for regular funds?
Next Steps: What other questions need to be answered for a policy manual? Should MHSA
conduct a Strength Weaknesses Opportunities and Threats (SWOT) analysis? Should MHSA
conduct a Gap Analysis?
Please see Attachment E for the full transcription of this group’s notes.
Identify Next Steps
MH/SA Retreat participants agreed that MH/SA bylaws and policies would not be ready before the
upcoming RFP cycle in October 2017. As such, they recommended the following approach:
Form an evaluation panel with MH/SA members and non-members.
Send copies of the RFPs to all MH/SA members (not just the members on the evaluation panel).
Have the panel use the scoring tool that was developed for the previous RFP cycle.
Have the panel provide a comprehensive recommendations report to the full MH/SA
Committee.
Seek legal guidance regarding how the Open Public Meeting Act applies to MH/SA meetings and
evaluation panel meetings.
Wrap Up and Adjourn
The MH/SA Retreat adjourned at 4:45 PM.
4
Attachment A: MH/SA Retreat Participants (alphabetical by last name)
MH/SA Members
Chair: Kathleen Kler, Jefferson County Commissioner
Jill Buhler, Board of Health
Anne Dean, Law/Justice
Michael Evans, Substance Abuse
Catharine Robinson, Substance Abuse
Sheila Westerman, Board of Health
MH/SA Staff
Vicki Kirkpatrick, Jefferson County Public Health Director
Anna McEnery, Jefferson County Developmental Disabilities Coordinator
Veronica Shaw, Jefferson County Public Health Deputy Director
Experts/Guests
Mark Freedman, Thurston/Mason BHO Administrator
Siri Kushner, Kitsap Public Health District
Philip Ramunno, Kitsap Public Health District
Facilitator
Sophie Glass, Triangle Associates, Inc.
5
Attachment B – Thematic Summary of Assessment Interviews
Triangle Associates, Inc. interviewed eight of the members and staff of the Jefferson County Mental
Health/Substance Abuse Advisory Committee in August and September of 2017. Below are quotes,
common themes, and recommendations that emerged from these interviews.
Strengths of MH/SA
“This committee has a passion for making our community better.”
“There is a real commitment to our goals on this committee.”
“Everyone has some expertise and passion.”
“This committee has been very collaborative and active.”
“Members are very committed and passionate.”
“The committee has open discourse and aims to be objective.”
“There is a good variety of people on the committee – all with commitment and passion.”
“Everyone cares a great deal.”
Structure
The majority of interviewees noted that MH/SA does not have any bylaws or operating protocols. There
was support for developing more structure to guide MH/SA’s work. In particular, interviewees expressed
a need to create official policies that guide funding allocation, membership selection, and meeting
processes.
Funding Allocation Process
Interviewees commented that MH/SA could benefit from a formal system for allocating funds during:
Regular Request for Proposal (RFP) cycles;
Supplemental RFP cycles; and
Emergency funding.
There were mixed feelings about the scoring criteria that was developed for the last RFP process. Some
interviewees thought that the scoring criteria was a step in the right direction and had potential, others
did not find it a useful tool for making decisions.
There were also split opinions about using a sub-committee to make initial recommendations about
funding allocations. Some people felt this was an efficient use of time, but others felt that it lacked
transparency.
Interviewees shared that in the past, MH/SA had set percentages for different funding categories, but
those were eliminated since they were viewed as “arbitrary.”
Membership
The majority of interviewees commented that Jefferson County was a small community and some of the
MH/SA members have potential conflicts of interests due to their connections with funding recipients.
Interviewees described informal mechanisms for reducing conflict of interest issues, including members
recusing themselves from voting or leaving the room during discussions that affect an organization they
are affiliated with.
A few interviewees noted that there was not a clear process for recruiting new members. MH/SA also
lacks any clear guidance regarding terms or term limits.
6
Funding Priorities
All interviewees understood that the basic priorities for the 1/10th of 1% sales tax funding are outlined in
state statute (RCW 82.14.460) and local ordinance (Jefferson County 08-1003-05 2005). However,
interviewees noted that these legal edicts still allowed some flexibility and there were a variety of
opinions on how funding priorities should be determined, including:
Funding should be allocated based on needs.
Funding should be allocated based on the outcomes of each provider, rather than outputs.
Funding should be directed towards preventative services.
Funding should be allocated to a mixture of long-standing recipients, as well as new providers.
Substance Abuse Advisory Board
Many interviewees shared that the Substance Abuse Advisory Board’s (SAAB) role has changed in recent
years. It was noted that there may be some duplications between SAAB and MH/SA. Some interviewees
expressed interest in possibly merging SAAB and MH/SA. Or, as an alternative, some interviewees were
interested in having MH/SA play a policy guidance role to the Jefferson County Commissioners, in
addition to making funding allocation recommendations. Another possibility would be to have the SAAB
serve as the core committee to manage/implement or serve as the backbone for the Mental Health and
Substance Abuse Priority area of the Community Health Improvement Plan.
