MENTAL HEALTH & DEVELOPMENTAL DISABILITIES SERVICES
MANAGEMENT REPORT
FOR
FISCAL YEAR 2005
Prepared by
Janice K. Heikes
CPC Administrator
11/05
Comments from the CPC Administrator 3
Overview of Planning Activities 4
Goals and Objectives 5
Profile of Service Network 11
Quality Assurance Activities 12
Statistical Report 13
Table A--Persons Served - Age Group by Primary Diagnostic Category 14
Table B Unduplicated Number of Persons Served by COA code and Disability Type 15
Table C--County Waiting List Report 17
Table D--Mental Health System Growth / Loss Report 17
Table E--County Dollars Spent by COA code and Disability Type 18
FY05 Revenues Cash 20
FY05 Expenditures-Cash 21
MH/DD Fund—Historical Perspective 22
Appendix A—Advisory Board Membership 24
Comments from the CPC Administrator
This past year completes the second year of the FY2004-2006 management plan. Overall, we found our goals to provide direction as we work toward our vision of:
One of the challenges in reporting about the county system is trying to represent all the various components relating to services to individuals with disabilities occurring in the community. Many of the statistics reported in this document reflect only those individuals and services that are paid for with county funds. There are many persons receiving services related to their disabilities that are funded through other funding streams such as Iowa Division of Rehabilitative Services, Iowa Workforce Development, Department of Human Services, Public Health, and other private non-profit entities. We partner with these entities to further our vision as stated above. Therefore, within this report there are numbers which reflect only those within the county system and description of activities that occur across the community.
FY05 completed the first year of combining the Allamakee Case Management Agency with the Howard County Case Management Agency. This collaboration allowed staff to more effectively manage growing case loads, presented each county with the opportunity to look at service delivery in new ways, creating a new agency that is more responsive to consumer needs and operating in a cost-effective manner.
Financially, the Mental Health & Developmental Disabilities fund has stabilized during the past year. Over the past 2-3 years, agencies have begun to provide services through the MR Waiver and Adult Rehabilitative Option Title 19 funding streams. County funds are used as matching funds for the federal dollars instead of paying 100% of the service costs. This means that the mental health levy could be lowered without the risk of not serving present and future consumers. This switch also brought programmatic changes that were more philosophically in line with the vision statement. Contract agency administration and staff have spent much time learning new regulations, implementing policies and procedures, and negotiating new billing processes. As a system, we all look forward to “refining” the process instead of “creating” a new one. Many thanks to all involved, especially consumers and family members, for whom it must have seemed very confusing!
Overview of Planning Activities
The Allamakee County Mental Health & Developmental Disabilities Services Strategic Plan for FY 2004-2006 served as the guide for activities throughout FY 2005. The following describes planning efforts that occurred during FY 2005:
1.
The Allamakee County MH/DD Advisory Board continued to meet throughout the year. Four meetings (in September, October, January, and April) were conducted under the open meeting law with the agenda being posted in the Courthouse. Minutes of Advisory Board meetings are maintained in the CPC office and are available to the general public. A list of Advisory Board members can be found in Appendix A. Advisory Board members were kept abreast of changes in service delivery as agencies moved to federal Medicaid funding streams to provide greater service variety and maximize use of county dollars.
2. Input from Other Areas
At regular meetings of the Board of Supervisors, the CPC Administrator gave progress reports. Overviews of the issues raised at the Advisory Board meetings and the concerns of the providers and families were also shared with the Board of Supervisors. The Board of Supervisors’ meetings are open to the public for community participation and discussion. These discussions often appeared in the local paper so the general community was informed.
In addition, the CPC Administrator met as needed with service providers to obtain input and revise goals. Agency directors and agency boards were especially helpful in providing input and suggestions of how to manage an extremely tight budget. The result was a blend of approaches, which allowed consumers’ needs to be met, agencies to provide cost-effective services within their individual philosophical framework, and
In FY03, due to the number of changes in service and funding streams, providers and CPC administrators from Howard, Winneshiek, and Allamakee counties began meeting on a bi-monthly basis to better coordinate services and systems across the northeast
Goals and Objectives
Note: Due to financial and political uncertainties of the next three years we have chosen to state our goals and objectives in more general outcomes. The action steps reflect some current ideas about measurable indicators of these goals.
Goal 1: People with disabilities will live lives no different than people without disabilities.
Objective A: Our community will actively include all people regardless of disability.
Action Step 1: Increase the number of individuals with disabilities participating on community boards and committees and volunteering in community service organizations.
