KEMP NAMED SERVICES BOARD EXECUTIVE

     Cindy Kemp, a veteran employee of Arlington mental health services, last month was named executive director of the Arlington Community Services Board and chief of the Human Services Department’s Behavioral Healthcare Division.

     She succeeds John Russotto, who resigned those positions last November.  Kemp has been serving as acting executive director since that time.

     Kemp joined Arlington County in 1982 as a Mental Health Therapist.  In 1989, she developed Arlington’s Clarendon House clubhouse, and became the first manager of the psychosocial rehabilitation program, which is modeled after New York City’s Fountain House program.  She also served as supervisor of Community Support Services, during which she developed Arlington’s Program for Assertive Community Treatment (PACT).

     At the time of her appointment as Community Services Board acting executive director, Kemp was serving as acting Mental Health Chief.  In this capacity, she developed and won for Arlington the federal funds for Project Resilience.

     Kemp was one of the initial recipients of NAMI-Arlington’s Recognition Award, receiving the award in 2001 for her contributions to strengthen Arlington’s mental health services.

     As acting executive director and chief of the Behavioral Healthcare Division, she has appointed key program managers and fleshed out the reorganization of mental health and substance abuse services.

     Kemp is the most recent of several ACSB executive directors.  In NAMI-Arlington’s 11 years of existence, Arlington has had an executive director for about 50 percent of the time.  Michael Holder served from 1993-1995.  Lenny Ames was executive director from 1996-1997.  John Russotto served from 1998-2002.

     The lack of continuity in leadership of the Arlington CSB was one concern raised by Durman Associates, consultants who reviewed the administration, management and operation of the CSB.  For the story related to this point, see page 6    

SERVICES BOARD DEVELOPS BUDGET

     The Arlington Community Services Board (ACSB) is expected to seek $1.64 million in Fiscal 2005 County funding to support urgent housing needs for 21 individuals who suffer mental illness and mental retardation or who abuse substances.

     The $1.64 million, of which $180,000 represents one-time costs, covers the operating expenses for intensive care or transitional residential services.  “Without these services, consumers will remain in the hospital or in residential treatment facilities, be discharged to our shelters or remain homeless,” the ACSB report said.

     Of the amount, $1.3 million covers the placement of at least 10, and possibly 12, adults, adolescents and children with mental illness or substance abuse issues.

     As its top priority, the Board’s Mental Health Committee urged development of three 24/7-group homes for severely, persistent mentally ill individuals with behavior problems, and individuals dually diagnosed with mental illness and mental retardation or substance abuse issues.  Operating these homes carries an estimated annual cost of $2.3 million.  The Committee also catalogued Behavioral Healthcare Division unmet needs of $2.3 million.  These included:

·         Medications for indigent clients ($25,000).

·         Therapist/Case Manager for Outpatient Team ($60,000)

·         Transitional programming for young adults ($256,000), which would assist high school graduates with psychiatric diagnoses to move into adult mental health programming, including supported employment.

·         Psychosocial day support for older adults with mental illness ($150,000).

·         Part-time staff member to oversee the CSB’s residential program contracts ($32,000).

·         Staff member for The Job Avenue ($55,000).

     The County this year is investing more than $2.3 million in past ACSB priorities of unmet mental health service needs.  These include funding for enhanced mental health services in the jail and at the Residential Program Center (a County homeless shelter), enhanced primary and psychiatric care at the Drewery Center, establishing a dual diagnosis program and hiring a part-time manager for Consumer Programming.

     The Human Services Department this month forwards its proposed budget to the County Manager who will develop his budget for consideration by the County Board.  The Board will review the Manager’s plan, and adopt a final budget document in April.  The fiscal 2005 budget covers the period July 1, 2004, to June 30, 2005.

