HomeMy WebLinkAboutMH Provider Meeting Minutes 09-14-18Mental Health Provider Meeting
Friday, September 14, 2018
MH 1 9/14/18
MEETING MINUTES
Welcome & Introductions
Everyone introduced themselves and their agency affiliation.
Provider Announcements and Updates
Keystone Rural Health Center
As of Monday (9/17), Keystone will have eight (8) psychiatrists. They have added two (2)
Child/Adolescent psychiatrists and will be adding an Adult psychiatrist on Monday.
Keystone has also hired a Physician Assistant (PA). In addition, Keystone is seeking
Therapy personnel. If anyone knows of a therapist seeking employment, please refer
them to Keystone.
Keystone started Transcranial Magnetic Stimulation (TMS) services. So far, they are seeing
positive results. Keystone has partnered with Brain Sway. TMS uses a helmet that is
positioned accurately onto an individual. The magnet stimulates the brain and relieves
depression. It has been approved for OCD and is in research for other things. There are
no side effects to this treatment minus a slight headache or discomfort from the helmet.
There is also no memory loss. The treatment takes approximately 20-27 minutes every
day for 4-6 weeks (5 days a week). After 4-6 weeks, some individuals may need a booster
(an additional 1-2 sessions). This service started four (4) weeks ago. For those currently
receiving treatment, Keystone has seen differences within two (2) weeks. There is
potential to eliminate medication and hospitalizations. This service is not typically
reimbursed by Medicaid. However, PerformCare is working with Keystone on a private
project with this. More information will be gathered as individuals complete treatment.
Kelly Goshen and Lori Young are co-chairs of the Mental Health Task Force; Kristin Fisher
is sub-chairing Children’s Services Committee. They are in the works of trying to revive
the task force/committee as well as add new members. Kelly has been in contact with
others. If your organization is interested in being a part of the task force and/or
committee, please contact Kelly or Lori.
Family Care Services
Family Care Services is seeking Case Workers in Foster Care and IDD services. If you know
of anyone who may be interested, please have them contact FCS.
Mental Health Association
MHA is hiring part time positions for Survey HelpLine Call Specialist and Peer Support.
Please contact MHA if interested. HelpLine is open seven (7) nights a week from 5:00
p.m. to 10:00 p.m.
Provider Meeting Survey Summary
Thank you to all who responded to the MH Provider Meeting survey. The feedback has been
very helpful! We are working on trying to make the meetings more beneficial and informative.
Question #1: What do you consider to be the most helpful/beneficial parts of the provider
meeting? – The top responses were provider updates and announcements and county updates.
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Question #2: What do you consider to be the least helpful/beneficial parts of the provider
meeting? – The top response was hospital report. The hospital report was emailed to providers
along with the agenda. The meeting agenda will allow time to respond to questions but the
meeting will no longer spend extra time discussing the report.
Question #3: What specific suggestions do you have that would make these meetings
helpful/beneficial to you/your agency? - Based on responses, there are a few things that MH
will be working on, such as type of programs counties are looking for or areas of services that
need more support and providers, information that is going on from the state level, and
developing a county wide goal/identified issue that the group can work on together.
In addition, MH would like to give opportunity for providers to be in the spotlight. Jim passed
around a Provider Spotlight document for providers to sign up to present at a MH Provider
Meeting. Another document handed out was the Community Resources Spotlight. The survey
responses mentioned wanting to know about community resources. The document listed
several resources that Jim is aware of. He requested providers write in contact names for the
resources as well as write any questions that they may want to know about others agencies.
Based on provider responses to the above mentioned documents – Service Access &
Management (SAM) will be presenting at the December 14, 2018 meeting; Pennsylvania
Counseling Services (PCS) will be presenting March 8, 2019; and TrueNorth Wellness
Services will be presenting June 14, 2019. At this point, September 13th, 2019 and
December 13th, 2019 are available for presentation. If anyone is interested in presenting,
please contact Jim to sign up.
