Mental Health Association of Portland

Looking to the future for local mental health services in Klamath County

Posted by CoffeeX3 on 14th January 2014

From the Klamath Herald and News, January 14, 2014

The Klamath Youth Development Center has more changes on the horizon than a new name — changes which will spur improvements in mental health services in the coming months.

Since KYDC took over Klamath County mental health services on Aug. 1, the organization and its director, Stan Gilbert have been working to offer services to more patients, as well as working with a variety of other mental health stakeholders to update programs and generally improve the health of the community.

Ron Woita, the director of emergency services at Sky Lakes Medical Center, said he was excited to see community partners tackling the issues surrounding mental health.

Ron Woita, the director of emergency services at Sky Lakes Medical Center, said he was excited to see community partners tackling the issues surrounding mental health.

“It’s going to change,” Gilbert said of the future of mental health in the county.

Since KYDC took over mental health services for the county, the number of complaints about access to care has decreased; the number of psychiatric emergencies and hospitalizations due to mental health problems are down, as are wait times for appointments and assessment wait times for mental patients.

Those positive changes will continue, Gilbert said.

Goals for health care, including mental health, Gilbert said, are threefold: offer better care, at a lower cost and improve the overall health of the community.

To that end, KYDC plans to consolidate programs to be more efficient, and modernize other programs to best serve clients’ needs.

KYDC and other mental health agencies, including Sky Lakes, Lutheran Community Services, Cascade Comprehensive Care and law enforcement are working to create a mobile response team. They also are working to create an adolescent respite care facility similar to Phoenix Place, which is the county’s only residential mental health care facility.

Community partnerships

Ron Woita, director of emergency services at Sky Lakes, is excited about how partners are coming together to tackle mental health issues.

“I’ve never seen a community really come together to address an issue like this,” Woita said. In the short time since the county mental health transition, KYDC has overcome a lot of hurdles, he said.

“It’s impressive, it really is,” Woita said. “It’s truly a positive change — from all aspects.”

He’s seen what he hopes is an increased response to mental health cases in the hospital’s emergency room. Cases seem to have decreased over the last few months even despite the typically stressful holiday season.

Greater access to needed mental health care keeps people from going in to crisis mode, when they could end up in the hospital, Woita explained.

Bob Pickel, the director of Lutheran Community Services, which also offers mental and behavioral health services, said he is glad to be working with KYDC.

Overall, there has been an attitude change in the county toward mental health, said Bill Guest, the CEO of Cascade Health Alliance, the state-designated coordinated care organization, or CCO, that began overseeing Oregon Health Plan and Medicaid patients in the county last fall.

Down the road, Gilbert hopes that mental health services will be more integrated with medical care; both medical and mental health practitioners would agree that there is a great deal of overlap between the two areas, he said.

For serious health issues and chronic diseases especially, mental health problems can hinder treatment, Gilbert explained.

The demarcation of drug and alcohol health problems and mental health, for example, are very closely intertwined and often can affect an entire family, Gilbert said.

Scott Munson, the director of Cascade Comprehensive Care and a registered nurse, agreed that with mental health and other providers working together, cooperation is growing in importance.

Munson envisions a patient-centered medical home, which could be one-stop shopping for patients.

In the past, adults had to receive treatment from the county, youth from KYDC, and families, to a small extent, could get treatment together at Lutheran Community Services, but those walls and barriers are now gone after the transition, Munson said.

“We’ve broken all those down,” Guest agreed. “We are much more coordinated.”

However, the county is in need of more mental health practitioners, especially psychiatrists. “It’s a big problem,” Gilbert said.

To Woita, every little step forward is nothing but good for the community, and he’s glad to see a variety of groups being proactive in making changes.

That doesn’t mean, however, that changes will happen immediately, he said. It’s not a light switch you can just turn on, he explained; instead, it takes a lot of work to make mental health, and health care services more efficient, and offer better access in a more timely manner.

Still, he’s encouraged by the progress so far.

“It’s very promising,” Woita said.

Upcoming projects for mental health care services in Klamath County

Two projects that will have a significant impact on mental health services in Klamath County are the creation of a mobile crisis response team and a new adolescent respite care facility.

The projects represent a new era of collaboration between a variety of mental health stakeholders.

Stan Gilbert, the executive director of Klamath Youth Development Center, said the crisis response team will be able to respond to psychiatric emergencies, wherever they take place, such as in a home or school or even on the street.

KYDC and other mental health care providers are dependent on Sky Lakes Medical Center in those emergencies because patients have to be admitted to the emergency room, which is an expensive and time-consuming process and takes a high degree of work for the hospital staff, Gilbert explained.