IN MEMORIAM

     We of NAMI-Arlington have lost a friend and advocate for those with mental illness with the passing of Jane Jack.  With her husband Bob, Jane was a mainstay within our NAMI-Arlington community, offering wise counsel and support for many families who cared for an ill relative, just as she and Bob did.  A pioneer in the family movement, her contributions affected many.  She was among the original members, if not a founding member, of Pathways to Independence (the precursor group for NAMI-Arlington), NAMI-Northern Virginia, NAMI-Virginia and the Friends of Clarendon House Inc., all of which support those with mental illness and their families.  She served for many years as a member of the NAMI-National Literature Committee, and many of the books on mental illness subjects that NAMI recommends are books that she introduced.  NAMI-Arlington offers its sympathy to Jane’s family and many friends.  We share their loss.

REGIONAL REPORT URGES RETENTION OF INSTITUTE BEDS

     A regional planning group is urging the state to retain the 127 beds at the state’s Northern Virginia psychiatric facility.

     In an Interim Report to Commissioner James Reinhard of Mental Health, Mental Retardation and Substance Abuse Services, the Steering Committee of the Northern Virginia Regional Partnership Planning Project said “no beds should be closed at the [Northern Virginia Mental Health Institute] at this time.”

     “This recommendation is based on anticipated population growth through 2010 and the proposed reduction in private-sector psychiatric beds for adults in Northern Virginia.”  The statement echoed a March letter that said it was not deemed “feasible at this time to reduce the bed capacity” at the Institute.

     The Regional Partnership was formed this year to respond to Reinhard’s Reinvestment Project, which calls for the reduction of beds at state facilities and using those dollars for community-based services. 

     “Our region is barely able to meet current needs despite having the lowest per-capita rate of using state facilities.  In addition, we have a growing population, reduced local funding for some CSBs, and the possibility that some private providers of inpatient psychiatric care may either relocate or reduce the number of adult inpatient beds operated in Northern Virginia,” the letter said.  There is “serious concern that Northern Virginia may actually require additional publicly funded mental health services – including inpatient psychiatric care – over the coming years.”

     The region has seen the loss of psychiatric beds with the closure of psychiatric units at hospitals in Culpeper and Alexandria and a Leesburg-area facility that treated children and adolescents.  In addition, Healthcare Corporation of America (HCA) is proposing to close its Arlington and Falls Church facilities, both of which have psychiatric beds, and to move those beds to Loudoun County.  (See related story on page….)

     The planning project brings together the five Northern Virginia CSBs – Arlington, Fairfax-Falls Church, Prince William, Loudoun and Alexandria – their staffs, family members and consumers of the public mental health, mental retardation and substance abuse systems.  The group agreed to focus on adult mental health services with special emphasis on persons with serious mental illness.

     Separate work groups focused on specific issues.  The Mental Health Work Group looked at hospital usage, forensics, NGRI (not guilty by reason of insanity) status and co-occurring mental illness/substance abuse issues.  A Structural Work Group is reviewing the overall structure of mental health services.  A Private Hospital Work Group is reviewing issues common to public and private psychiatric services.  Initial efforts developed considerable data on the region, including the projection that the Northern Virginia population will increase by more than 20 percent to 2.2 million by 2010.

     The region gained $2.5 million in state funds this year, and will use $1.8 million for the purchase of psychiatric beds at private hospitals, $550,000 to enhance diversion and discharge projects and $50,000 for discharge assistance.

     Other actions established the Partnership’s vision and guiding principles that, among other things, call for ensuring quality services, ensuring consumer and family protections and broadening community service options.  The principles emphasize the use of the Recovery Model in service planning and practice.

     The Interim Report also cites a Steering Committee finding that the number of Northern Virginians with no health insurance or inadequate coverage for psychiatric care is increasing.  “Many indigent people are ineligible for Medicaid because of Virginia’s restrictive eligibility.”  It added that most of the 28 percent of those uninsured are treated as charity care by private hospitals.