Presentations/Training
Crisis Intervention Team (CIT)/Co-Responder Programs
Crisis Intervention Team –
CIT has been in place for five (5) years with local law enforcement, mental health
advocates, and providers building a relationship. The goal is to move that relationship
from courtship to marriage. Courtship is a casual relationship while marriage is a formal
relationship that we must work hard to foster. That involves policies and procedures.
Challenges that are faced in the behavioral health system are: always being worried who
is funding the program, where the money is coming from, is the money able to be
shared, competing with priorities, access to services, are we providing the right services,
inadequate training, getting people trained and finding funding for it, etc. There is a lack
of understanding about law enforcement, policies and MOUs when working with law
enforcement and the criminal justice system, HIPAA, mental health law as well as the
workforce.
Challenges that law enforcement faces: worrying about funding, not enough money for
staff, equipment, training, etc., competing with the same priorities as we are, inadequate
training, access to services, etc. They have a lack of knowledge about behavioral health
field and sharing HIPAA as they are not bound to HIPAA. They have a lack of policies
and MOUs and a dwindling workforce.
As shown above, there are common themes for behavioral health system and law
enforcement. We assume each other understands each system. Each system is facing the
same problems, seeing similar individuals and has similar goals. Both systems are public
servants and do challenging work. There are limited responses, manpower and support.
The community would like to see more of us working together! We are working towards
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joint common things, such as goals and outcomes. There are various things that can be
done due to grants and data obtained.
CIT courses will continue in order to build relationships. Refresher courses will be
conducted as well as behavioral health training. CIT is a 40 hour course. Law
enforcement has learned about mental health and various resources but what do we,
the mental health system, do to teach our staff about their system. We are going to work
on training on Cop Culture and how to talk to law enforcement. If anyone has any ideas,
please share with Cori Seilhamer.
The next training is December 3rd – 7th at the Public Safety Training building. The training
is free to attend. A flyer will be coming out next week!
Cori and Kay will be presenting “How Being Trauma Informed Improves the Case
Management Response” at Training Days on October 16th at Rhodes Grove. This is a four
(4) hour training for mental health/case managers.
Co-Responder –
The County has partnered with Keystone Rural Health Center on a Community Liaison
that is housed in Washington Township, Greencastle and Waynesboro Police
Departments. We have been recently granted the ability to extend the liaison program
into the Chambersburg area.
Washington Township, Greencastle and Waynesboro make up 20% of Franklin County.
At the time of looking at the Co Responder grant, the southern part of the County was
specifically recommended due to lack of services, higher suicide rate and lack of
transportation. The grant was written for two (2) years where we thought we’d only see
80 individuals. Within a year, this program has seen 240 individuals; resulting in 1,956
contacts. Of these individuals, about 20% are in the 60 years of age and older age
bracket and 16% are under 18. This was not expected when originally applied for. The
youngest referral was 7 years old and the oldest was 98 years old.
Suicide activity is the reason for the most referrals followed by behavioral related issues,
domestic violence (including issues with parents and children), and frequent callers.
Frequent callers are those who call law enforcement 3-4 times a day just because. These
individuals do not have someone to talk to or they think something is happening in their
homes. A good bit of the individuals seen in the program have a documented serious
mental illness. However, some of the other individuals could have a serious mental illness
but do not have the supporting documentation. There are many individuals with co-
occurring diagnosis as well. Referrals can be made to various programs/agencies, such
as Get Back Up for Drugs & Alcohol.
Of the 240 individuals served, 106 are already receiving services. Those involved look to
see how we can get individuals engaged back into services to keep them out of the
criminal justice system. Of the numbers reported, we have been able to get 61
individuals into services, re-engaged into services, or added additional services; 36
individuals have been diverted from the criminal justice system and 23 have been
diverted from involuntary commitment/302.
Kay Martin, Community Liaison, stated that the biggest reason the Co Responder has
been so successful is because law enforcement is on board. They have bought into the
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program and make referrals. Co Responder is excited to expand into Chambersburg.