A mobile team would be less costly, and it also would offer better care for patients by avoiding the added stressors of being transported and admitted to the hospital.

Ron Woita, the director of emergency services at Sky Lakes, said it is expensive to admit those mental patients because of federal regulations; the Emergency Medical Treatment and Labor Act (EMTALA) requires that anyone who comes in to the hospital needs to have a medical exam, Woita said, and they have to be medically cleared to a certain level for liability reasons, for one.

The staff also needs to make sure patients are healthy in general.

A patient admitted to the emergency room might need a CT scan, for example, Woita said, to ensure they are medically stable. The same is true for mental health patients.

Another change is the creation of a local adolescent respite care facility, similar to Phoenix Place for adults, said Bill Guest, the CEO of the county’s coordinated care organization Cascade Comprehensive Care.

Community partners are using money from a state transformation grant to launch the facility hopefully this summer, Guest said.

The CCO’s medical director Dr. Lawrence Cohen said he is “as excited as can be” about the prospect of such a facility, and about the crisis response team.

The care facility will serve mental health patients 17 years old and under, Cohen said. Those patients in need of longer care are now sent out of the county for that care as far as 300 miles away.

“We don’t have places for them to go,” he said.

Sometimes, in those advanced situations, local mental health practitioners will not see the children in those cases again for a long time, Gilbert said.

“A lot of times they go away and we don’t see them again for years,” Gilbert said.

The buy-in on both projects throughout the community is tremendous, including with law enforcement, Cohen said.

“We have so many things that we want to do all at once,” he said. “This is the tip of the iceberg.”

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Will Klamath Youth Development Center do a better job for less money?

Posted by CoffeeX3 on 4th September 2013

From the Klamath Herald and News, September 4, 2013

When the Klamath County commissioners decided to transfer the mental health department to a nonprofit, they did it because the county was no longer financially able to provide the service. But an equally important question needed to be asked: will Klamath Youth Development Center do a better job?

“I will have to wait and see,” said commissioner Tom Mallams. “My philosophy is I believe they will be more efficient at it. Efficiency isn’t always better.”

“I don’t know whether I would say ‘better job,’ ” said commissioner Jim Bellet.

“I’m not going to say they can’t do a better job, but they can do the same job for less money,” Bellet said.

Bill Guest, CEO of Cascade Health Alliance, the state-designated coordinated care organization that begins overseeing Oregon Health Plan and Medicaid patients in Klamath County this month, seemed confident in KYDC’s ability to be more effective than the county.

“We’ve seen much more stability over the years at KYDC in management than we have at the county,” Guest said, referring to the changes in leadership at the county mental health department, while Stan Gilbert, executive director of KYDC, has been at his post since 1986.

Asked if KYDC was going to do a better job with mental health care in Klamath County, Gilbert said:

“You betcha.”

Beliefs vs. reality

Even though they are not able to predict the future for KYDC, the idea of having a private business perform a service for the county lines up with the commissioners’ philosophies.

“The reason the county can’t be effective and private enterprise can be more effective is private enterprise is focusing on actually getting the individual involved in their own health care, and having them make choices, and having them be responsible for those choices and how it might impact their lives,” said commission chairman Dennis Linthicum. “The reason federal money or state money or county money becomes ineffective is, we give all that money to the CCO, and the individual never sees the result of his bad choices or his good choices. He just is removed in a meaningful sense from his decision-making process.”

Linthicum said he hopes because private companies like Cascade Health Alliance, the county’s CCO, and Klamath Youth Development Center, the county’s mental health care provider, have “lived and breathed in the private world,” they will continue the innovative and creative practices that have kept them in business up to this point, even though they now are receiving public funds.

“They will run more efficiently than government can because government has so many restrictions and the process they have to go through,” Mallams said. “Whatever government can do, private enterprise can do cheaper and better.”

“Private business tends to be a little more nimble than the bureaucracies that are associated with the public sector service,” Guest said. Whether it’s mental health or whatever. There’s more flexibility.”

“There is a real interest in participating in development of a system of care that is more responsive, more efficient, lower cost, and yet provides more consistent, better quality care,” Gilbert said. Working with entities like Cascade, he sees that as the future for mental health care, and general health care, in the county.

The issue of mental health care

According to the Oregon Health Authority, the Klamath County mental health department saw or wrote prescriptions for 1,400 clients before the transition. As of last week, 693 clients had transferred to Klamath Youth Development Center.

Gilbert said he didn’t believe the issue of mental health was as big in Klamath County as, the need for more jobs and economic development, or the need for better graduation rates in schools, or the big issues agriculture is facing with water shortages and drought. But mental health is an important issue.