     In a related item, the plan to reduce 43 beds from Eastern State Hospital and place those patients in community care was delayed for 30 days last month.  One reason for the delay was the search for a project coordinator who will act as a liaison between the state facility, private hospitals and the local community services board.  Doctors at Eastern State are opposing the plan to close beds there.

NAMI-NORTHERN VIRGINIA DEVELOPING FAIRFAX JAIL-DIVERSION PLAN

     NAMI-Northern Virginia is partnering with the Fairfax-Falls Church Community Services Board (FFCCSB) to develop a pilot program to divert individuals with mental illness who are charged with a crime from jail and into treatment programs.

     “Jail is no place to treat those with mental illness,” said Carol Ulrich, NAMI-NV president, in opening the September Speaker’s Program that unveiled the jail-diversion project.  Many who are mentally ill cannot post bail and languish in jail between their arrest and trial.  Under the proposed project, NAMI-NV will provide bail for nonviolent misdemeanants, and NAMI-NV volunteers will serve as mentors to support the individuals’ entry to treatment as an alternative to incarceration.

      “Jail diversion is a simple concept, but not easy to do,” said Steve Weiss, head of the Fairfax-Falls Church CSB’s jail-based programs.  “What we know is that individuals who are mentally ill are at risk of ending up in jail.

     “Common sense and experience show that a lot of the population has shifted.  Thirty years ago those with mental illness would be in hospitals.  Today they are in jails.  The charge is negligible, but since many have burned their bridges behind them, there is no one to pay their bail,” Weiss said in explaining the conceptual basis of the pilot project.

     He pointed out that the average stay at New York City’s detention center is 42 days, but those with mental illness are incarcerated an average of 215 days.  Similar statistics hold for the Los Angeles jail which, Weiss said, has more individuals who are mentally ill than state hospitals.

      FFCCSB panelists discussed the role of their separate programs in the process of diverting individuals to treatment instead of jail.  Chris Tull of the FFCCSB’s Woodburn facility said his crisis-team workers intervene with police before an individual is arrested.  “We do roll-call first-responder training to help police recognize the signs and symptoms of people who are mentally ill.  Woodburn also works with released individuals, providing psychiatric care and medications.  “We are a resource for folks who are coming from jail,” Tull said.

     Sandy Lopez works within the Fairfax Detention Center.  Although no one at the jail can be forced to be on medication, most choose to take them.  “They stabilize quickly when on meds.”  Lopez’ program focuses on relapse prevention and education to help the individuals understand that medications help control symptoms.  “They want to be normal,” she said.  “They have a choice at jail.  A lot depends on their participation.”  Jail staff tries to connect individuals to services, but she noted there is recidivism.

     Tim Manley, another FFCCSB staff member at the jail, agreed.  “We do what we can in jail.  We provide medication and we provide a therapeutic environment.  But, the individual gets a criminal record.”  Manley wants to stop the cycle of recidivism. .  “We want to bring them someplace else.”  Jail is no place to treat those with mental illness, he repeated.

     The proposed mentor system will connect individuals to services in the after-arrest phase, and to provide structure.

     Dale Davidson, in charge of the FFCCSB’s homeless outreach, said a major issue is the need for housing.  He estimated that between 81 and 86 percent of those living on the street were seriously mentally ill or abused substances or had both disorders.  Davidson said adequate housing is one way of “truly diverting people from jail.”

PRINTING AND MAILING COSTS – HELP!

     NAMI-Northern Virginia generously supports the printing and mailing costs of The Arlington Voice and has done so since the Arlington newsletter began in 1992.

     Total monthly costs for production and mailing of each issue has now risen to more than $375.

     NAMI-Arlington has been publishing The Arlington Voice for the past 11 years, but has only solicited support from readers three times — in 1996, 1999, and 2001, although we are always thankful and appreciative of donations.

     We are hoping that you believe The Arlington Voice is worthy of your support, and that, perhaps, you might contribute to help NAMI-Arlington cover some of our costs and ease our financial dependency on NAMI-Northern Virginia.