7
Attachment C: Envisioning Success Transcription
MH/SA Retreat participants were asked to answer this question: “Imagine it’s 2020 and we are all back
in this room, what has happened that shows MH/SA has been successful?” Below is a transcription of
participants’ responses to this question, grouped into themes that were developed during the retreat.
Values:
We always looked at the big pictures and didn’t overly focus on one component.
We maintained our perspective and kept the lessons of the past in mind and remained open to
new learning.
We maintained empathy and understanding for each difficult choice we made.
We remained thoughtful not reactive.
We brought flexibility to the table when faced with unexpected exigencies.
We preserved mutual respect and treated one another cordially.
Structures:
We will have bylaws that structure committee roles, term limits, and direct investment oversight
(admin, evaluation).
Clear by-laws/policies regarding funding allocations for reg. RFP’s/Supplemental RFP’s and
emergency funding.
1/10th committee has created: bylaws, policies/procedures, more structure to funding requests
(RPFs, emergent, and supplemental), membership process/structure.
Funding is allocated based on clearly defined goal and objectives and focuses on gaps and
prioritized community needs.
MH/SA-Adv. Committee yearly retreats to review goals, priorities, outcomes, gaps, community
needs.
No committee member served on the committee if they had a conflict of interest that would not
be mitigated.
Staff Support:
We supported our staff.
Providers:
NFP (nurse family partnership)
Jumping Mouse
Local Workforce:
We kept local providers of mental health and substance use disorder.
Outcomes (General):
We provided support to the full spectrum of human need – birth to adult
Outcomes (ER Visits):
____% reduction in ER visits as attributed.
Reduction of use of emergency dept. for acute MH or SA episode.
8
Outcomes (Jail):
Jail or Ed do not receive MH or SA people who are better served elsewhere (diversion) because
diversion locations and services are available.
We increased # of jail inmates who were treated for mental disorders and were subsequently
rehabilitated.
Case management program for the jail to reduce recidivism.
Halt the pipeline into the jail – with a “warm-hand” off (case management) for inmates leaving
jail (housing, employment, treatment).
___% reduction in jail bookings, as attributed to 1/10 of 1% funded programs.
Reduction of # of individuals incarcerated with mental illness or substance use.
Outcomes (Children and Youth):
We decreased # of teenage suicides/attempts by increasing access to school based clinics.
We have MH programs in all our schools with therapists available separate from the school
counselor – and these therapists are clinically supported with sufficient clinical supervisor – our
teachers have regular clinical support to help with dealing with children in their care.
___% reduction in ACES (Adverse Childhood Experience).
Outcomes (Opioid):
We addressed the opioid epidemic by preventing excessive use of painkillers through treatment
of their addiction by establishing a new task force to foster collaboration among local agencies.
We integrated our local clinical health providers with the MH/SA providers (decrease in opioid
use)
Outcomes (Housing):
For MH and SA clients: we have transitional housing – sufficient for the needs – with connected
services provided. We also have transitional programs for folks coming out of jail, to connect
with housing, employment, and support services.
We provided transitional therapeutic housing for released/incarcerated with MH/SA diagnosis.
Reduction of # of homeless through increase in permeant housing and housing stock.
Collaboration:
The advisory committee is connected to and understands federal, state, and local funding
available; what it can be used for and how 1/10th funding can complement or leverage.
We will have accomplished coordinated funding with BHO, OCH, and other partners.
1/10th committee has been a resource in creating a true funding picture in Jefferson County;
funding streams known and max efficiency with dollars that come in.
Evidence Based Evaluation/Return on Investment:
We will have a system of evaluation program results to understand impact and outcomes and
community/population level.
9
Attachment D: Transcription of Break Out Group 1: Bylaws
Below is a direct transcription of Group 1’s responses to the prompt: what questions do you need to
answer in order to develop bylaws for the MH/SA Advisory Committee?
Mission Statement
o Staff will create samples and sent to committee
Membership
o Open public meeting training
o City, law, school, courts, O3A, EMS, BOH, Hospital, consumers, community members,
youth serving org., jail
Terms
o 3 year staggered term
o Limits?
Meeting frequency
o Monthly? Bi-monthly?
o Advertised?
o Annual retreat?
Conflict of interest language
o Leave the room?
o Recuse oneself?
o Quorum, purpose, duties, appointment, termination, resignation, removal
Sub-committees/Ad Hoc
10
Attachment E: Transcription of Break Out Group 2: Policies
Below is a direct transcription of Group 2’s responses to the prompt: what questions do you need to
answer in order to develop policies for the MH/SA Advisory Committee?
Annual or biennial review of priorities?
RFP/RFQ review of responses – full committee or subcommittee
o Who – initiate outside eyes
o Clarification process
Regular vs supplemental
o Same or targeted?
On-going support or new look every year
Committee can direct funding based on needs
On-going
o No RFP?
o SBOH – not duplicate?
o Include an increase clause?
o Separate $ for new and innovative
Use of BHO reserves?
What happens when BHO go away?
Counties and MCOs in the future
o Medicaid TX Service
o Crisis – ASO
o Co. Govt. stay in Medicaid game or not?
Process
o Ask questions (identify them)
o SWOT and Gaps
o Policies to define processes