“I would think that mental health probably doesn’t rise to the level of priority like those other things do, but at the same time, 25 percent of the population would benefit from mental health treatment,” Gilbert said. “They don’t get it. There aren’t enough providers. There’s not enough access to go around. But generally speaking, across the country 25 percent of all Americans need mental health care.”

The Oregon Health Authority said, including KYDC, there are 15 certified mental health care providers in Klamath County.

At KYDC, Gilbert said he prefers psychiatrists to treat about 400 patients at a time. For therapists, he wants to keep the number of cases down to about 50.

“I think people don’t think about it until it affects them directly,” Dannielle Brown, residential program supervisor at Phoenix Place, the facility once managed by the county but now run by KYDC, said about the issue of mental health care. “Or until something major happens.”

Something like the Sandy Hook school shootings in Connecticut last year. Then mental health becomes a big issue for a short period of time.

“And that lasts about five minutes,” Brown said. “It’s a flash in the pan, and everybody’s done.”

She wants to change the perception of the mentally ill and the way the community sees the people she works with every day.

“I definitely think we have the opportunity to provide a lot of community education, get the stigma of mental illness decreased. These aren’t the big scary monsters that go out and strangle you in your sleep. But that’s what people think,” Brown said. “It’s just the stigma of mental illness. There’s a tremendous opportunity to educate the community on mental illness so people don’t fear what they don’t know.”

The majority of the time, if a person is having a crisis, he or she is more likely to hurt him or herself than others.

“It’s that they’re so psychotic that they forget to eat, they forget to drink, they forget to take their meds. They can’t provide for their own basic needs,” Brown said.

What is KYDC’s role now and in the future?

Klamath Youth Development Center first applied to provide mental health care to adults — traditionally the county’s job — in 2000, Gilbert said. Then, KYDC needed permission from the county. KYDC never got permission and continued to only treat clients under the age of 18.

“I knew the only thing that was prohibiting us from treating adults — at the time we wanted to treat families as a unit — I knew the only issue that was preventing that from happening was approval from the county,” Gilbert said.

Now KYDC has that permission, and that responsibility, thanks to the state.

“Initially our goal has been to provide continuity to everybody that was currently receiving services,” Gilbert said. “We do not want any individuals to fall through the cracks … Our No. 1 priority has been to maintain services and provide a secure, supportive, kind environment for patients to get that care.”

Asked what was in store for the future of mental health care in Klamath County, given all that has happened in recent years, months, weeks and days, Brown said she wasn’t sure.

“Oh gosh, I don’t know. I’ve been so focused on getting through this, I don’t know,” she said. “I’m hopeful for the future. I’m hopeful that we can continue to provide clients services and expand the services we’re providing.

“I’m hopeful instead of being the county that’s felt so unstable for the last three years,” Brown continued, “we can be the stabilizing force in the community.”

With KYDC taking the reins of mental health care in Klamath County, Gilbert sees an opportunity to start over.

“Our plan is to have a large conversation with the community,” he said. “What do we want this to look like? Let’s design the kind of system that, as a community, we really want to have.”

To start, Klamath Youth Development Center is going to change its name. Gilbert doesn’t know what that name will be, but he wants to include all the different clients the company treats, young and old.

“We want to find an identity that closely reflects our new responsibility and expanded population,” he said.

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Mental health employees get layoff notices – Transition to CCO makes budget situation unclear

Posted by CoffeeX3 on 6th June 2013

From the Klamath Falls Herald and News, June 6, 2013

About 81 employees from Klamath County Behavioral Health and Wellness, formerly the mental health department, received 30-day layoff notifications Tuesday.

Department head Amanda Bunger said all the department’s employees received the pink slips to comply with layoff notices required by the county’s union contract. Notices are required if there is layoff potential.

As the behavioral health department transitions into its contracts with Cascade Health Alliance, the coordinated care organization for the county, and transitions from its former agreements with Jefferson Behavioral Health , it is unknown what the department’s budget will look like. Without a budget, staffing also is an unknown at this time.

When things are more sure, Bunger said the department can rescind the layoff notices.

Though Klamath County signed a memorandum of understanding with Cascade Health Alliance, it is still working on a precise contract with the CCO. Cascade CEO Bill Guest has said the contract will resemble similar contracts his company has made with other providers in the area. Once the contract with the county is set, Cascade will show the Oregon Health Authority it has a sufficient panel of providers to begin operating as a CCO.

Jefferson Behavioral Health has covered Coos, Curry, Jackson, Josephine and Klamath counties before the advent of CCOs. Jefferson Behavioral Health is ending its mental health managed care contracts July 1.