     The Arlington Voice goes to nearly 500 individuals, mostly in our Northern Virginia region, but also to many others across the state.  It is distributed to our local and state policymakers, adding to the voices of others in spelling out mental illness issues from a family and consumer perspective and in making it clear what public-sector care must be for adults and children with serious mental illness.

     We of NAMI-Arlington do not seek a membership or subscription fee because of our affiliation with the NAMI-Northern Virginia.

     We encourage NAMI membership through our Northern Virginia affiliate.  At $35, NAMI-Northern Virginia membership is a bargain and a partnership in support and advocacy at the local, state and national levels.  A membership includes four newsletters – NAMI’s Advocate, NAMI-Virginia’s The Network, the NAMI-Northern Virginia’s excellent monthly newsletter and, of course, our own The Arlington Voice.

     If you are inclined to support this appeal, please make your check payable to the NAMI-Northern Virginia, a tax deductible 501(c)3 organization, and send it in care of Betsy Greer, 4141 North Henderson Road – 624, Arlington, VA 22203.  We will record your contribution before passing it on to NAMI-Northern Virginia.

ANNUAL LEGISLATIVE BREAKFAST SET FOR DECEMBER

     The Northern Virginia Coalition for Mentally Disabled Citizens has set Friday, December 5, for its Annual Legislative Breakfast that, this year, will be held at 7:30 a.m. at the Holiday Inn at Fair Oaks in Fairfax.  The theme this year is “Setting the Priorities:  Where Do We Stand?”  Mark your calendar now for the Breakfast so that you will be sure to attend.

     This is the time advocates have the opportunity to meet and be with members of the Northern Virginia delegation to the Virginia General Assembly, and to discuss the programs and services for those with mental illness and mental retardation and for those who abuse substances.  The breakfast also recognizes individuals through its Nancy McDonald Beyer Exemplary Community Service and Distinguished Leadership awards.

     November 21 is the deadline to register for the breakfast.  The cost of a ticket is $20 for consumers and family members and $25 for professionals.  Checks should be sent to Legislative Breakfast Committee, PRS-Falls Inc., Attention: Marilyn Gallant, 500 West Annandale Road, Falls Church, VA 22046.  Or call Christina Annett at 703/531-6395.

HCA AGAIN PETITIONS TO CLOSE ARLINGTON-AREA HOSPITALS

     The Healthcare Corporation of America (HCA) has again petitioned the Commonwealth of Virginia for approval to close Arlington’s Northern Virginia Community Hospital (NVCH) and Dominion Hospital in Falls Church and to move the allocated beds to a new facility in Loudoun County.

     The Health Systems Agency (HSA) of Northern Virginia in October rejected the petition, which now goes to the Commissioner of Health for review.  Arlington County, the Arlington Community Services Board, the Arlington Civic Federation and NAMI-Northern Virginia were among those opposing the proposal.

     NAMI-Arlington also opposed the HCA petition because of the loss of psychiatric beds in the Arlington (and eastern Northern Virginia) area.

     “The petition comes at a time when there is a growing capacity of in-hospital psychiatric beds for the eastern Northern Virginia Region,” Betsy Greer, NAMI-Arlington coordinator, said in a letter to the regional agency.  The petition “comes at a time when population growth requires more, not fewer, psychiatric beds.  We need every existing bed there is,” the letter said.  The petition was filed as hospitals in Alexandria and Culpeper announced closing of psychiatric units, and a Leesburg-area facility announced it was terminating its intensive-care psychiatric services for children.

     Greer said proximity of care is important not only to those who are ill, but also to their families who, as primary caregivers, are part of a treatment team.  “Eliminating the opportunity for treatment in eastern Northern Virginia adds to an already overwhelming burden a family faces in coping with the mental illness of a loved one.  It could be an obstacle that prevents much-needed family participation and support.”