FY04 Progress: Three consumers serve as members of the Allamakee County MHDD Citizens’ Advisory Board.
Six individuals volunteer at local nursing homes visiting residents, some of which they may or may not know. This benefits both those visited and those who visit.
TASC, Mosaic, and Makee Manor all have consumer advisory boards.
Several individuals planted flowers at the
Individuals served by TASC take an active part in staffing the TASC Information Booth at the Allamakee County Fair, Taste of Postville, Corn Days, and River Boat Excursion days.
Four consumers and a staff person from Mosaic are board members of Fair Plan, a group working to bring accessibility improvements to the county fairgrounds. This effort is funded by Real Time Community Change, from the Governor’s Council on Developmental Disabilities.
FY05 Progress: In addition to those activities mentioned in FY04, there is a consumer on the Allamakee-Howard Case Management Advisory Board which meets quarterly.
Action Step 2: Increase the number of individuals with disabilities participating in religious activities (other than worship) such as church choirs, helping with funerals, and participating in church dinners.
FY04 Progress: Four individuals are active members of various church organizations, including being part of the bell choir and serving as ushers.
Two individuals led prayers (without assistance) at Mosaic’s Autumn Banquet.
Individuals in three homes host monthly “Fellowship” meeting which provide “low-key” spiritual and fun events along with sing alongs and potluck suppers.
FY05 Progress: Participation remains at the FY04 level.
Action Step 3: Increase community advocacy, education and involvement in legislative issues dealing with people with disabilities.
FY04 Progress: Both Mosaic and TASC staff provided training and encouragement on how to participate in the election process, including the distribution of information from ID Action. Several individuals voted in this last presidential election, and one individual attended the local caucus meeting.
Many of the people served by TASC have been involved in the planning and capital campaign to expand the facility.
FY05 Progress: On April 6, 2005, a van of consumers, family members, and staff traveled to
Objective B: All members will have the right to risk both failure and success.
Action Step 1: Increase the number of individuals with disabilities working in community businesses for real wages.
FY04 Progress: Seven individuals have been competitively employed within the last year. Places of employment include Quillins, Stoney Creek Inn, Northern Engraving,
FY05 Progress: As noted in the chart below, the number of individuals receiving supported employment services this past year decreased. CPC, case management, and agency staff continue to explore reasons/trends that this occurred.
Action Step 2: Increase the number of individuals with disabilities living in affordable housing in communities of their choice.
FY04 Progress: At present, Mosaic serves 9 individuals living in their own homes with services funded through the Medicaid Home and Community Based Services (HCBS) Waiver program. Many of these individuals choose to decorate their rooms to their own tastes.
Nine individuals served by TASC live in affordable housing in various communities and receive “drop-in” services. Others live in the Supported Community Living Apartments where they receive assistance with daily living skills. Others choose to live with more support in homes where services are funded by HCBS where they receive more one on one attention and assistance with their daily living skills.
Overall,
FY05 Progress: Two individuals moved from care facilities to their own homes with supports through the HCBS/MR waiver.
Objective C: Individuals will actively assert both personal responsibility and rights when utilizing services.
Action Step 1: Increase the number of individuals with disabilities making their own decisions and accepting the consequences, both positive and negative, with the support of their families, friends, and providers.
FY04 Progress: Various individuals have voiced their wants and needs to their team, requested assistance in obtaining these things, and ultimately got what they desired. One individual purchased a vehicle so that he could have a means of transportation. He requested assistance from his team in helping him budget this into his monthly expenses, and within a couple of months obtained his truck. Another individual requested assistance with obtaining the skills necessary to drive through the driving simulator and driver’s education in order to obtain a driver’s license and vehicle to aid in more employment possibilities. Another individual requested help from his interdisciplinary team to change living arrangements as he desired more assistance with daily living skills. He moved from the SCL apartments to a HCBS house.
Seven individuals served by TASC have asserted their right to be healthy, and expressed an interest in participating in an exercise program. These individuals go to the local hospital to receive education in weight training and cardio exercise.
Individuals in all HCBS settings make their own choices about what to purchase for clothing and groceries and what to eat. They also choose which activities they wish to participate in.
Mosaic is supporting all persons served in not only learning their rights, but actually exercising them. They use the United Nations’ Declaration of Universal Human Rights as a guide and have formed a Human Rights Committee to keep them on the right track. Some outcomes have included: several individuals having computers with internet access, allowing them to surf the web and have email access; other persons are able to spend time without staff supervision and have those guidelines outlined in their service plan; and one individual choosing to move to a different town to be close to family despite objections from other individuals.