For Klamath County, which does not yet have the CCO in operation, that means patients managed by Jefferson Behavioral Health will be put on a fee for service program until the CCO is in place. Bunger said agencies like Klamath Youth Development Center and Lutheran Community Services will be billing the state until the Cascade is up and running as the CCO.

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Klamath County still at odds over mental health care

Posted by CoffeeX3 on 6th December 2012

By Diane Lund-Muzikant, The Lund Report, Dec. 5, 2012

A last-ditch effort is under way in Klamath County to mediate the dispute over mental health services for the nearly 13,000 people on the Oregon Health Plan.

State officials have intervened once again, sending in another mediator, while residents continue circulating petitions, asking the Oregon Health Authority to re-open the bidding process and allow a new coordinated care organization to emerge. But that won’t happen while the mediation process continues, according to Patty Wentz, spokesperson.

Two issues still separate county officials and Cascade Health Alliance, the physician-hospital owned group that’s attempting to become the CCO – the control of mental health services and representation on Cascade’s for-profit board of directors.

As the local mental health authority, the county is responsible for such services and has the ultimate contracting authority, but Cascade prefers to establish its own provider network.

Commission Chair Dennis Linthicum is willing to sign an agreement with GOBHI, a mental health group in 17 rural counties, but its CEO, Kevin Campbell, has been unsuccessful in reaching agreement with Cascade. “It could be a boost if they could be brought to the table,” Linthicum said.

For the time being, he’s not ruling anything out. “Right now everyone’s back at the negotiating table. If we can clean up those areas of hesitancy, we’d be more likely to sign an agreement. But if the public doesn’t have the ability to help direct those interests, it becomes problematic. Because of our statutory authority, this lands directly on the county’s shoulders.”

Neither Linthicum nor Bill Guest, CEO and president of Cascade, was willing to discuss details about the negotiations. “We’re not under a cloak of silence but would like to play our cards as close to the vest as possible,” Linthicum said. “I’m looking forward to seeing what the mediation process bears, and am hoping for results amenable to both sides.”

Cascade, which has been struggling to get the go-ahead as a CCO, is now saddled with a financial penalty imposed by the Oregon Health Authority and receiving 1 percent less in reimbursement, Guest said.

“We’re hoping the CCO can happen as soon as possible, and we’re going to abide by the original agreement with the county not to discuss the issues outside the mediation process” Guest said. “We’re working in a positive manner toward resolution with a state-appointed mediator.”

In earlier article about this situation, The Lund Report inadvertently said that Guest refused to comment on the situation. Instead, he had not responded by press time because of the Thanksgiving holiday.

Cascade, with 10,000 members, is managed by a nine-person board of directors – three primary care physicians, three specialists and three representatives from Skyline Hospital, and owned by its physicians and the hospital. The company also runs a Medicare Advantage Plan, known as Atrio, with 12,000 members.

“I really hope we have good news very shortly, and that the mediator is able to conclude the process successfully. It’s the first time we’ve been involved in the mediation process in our history,” Guest added.

It’s also premature, he said, to discuss the details about Cascade’s intention to integrate mental health care. “We’ve put together contracts with providers, and the first step is to do a memorandum of understanding with the county mental health authority.”

Earlier, GOBHI was rebuffed by Cascade after trying to buy into the company, according to Kevin Campbell, CEO. “It’s unfortunate that Cascade has a design plan in mind that is highly privatized and doesn’t see value in GOBHI being involved in the future. We’d like to be part of the solution, not the problem,” he said. “We’ve had tremendous success getting people out of the state hospital and into long-term care and community living.”

Campbell believes it’s beneficial for rural counties to join together and help move the system forward with a critical mass, rather than small counties going in different directions. “We’re willing to work with all providers if we get a chance to move forward,” he said.

He’s also interested in having a minority voice on Cascade’s board. “At the end of the day, decisions have to be made about whether to put money into public health or other preventive initiatives or pay dividends to shareholders.”

Campbell also questioned why Cascade intends to split adult and children’s services into two programs. “That’s a mystery to me. You don’t spend a million dollars on children just to have them go into the adult program and be ignored and end up in prison. You need to wrap services around so people know the services are there, whether they’re 18, 25 or 55.”

No matter what transpires, GOBHI is likely to become the go-between for mental health services until new contracts are in place since the county’s relationship with Jefferson Behavioral Health’s ends in January, Linthicum said.

Jefferson Behavioral Health is evaluating its future role, said its chief operating officer, Bob Furlough. “We’re continuing to work with our board of directors to identify what activities we’ll be involved with.” Currently his organization has contracts with the state for acute care indigent services and developmental disabilities services.

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