     Greer also cited an example of the scarcity of psychiatric beds, noting recently 18 telephone calls were made to find a psychiatric bed for an Arlington consumer.  The effort ended when Tidewater-area facilities – four hours away – were about to be called.  “The individual had to remain in the community at great risk to him-/herself until a psychiatric bed was found in the region.”

     The scarcity of beds was also cited in the Interim Report of the Northern Virginia Regional Partnership Planning Project, which recommended against the reduction of any beds at the Northern Virginia Mental Health Institute.  See related story on page….

     Virginia earlier this year rejected a similar proposal.  In addition to this latest petition for approval, HCA is appealing earlier decision.

COUNTY CELEBRATES MENTAL ILLNESS AWARENESS WEEK

     “Consumers want to maintain wellness and live within the community,” a keynote speaker told Arlingtonians attending the County’s Annual Mental Illness Awareness Week (MIAW) Symposium.

     Mary Ann Beall of Falls Church, an individual with psychiatric disabilities and long-time advocate for others with disabilities (especially mental disabilities), addressed the well-attended Symposium that also featured presentations by other consumers on their experience of living with mental illnesses.

     “Arlington County is proud of what we do for those with mental illness,” said County Board Chairman Paul Ferguson who opened the Symposium with the reading of the Board’s Proclamation designating Mental Illness Awareness Week in Arlington County.

     “People who have mental illness can lead productive lives, “ Ferguson said.  He said that many Arlington consumers volunteer within the community and sit on Arlington advisory boards.  “We appreciate what you and your family members do.”

     Beall focused on the meaning of “recovery” to consumers – a concept that is not new.  “People with mental illness have been talking about recovery since 1985.”  Beall began her own recovery when her psychiatrist asked her to partner with him in her treatment.

     Consumers are just people.  “Our needs are like those of everyone else.”  But, she also made the point that consumers are very different from one another.  “No one size fits all,” said Beall, who has been active with advocacy boards and organizations involved with services for those with disabilities.  She served as the first president of the Virginia Mental Health Consumers Association, on the Board of NAMI-National and currently serves as a Board member of NAMI-Virginia.

     Recovery raises questions about a service system based on pathology – which causes those who are ill to lose hope – rather than wellness,.  “It is important for us to learn about our disabilities.  It is just as important to build on our strengths when we are well because we know recycling is a part of our illnesses,” she said.  “We have to learn that recurrence is not failure but is a part of the illness, and we need to learn how to handle these recurrences."

     “We need to work with others who have been there.  It is a process with many stages.  We need to be taken seriously.  We want recovery to be as common as dirt.  We want choice in services and a system that communicates well with us.  Professionals must listen carefully because each consumer is different,” she said.

     Beall said research is under way to measure recovery and to offer model services.  Findings show that when individuals get what they want, they are satisfied with their lives.

     For consumers today, there is hope.  Change is occurring, Beall said.  “In the past, most consumers recovered by accident but today more and more are recovering by design.  We are learning how to promote recovery and self-determination.  This is good news for all consumers.”

PROCLAMATION HIGHLIGHTS COUNTY GOALS FOR CONSUMERS

     Arlington County designated October 5 to 11 as Mental Illness Awareness Week under a County Board Proclamation.

     Arlington County Board Chairman Paul Ferguson read the Proclamation as he opened Arlington’s annual Mental Illness Awareness Week Symposium.

     Arlington County, the Proclamation said, strives “to strengthen community-based services which enable those seeking help to attain ‘Recovery’ and to live within the community at the highest levels of independence, with a caring and effective support network at hand.”  The County also seeks greater integration of consumers “within our community, our neighborhoods and our workplaces.”

     The Proclamation acknowledged a “critical shortage of services,” but added this only strengthened the resolve to provide services that target the needs of consumers “so they may regain control of their lives and integrate successfully into the daily life of the Arlington Community.”

MISS THE SYMPOSIUM?