Almost all of Chambersburg Police are CIT trained. Kay spoke to the effect of her, Cori
and Keystone naming the position Community Liaison in order to take behavioral health
out of the name as the program involves so much more. Kay works with various police
departments, drug & alcohol, humane society, transportation, PerformCare, etc. Some
individuals don’t need formalized services but need to develop their own strategies.
Communicating with Law Enforcement
The police have been called to the third floor at the hospital on many occasions. During
these times, they have been told someone has been assaulted. When the police show up
and ask who has been assaulted, staff states that they are unable to share this
information. Law enforcement has to know what happens and who was involved.
However, due to HIPAA, staff is afraid to report names/information. A handout was
provided titled “Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule:
A Guide for Law Enforcement.” This informs law enforcement of what they are allowed
to ask and what they cannot. They do not need to know individuals diagnosis or medical
record; they just need to know who was involved in the incidents being reported. If
hospital staff does not want to share names, they can send the individuals to the police
and the police can figure the information out. Or they can contact Cori Seilhamer or Kay
Martin and they can work with the police. Basic information is able to be shared with law
enforcement in the event of a threat, concern or danger to someone. Law enforcement
is looking for information that would be on someone’s license (basic demographics); not
services, diagnosis, etc.
An article posted in the Jefferson Journal of Psychiatry titled “The Duty to Warn/Protect
Doctrine and Its Application in Pennsylvania” was discussed. In PA, you have a duty to
warn/protect as noted in the Tarasoff case. Law Enforcement has the duty to protect.
Practitioners/staff can tell law enforcement what has happened and they will take care
of it. The documents do not trump your solicitors and attorneys. It’s to develop policies,
change interaction and be prepared for that interaction. We tend to get lost in our
policies but the case of Tarasoff provides information in terms of understanding.
Law enforcement would be happy to come to your agency for a visit. Agencies can work
out a plan on where they should park, enter the building, etc. They are available to train
and educate and allow for staff to talk to law enforcement. When calling the police
department, you can specifically ask for a CIT trained officer. These individuals have
additional training and specialization; 911 Dispatch is also trained and aware of CIT.
CIT/Co Responder is working with 911 Dispatch to develop a flag beside each officer
that is CIT trained. Some departments, such as Shippensburg Borough and Shippensburg
University Police, have MOUs that if they get a call and need a CIT officer but an officer is
not available in their jurisdiction they can send an officer from that jurisdiction to assist.
Chambersburg Police Department has a ride along program. Any adult citizen can ride
along with a police officer during their shift. There is a Citizen Police Academy powered
by Crime Watch that citizens can sign up for in the summer. This is a great program to
get to know law enforcement.
Critical Time Intervention (CTI)
The Critical Time Intervention program will be pairing up with Co Responder, Crisis
Intervention Teams and programs. CTI is in the start-up process. Staff will be getting
trained in October. It is a time limited, nine (9) month program for adults in Franklin and
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Fulton counties. Pennsylvania Counseling Services is working with Crisis Intervention
(Keystone and TrueNorth) to identify adults that would qualify for services. Qualification
is for individuals accessing crisis programs and not engaging in recommended services. It
is not necessarily individuals with a serious mental illness diagnosis who are already
involved in and accessing services. But for those who are not following through with
case management, therapy recommendations, or engagement in other supports in the
community. Individuals involved with CTI will be referred to a CTI team. The goal is to
work at linking individuals to the community. It is a three phase process that is highly
intensive. The team links and connects them to supports, spends time with them, works
on developing a relationship then moves them towards community supports that would
be long term and stabilizing. As the individuals engage, the team will titrate out.
Individuals can have a mental health diagnosis but may not be fully identified.
Individuals can also have drug and alcohol (D&A) concerns but the program is not
meant for D&A only; individual would need to be co-occurring.