FY05 Progress: During FY05, Makee Manor began providing services through the HCBS Waiver program (Title 19). This change in philosophy and funding has improved the quality of life and increased opportunities to make choices about their lives for five individuals. Although they remain living in an “institutional setting”, their daily choices are enhanced by a different service provision model.
Action Step 2: Provide education for individuals with disabilities, their families, service providers and the communities, about consumer rights and responsibilities as people, clients, workers, volunteers, board members, friends, community members, etc.
FY04 Progress: Five individuals served by Mosaic are their own payees. All individuals have a key to their own home.
At TASC, each individual (and their guardians) review their rights and responsibilities on a yearly basis in detail, usually prior to their annual staffings. This helps ensure that individuals are aware of their rights as well as understand the responsibilities that come with those rights. Additionally, we’ve had classes open to all the people served regarding the meaning of responsibility that goes with each respective right.
FY05 Progress: No formal education program was presented in
Goal 2: Our community will provide an array of opportunities that aid in life’s transitions.
Objective A: Individuals’ entry into the system at any point, whether accessing child or adult services, will be straightforward and simple with helpful interactions between professionals and clients.
Action Step 1: Increase education of community gatekeepers from a variety of service groups about individuals with disabilities and the services available with emphasis on the referral process.
FY04 Progress: The CPC Administrator and agency staff are members of the Allamakee Interagency group which meets quarterly to share information about services and issues within the community.
FY05 Progress: The CPC Administrator has been part of the Keystone Transition Advisory Board which has developed several tools to aid in the referral process from schools. Staff have also been part of the advisory board for the Safe Kids/Safe Communities grant.
Action Step 2: Increase community education about access to services to increase knowledge and decrease stigmatization.
FY04 Progress: Due to changing funding streams of existing programs and new referrals from schools, no formal education occurred.
FY05 Progress: CAB members developed a community brochure containing mental health resources to be distributed at the County Fair and other community events in FY06.
Objective B: Individuals moving from child to adult services and adult to elderly services will experience ease and assistance from all agencies involved.
Action Step 1: Create advocacy teams of families and consumers.
FY04 Progress: Transition teams are typically created for individuals moving from the child to the adult system. Transition to the elderly system is not clear as to where the official interfaces are. Staff are working on a case by case basis.
FY05 Progress: Case Management and CPC staff attend staffings held as part of the educational system or the DHS transition plan.
Action Step 2: Provide life planning education for clients, family members, and service agencies.
FY04 Progress: Case Management and other agency staff incorporate this aspect into each individual’s ongoing case plan.
FY 05 Progress: Members of the disability community (consumers, family members, and providers) attended a forum sponsored by Northland Area on Aging on 6/30/05 to discuss and explore mutual needs and resources with the aging community. It is an ongoing exploration of resources and collaborations.
Objective C: Our community will provide a supportive and safe environment where clients can transition out of crisis and back to everyday activities.
Action Step 1: Increase training in Wellness Recovery Action Planning with clients and community members.
FY04 Progress: Two individuals at TASC chose to participate in WRAP training and have developed their own plans to help identify “triggers” that might possible set off a psychotic episode. They are encouraged to review the plan daily, not only to keep it at the front of their minds, but to remind them of the triggers and coping strategies.
Funds from the five county area are used as matching funds for the state mental health block grant to
FY 05 Progress: Once again, funds from the five county area were used as matching funds for the state mental health block grant to Northeast Iowa Mental Health center to support the WRAP program. Throughout the year, nineteen (19) individuals with serious and persistent mental illness attended WRAP sessions. The total program cost was $24,968 with $10,508.88 coming from the counties.
Action Step 2: Continue to explore more crisis options in local communities, including psychiatric hospitalization.
FY04 Progress: In addition to
FY05 Progress: In addition to the above options, a contract was signed with
Action Step 3: Continue to explore options for accessible and affordable transportation.
FY04 Progress: Transportation for many individuals is now covered by Medicaid Waiver program, making it more affordable to counties.
FY05 Progress: No changes in this area.
Profile of Service Network
The following services and agencies have been part of the service network in FY2005:
Public Education Northeast Iowa Mental
Case Management Allamakee
DHS Case Management
Transportation
REM Iowa Community Services, Inc.
Opportunity Homes, Inc.
Respite & Homemaker Aid Mosaic
Psychotropic Medication Hartig Drug
Pamida Pharmacy
Psychotherapeutic Services Northeast Iowa Mental
North Central Iowa Mental
Vocational Services Mosaic
REM Developmental Service, Inc.