    Arlington’s Government Access Channel on Cable TV is broadcasting the 2003 Mental Illness Awareness Week Symposium in November on Mondays at 4 p.m. and 8 p.m.  The channel is 71.  You must be a subscriber to Arlington’s Comacast cable system.  For additional schedule information, check Channel 71’s website at www.co.arlington.va.us/channel71.

CONSUMERS TALK ABOUT LIVING WITH MENTAL ILLNESS

     “People see us as scary, but they don’t know who we are,” said Kim Adams, a Clarendon House member and a panelist who addressed the Mental Illness Awareness Symposium about her experience with mental illness.

    “The path has been bumpy, but it is now smoother.  I have never let obstacles stop me.  I have never given up hope,” she said. 

Her path to recovery has shown “that you can do whatever you put your mind to.”

     Zed Adams, Kim’s brother and a university graduate student, praised her courage.  Mental illness has challenged his sister daily, he said.  She has had scores of problems to overcome.  “She has to distrust her inclinations.  She has to stop and think about her actions.  It amounts to courage,” Zed said.

     Norman Hill, an employee of the Behavioral Healthcare Division and CR peer Counselor, began treatment for his mental illness in 1980.  By 1995 he became an advocate and in 1998, he became a peer advocate for CR.  His advocacy allows him to show support for “people who are my friends,” Hill said, adding that he is now active in advocacy with The Arc and NAMI.

     To Pennie Kinsey, an English honors graduate and poetess, her mental illness is a gift from God.  “My journey to wholeness helped me to uncover my wholeness of self.  We can be whole while living with limitations,” said Kinsey, who was initially diagnosed with mental illness at 15.

     “My biggest hurdle was to regain self-confidence and self-esteem.  Progress begins with small steps, but begin we must.”  Kinsey attributed her journey to wholeness to the quality care she received by Drewery Center staff – her psychiatrists, case managers and nurses.  With their help, Kinsey said she broke her cycle of illness into respite and wellness.  “I regained stability.”

     “Be compassionate and understand that we are all on a journey to wholeness.  Take care of your own special gift to yourself,” she said.

     Sharon Wells, a member of Clarendon House and a client of Fellowship Health Resources, said she covered up her depression for years.  She was homeless.  She was hospitalized.  “I thought I was admitted [to the hospital] because people thought I was crazy.  I found out I was not alone.  I found out I was not experiencing a case of the blues.  I needed to be treated.  If untreated, depression can last for years.

     “Depression is a real thing.  No one should feel sad and without support,” Wells said.

“NOTHING TO HIDE” EXHIBIT

     The Arlington Central Library featured a national photographic exhibit of individuals who suffer from mental illness and family members.  Each photographic told of the individual’s or individuals’ experience living with mental illness.  The exhibit was co-sponsored by the Friends of Clarendon House, Inc. and NAMI-Northern Virginia, and was dedicated to the memory of Jane Jack, a long-time member of both organizations and an active Arlington advocate for those with mental illness.  The Friends is making available the companion book to the exhibit for a suggested donation of $25.  Checks (only) should be made out to the Friends of Clarendon House and books may be picked up at Clarendon House.  Proceeds benefit the Clarendon House Consumers’ Account, the fund that supports the activities of Clarendon House members.  The Friends is offering the companion book to the exhibit for a suggested donation of $25.  Checks only to be paid to the Friends of Clarendon House.  Books may be obtained at Clarendon House.  Contributions are supporting the Clarendon House Consumers’ Account, which supports the activities of Clarendon House members.

CONSULTANTS REVIEW ARLINGTON COMMUNITY SERVICES BOARD OPERATIONS

     Changes are needed to permit the Arlington Community Services Board (ACSB) to fulfill better its state administrative policy responsibilities, a consultant’s report says.