Half the team has been hired for CTI. Rebecca Troutman is the Team Leader; Matt Keller
is the Direct Supervisor; and the rest of the team is made up of Certified Recovery
Support Specialist or Peer Support Specialist as well as an individual with a Bachelor’s
who has 2+ years’ experience in Human Services. This would allow for an understanding
of Franklin County and its resources. Those currently hired have been researching the
available resources in the county. Referrals come directly from crisis programs. CTI will
work with Co Responder for those who are accessing Co Responder frequently as well.
Once the program is up and running, information and handouts will be provided.
Originally, the program was designed to capture individuals who were homeless and on
the outskirts of programs, supports, etc. The program has since been used in a wide
variety of ways as it has been implemented.
CTI is a reinvestment plan out of Managed Care. These plans typically have a fairly
narrow population that qualifies for services. The program is not for children. It is looking
at those not engaged in services. As the program is up and running, it can be morphed
into what is needed. Reinvestment plans are flexible. The County will provide funding for
those who do not have Managed Care.
Children’s Services Updates
CASSP
Kim Lucas, CASSP Coordinator, has been participating in school meetings. She has been
working with Service Access & Management (SAM) case managers and supervisors. She
has been partnering with PerformCare to provide presentations on accessing children’s
mental health services. This presentation is always open to providers. As you hire new
staff, Kim and PerformCare can provide this presentation.
Any meetings that staff are aware of children being at risk for out of home placement or
if it is unknown if children are accessing services, Kim can be a navigator to get them
started and to work with SAM.
A flyer will be coming out soon in regards to a Community Provider Meeting at the end
of October at the Coyle Free Library. We are encouraging anyone working with children
(providers, families, staff, etc.) to attend. The goal is to discuss information going out in
the community pertaining to children and families.
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TMCA
OMHSAS has reviewed program descriptions for Youth/Young Adult Peer Specialist by
Mental Health Association (MHA) and TrueNorth Wellness Services. MHA has been
approved. TrueNorth has been moved to the next level of review but not yet approved.
The service cannot start until the provider receives the recommended training. A
schedule is being worked on now.
TMCA’s annual report has not been published yet but will be coming soon. It is currently
awaiting approval from the Board then will be posted to the website. A few things to
note from the annual report are:
There have been over 36,000 members; 6,976 unique consumers for a 19.02%
penetration rate. There continues to be a small increase year after year.
Children’s top utilization consists of 2,196 Mental Health Outpatient (MHOP), 487
Behavioral Health Rehabilitation Services (BHRS) and 323 Targeted Case
Management (TCM).
Adult’s top utilization consists of 3,543 MHOP, 875 Drug and Alcohol Outpatient
and 486 TCM.
Over 28 million dollars have flowed through TMCA’s department to deliver
behavioral health services to Franklin and Fulton counties.
Michelle Mosher’s last day with the County is Friday, September 21st. Her position has
been posted to the County website. Duties have been reassigned in the absence of this
position. Gen and Brad will be handling reinvestment plans.
PerformCare
PerformCare has a new Account Executive that will be starting Monday (9/17), Kourtney
Griggs. She will be responsible for Franklin and Fulton counties. Janina Kloster will be
covering Cumberland/Perry region. Joanna Cordell, Field Manager, has moved to
another position as well. Her position is still open; PerformCare is actively recruiting to fill
that position.
There is an Outcome Tool called DLA 20. Some providers have been trained to use this
tool. TMCA and PerformCare are going to be working to develop a more structured
outcomes reporting program. It will be rolled out in phases. The first level of care will be
Mental Health Outpatient. There are a number of providers that have higher volume
that will be trained to get data that can be reported out based on the outcome tool.
More announcements on training on DLA20 tool will be coming in the fall. A follow up
train the trainer will be conducted as well. The hope is to add additional level of cares to
this training in the future.