Spectrum Industries
Systems Unlimited, Inc.
T.A.S.C., Inc.
G&G Living Centers
Supported Community Living
Community Care, Inc
Full Circle Services
Goodwill Industries of
G&G Living Centers
Mosaic
T.A.S.C., Inc.
Spectrum Industries
Systems Unlimited
Opportunity Homes
Oneota Riverview Care Facility/CLASS
REM Iowa Community Service, Inc.
Quality Choices, Inc.
Residential Care Oneota Riverview Care Facility
Makee Manor
Intermediate Care Comprehensive Systems
G & G Living Centers
Harmony House
REM
Inpatient Hospitalization
Commitments-Evaluations
Transportation
Legal Representation
Advocacy
Quality Assurance Activities
- System Evaluation
Consumer and Family Satisfaction
In September and October 2000, consumers with mental illness and chronic mental illness diagnoses were surveyed by the Consumer Resource and Outreach Project (CROP). In general these consumers report an overall satisfaction with their services and supports. This survey establishes good baseline data. Subsequent surveys are planned in 3-4 year intervals.
Consumer Choice and Empowerment
At annual staffings, most consumers express satisfaction in their current lifestyles. A small number of consumers wish to move into their own apartments but are restricted due to affordable housing and sufficient supports. Family members are sometimes concerned about the consumer safely living independently, which sometimes becomes a barrier. Case managers and agency staff continue to educate family members and consumers on consumer choice and safety issues.
Consumer Outcomes
A revised CPC application now requests an outcome statement for each service request. This is the first step in educating our community to think about outcomes.
During FY2005, the CPC Office received 39 new applications. Of those, 15 (38%) were denied service funding. Of those 15, 8 had legal settlement outside
Quality of Life
Consumers report an overall satisfaction with their quality of life.
Provider Satisfaction
The CPC Administrator met with agency staff both individually and as a group. Any concerns were addressed as they arose.
Consumer Appeals and Corrective Action
There were no appeals filed by consumers in FY05.
Cost Effectiveness
Service requests signed by the consumer and case manager list all services with number of units and cost per unit requested. The interdisciplinary team is responsible for putting together the service package in the most cost effective manner.
B. Consumer and Family Involvement
During FY 2000, the structure of the consumer/family board changed drastically. The original Managed Care Board was responsible for all policies and procedures, including staffing and funding decisions. This at times conflicted with the decisions/wishes/policies of the Allamakee County Board of Supervisors. The CPC Administrator felt caught between two bosses with different philosophies. In September, the Board of Supervisors rescinded the Managed Care Board bylaws, taking back full responsibility for all polices and procedures. A CPC Advisory Board consisting of eight members was appointed. Board members include consumers, family members, and citizens at large. Input from consumers and family members is valued and is incorporated into policy decisions by the CPC Administrator and the Board of Supervisors.
Statistical Report
The county MH/DD service system is part of a larger whole that includes financial support through social security disability checks and medical services through Medicare/Medicaid. It also includes support from family, peers, and employers as well as other resources in the community. Local county dollars are the source of last payment, and meant to cover the cost of those services not funded elsewhere. Financial guidelines are set at $2000 or less in resources, and 150% of poverty level or below. Persons must also meet the diagnostic categories of mentally ill, chronically mentally ill, mentally retarded or developmentally disabled.
The following five tables show the number of individuals that the county paid for services received from 7/1/04 to 6/30/2005. Not counted in the system are those individuals receiving crisis/emergency services at
Table A--Persons Served - Age Group by Primary Diagnostic Category
Date Prepared 11/28/2005
DISABILITY GROUP Children Adults Unduplicated Total
Mental Illness 11 38 49
Chronic Mental Illness 0 36 36
Mental Retardation 0 68 68
Other Developmental 0 5 5
11 147 158
One-hundred-sixteen (116) individuals were served in FY97, 111 individuals in FY98, 171 individuals in FY99, 143 individuals in FY00, 168 individuals in FY01, 169 individuals in FY02, 159 individuals in FY03, 156 individuals in FY05 and 158 in FY05. This growth represents an increase of 42 individuals since FY97. Overall, the numbers remain fairly constant in the MR/DD groupings. In the mental illness grouping, there was a decrease from 52 to 49, and an increase from 35 to 36 in the chronic mental illness grouping. This is a service area that has traditionally felt to be underserved and is therefore more representative of the need that exists.