     “The basis for an integrated department is in place, a new executive director for the ACSB is about to be appointed and key subordinate positions have also been filled.  Now is the time to get beyond troubling issues and assure that the internal structure, policies and procedures will enable greater balance in the intergovernmental system and productive local relationships,” concluded Durman Associates’ report on the ACSB’s “Management Review on Organizational Structure and Governance.”

     In their four-month evaluation, the consultants also reviewed ACSB’s Administration and Operations, its Clinical Management and Operations, and Service Delivery System. 

     The report on management and governance focused on the position of the ACSB executive director within the County’s Human Services Department (DHS) and on the executive director’s line authority over ACSB programs.  It noted the dual responsibilities of an executive director over ACSB programs while also serving as chief of the Department’s Behavioral Healthcare Division, which covers only adult mental health and substance abuse services.

     “The executive director has line authority for only part of mental health, mental retardation and substance abuse services, but is expected to be the primary support for broader CSB responsibilities,” the consultants’ said.  “The reporting relationships of the position may be considered as reporting to at least two masters with differences in power and focus.”  One result was exceptional turnover in the ACSB position that, over the past 10 years, saw “numerous individuals” as executive director or acting executive director.  This “leads to a lack of continuity and systems for the Division and the CSB.”

     In its oral presentation of its report, the consultants said that of the 40 CSBs in Virginia, only Arlington’s executive director is denied direct access to the County Manager and County Board.

     The consultants suggested several options to strengthen the ACSB executive director.  DHS could specify and enforce the lead role of the ACSB executive director to ensure the director is accorded staff resources and information essential to the ACSB’s programmatic accountability.  It could also place the ACSB executive director at a DHS deputy-director level.

     Lastly, the consultant’s recommended “reconstructing” some elements of the former Mental Health, Mental Retardation and Substance Abuse Division.  “Particular attention might be given to Mental Retardation Services since they were originally moved because of management rather than programmatic concerns.  With stronger management, service integration could be addressed through interdivisional planning and service delivery.”

     In Arlington, as with other urban communities, programs for mental health, mental retardation and substance abuse are integrated and are a part of the local service system.  In Arlington, the department operates these programs under an agreement with the ACSB.  State law, however, assigns the ACSB responsibility for overseeing the operation of the programs.

     The consultants reviewed the integration of the mental health, mental retardation and substance abuse programs within the County government.  Initially the ACSB programs constituted a separate and distinct department.  Gradually, however, departmental reorganizations removed the ACSB executive director’s line authority from several of these programs – Senior Adult Mental Health Services (Aging and Disability Services), Children’s Mental Health (Child and Family Services) and in 2001, Mental Retardation Services (Aging and Disability Services). 

     They noted continuing programmatic concerns.

     “Although the Board coped with the change in children’s services by creating a new committee, program concerns continue to be raised regarding the needs of children for treatment services beyond the IEP [Independent Education Plan] and the risk of losing youth transitioning from the schools.  Additionally, the transfer of Mental Retardation Services appeared…to be more a failure of management than a necessary program adaptation.”

     A Memorandum of Agreement (MOA) has defined the relationship between the ACSB and the County.  The consultants said that such a document is common in localities where CSB services are integrated with County departments.  In Arlington “the blurring of responsibilities between the department and the board in the current memorandum may go beyond the usual parameters and contribute to the relationship issues that now exist.”

     The consultants encouraged a review of the document to ensure that the content is consistent with current intent.  The document could “simply be reorganized,” could focus on items important to the administration or County systems or focus only on key County management concerns.

     They also:

·         Urged the CSB and staff to review and revise existing policies, and establish a consistent format for policy formulation.

·         Suggested the development of a work plan so the Board has timely notice for carrying out its responsibilities.

·         Encouraged more involvement of stakeholders so that stakeholders can learn about emerging state of the art systems’ developments, help identify issues and help develop issue options.  “This makes for more informed advocacy and may lead to coalitions of broad importance.  Formats may vary but should go beyond attendance at committee meetings or comment periods at board meetings.”  They suggested focus groups, conferences or forums.