County Announcements/Information
Reports due since our last MH Provider Meeting
Audit Engagement/extension letter (FY ending June 30th)
Progress report on outcomes in Appendix A
Quarterly report of expenditures (April – June)
Salary review (FY ending June 30th)
Property purchased/leased report (FY ending June 30th)
Fixed assets purchased with MH/IDD/EI funds (FY ending June 30th)
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Reports due prior to our next MH Provider Meeting
Quarterly report of expenditures (July – September)
MCR Report – Program Funded providers only (due September 30th)
Psychiatric Admissions Reporting
Psychiatric Admissions report was sent out via email to all providers with the meeting
agenda. The report was a comparison of April – June 2018 with April – June 2017. If
anyone has any questions, please contact Jim.
Block Grant Updates and Requests for Proposal
Human Services Block Grant plans have been finalized and submitted. Co Responder position
was covered by a grant that is expiring in December 2018. The service has provided good
outcomes. The Block Grant has agreed to continue to sustain the service through June 2019.
As we work with TrueNorth, funds will be used for their Supported Living Program to potentially
add two (2) additional apartments.
OMHSAS has been putting out information for forensic proposals. MH has looked at two areas –
Co Responder and Specialized Community Residence (SCR). The current Co Responder is only
focused on Waynesboro, Washington Township and Greencastle. With the approval from
OMHSAS, an expansion of Co Responder will move into the Chambersburg area.
With the approval from OMHSAS, we will be looking to expand Specialized Community
Residence (SCR) service but will be forensic driven. Individuals must have past or current criminal
justice involvement or identify that they are at high risk of becoming involved. RFP is out for this
service. SCR will take some time to implement but the goal is to be up and running by May 2019.
Currently, Keystone Service Systems operates an eight (8) bed SCR located on McKinley
Street for individuals with a serious mental illness. The individuals have their own
bedroom but share common areas. Staff is available 24/7.
The expansion of SCR would work with individuals coming out of jail, state correctional
institutions (SCI), have touched the criminal justice system, parole, probation, etc. There
will be monthly treatment team meetings for the residents. These meetings would also
be attended by case management, adult probation/parole, etc. The individuals would be
open with SAM for case management; potentially their Forensic Case Manager. The SCR
would operate under personal care home regulations which means a MA 51 must be
completed indicating that the individual needs this level of care.
We have been able to keep the current SCR full since day one. There are currently eight
(8) individuals on the waiting list. We have reached out to Adult Probation and various
other agencies to get a sense if referrals to the forensic SCR would be feasible; in which it
has been determined they would be. The priority will be for individuals who have been
involved in the forensic system but to keep the facility full, we will look at individuals
coming out of Danville and other situations in order to utilize the resource.
The Block Grant has also awarded funds for Mobile Psych Nursing. A RFP is out to obtain
applicants. Responses can come from individuals or agencies. The expectation is to have this
service up and running after reviewing applicants and making a selection.
The County previously had a Mobile Psych Nurse program for several years. However,
due to funding, the service was terminated. It has been found that having a nurse on
our end with psychiatric training has been beneficial. The nurse is able to go to the
Clubhouse, Personal Care Homes, SCR, senior centers, etc. The nurse is available to
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provide training to staff, complete blood pressure readings, talk about medications, make
assessments, etc. The nurse will be able to work one on one or in group settings.
In the past, the individual worked under psychiatrists. In this case, medications were able
to be provided. It is unknown, at this point, if this component will be available until an
individual/agency is selected. The position is full time; $73,000 salary; must provide their
own insurance.
Both RFPs (SCR and Mobile Psych Nurse) are due by September 28th. RFPs have been emailed to
providers and posted on the County website. If your agency did not receive the email and
would like to, please let Jim know. After September 28th, the RFPs will be reviewed. MH is
working with MHA to have consumer involvement on the review panel. The plan is to utilize
graduates from the Leadership Academy. They will have access to look at the responses
received, score them, interview the applicants, and assist in the decision making of who to
award the respective contracts to.
The meeting was adjourned.
Next Meeting
Friday, December 14, 2018 starting at 10:00 a.m. in the Human Services Building
[425 Franklin Farm Lane, Chambersburg]
2019 Meeting Schedule
March 15th June 21th September 20th December 20th
Minutes by Erin Nye