SURVEY POINTS TO STAFF PERCEPTIONS

     As part of their review of the operations of the Arlington Community Services Board (ACSB), the consultants surveyed DHS staff.  Sixty-eight percent surveyed, responded, with 80 percent responding from the Behavioral Healthcare Division and Project Resilience.  The survey showed staff was positive about working independently and with co-workers and about training. 

     Staff said its ability to work independently and make decisions was a factor in remaining in Arlington.  Reaction was mixed about the recent reorganization of mental health and substance abuse services into the Behavioral Healthcare Division.

     Mental health areas that needed improvement were in adult residential, emergency and outpatient services.  Improved services could be obtained through decreased paperwork, increased resources and more staff training, staff said.

CONSULTANTS RATE CSB CLINICAL OPERATIONS HIGH

     Arlington’s Human Services Department and the Arlington Community Services Board (ACSB) is about 50 percent in conformance with the best practices standards of the Commission on Accreditation of Rehabilitation Facilities, a national agency that reviews and credentials mental health, mental retardation and substance abuse programs.

     “This is a testimony to the leadership and service delivery of the system,” Durman Associates said in its report reviewing Arlington’s “Clinical Management and Operations” of its mental health, mental retardation and substance abuse programs.  “Many behavioral healthcare systems start at ‘ground zero’ when preparing for national accreditation.”

     Among the consultants’ findings:

·         Attention to the person-centered treatment planning approach is needed to move toward a recovery-oriented model and offer true individual services.  The consultants urged the ACSB to consider seriously to putting a recovery-based model of services throughout its service system.  “A keystone of the recovery model is a person-centered planning approach to individual service plan development and implementation.”

·         Mental Health Services should evaluate the efficacy of its system of having the same clinician delivering outpatient and case management services.  The consultants also said Arlington should be able to get more Medicaid reimbursement for its services.  Greater focus on case management services is one way to achieve this.

·         There appears to be adequate staffing to provide outpatient mental health and substance abuse services.  “Staff are highly credentialed, and they appear to be talented and dedicated professionals.”

     The consultants also called for greater family involvement.  “There was no documentation seen as to family involvement in both SA and MH Outpatient services.

     The report covered business practice standards, including information management and performance, protecting the rights of individuals served and leadership issues.

     One mental retardation recommendation called for this service to be returned to ACSB management.  Two years ago, Mental Retardation Services was integrated as a component of DHS Aging and Disability Services for what the consultants’ termed were management, not programmatic, reasons.  The consultants called for Substance Abuse Services to open a satellite office to provide better service accessibility, move from a program-based model to an individualized approach, and consider adding a day-treatment program or intensive outpatient program component to its array of services.

     Improved revenue maximization was a critical recommendation of the consultants’ review of ACSB “Administration and Operations.”  They called for removing non-billable services, especially administrative tasks, from clinical staff, and urged setting standards for billable hours that staff be expected to perform.  They urged the installation of an automated scheduling system, and for the ACSB to charge and to bill for intake services.  They also urged the tracking of “No Show” appointments and charging for them.

CONSULTANTS RECOMMEND IMPROVEMENTS FOR SERVICE DELIVERY

     A consulting firm reviewing program operations of the Arlington Community Services Board (ACSB) recommends rethinking the reorganization plan that established a special dual diagnosis unit.

     “Consider investing the allocated dollars for establishing this new dual diagnosis unit that will require its own infrastructure into teaching staff the skills and tools necessary to help all [substance abuse and mental health] clients.  This approach may be especially beneficial since staff reports that most of the clients are dually diagnosed … and a new unit of work will add more bureaucracy to the ACSB system,” said the “Service Delivery System” report by Durman Associates.  This was among a number of recommendations.  These included that the ACSB:

·         Develop enhanced case management.

·         Seek more funding and expanded capacity – along with smaller caseloads.

·         Develop more employment options for consumers in all disability areas.