Mental Health Association of Portland

Oregon's independent and impartial mental health advocate

Douglas County gives up mental health programs

Posted by admin2 on 30th March 2014

From AP.com, March 27, 2014

Two mental health programs in Douglas County are being turned over to an alliance of health care providers established by the state.

The Roseburg News-Review reports (http://is.gd/dfVZS6 ) the two programs employ more than 100 county employees. Most of the workers will be offered positions through the new Umpqua Health Alliance.

The transition is part of Oregon’s effort to develop coordinated care organizations.

The health care providers within these organizations work together to handle physical, mental and dental health services for Oregon Health Plan patients.

Starting in July, the Umpqua Health Alliance will provide services for patients previously helped by the county’s Community Mental Health and Developmental Disabilities programs.

County Commissioner Susan Morgan says consolidating services will make the delivery of mental health care more efficient.

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Columbia Pacific Coordinated Care Organization takes over North Coast Medicaid

Posted by admin2 on 12th August 2012

Press release from the Columbia Pacific Coordinated Care Organization, about August 10, 2012

The Oregon Health Authority approved an application from Columbia Pacific Coordinated Care Organization to take over managing Medicaid mental and health plan services on the North Coast as of Sept. 1.

Columbia Pacific CCO will serve all of Columbia, Clatsop and Tillamook counties, as well as the coastal arm of Douglas County. Each CCO will receive a set budget to manage care for people on Medicaid and work with community-based governing boards and advisory councils to direct spending.

“It basically serves like a health plan function, but it works much more closely with the community,” said Patrick Curran, Columbia Pacific CCO board member and director of business integration for CareOregon. “[CCOs] will grow and change and improve based on the needs of that community.”

The establishment of CCOs around the state is part of the Oregon Health Policy Board’s health care reform efforts, which are centered on the “Triple Aim”:

  • Improve the lifelong health of all Oregonians;
  • Increase the quality, reliability and availability of care for all Oregonians;
  • Lower or contain the cost of care so it is affordable for everyone.

The idea behind CCOs is to improve communication among health care providers, hospitals, health plan and social agencies in order to reduce costs and improve the health outcomes for patients.

“If you look at the population on Medicaid, 20-percent of the people incur 80-percent of the cost,” Curran said.

That additional cost is often a result of preventable visits to urgent care or the emergency room by people with chronic health problems, Curran said.

“If we can better provide those services at an earlier time, we can achieve that triple aim,” Curran said.

Columbia Pacific CCO is a partnership between Greater Oregon Behavioral Health Inc. (GOHBI) and CareOregon, which is one of the current Medicare and Medicaid plans available to Columbia, Clatsop and Tillamook county residents.

Initially, the CCO will combine health and mental services under one insurance plan. By 2014, it will also incorporate dental services.

“By integrating medical care, behavioral health and eventually dental care, CCOs will meet the needs of the whole person, rather than treating mind separately from body and separating primary health needs from specialty and hospital care,” said GOHBI CEO Kevin Campbell.

Most plan members shouldn’t notice any change in service since the benefits and access to doctors won’t change. “The day-to-day will remain undisrupted… I think it’s fair to say that a lot of work will be happening behind the scene,” Curran said.

However, Curran anticipates that the CCO will assign an outreach worker to people with episodic (pregnancy) or chronic (diabetes) health issues to help them manage health issues and identify the best use of insurance funds.

“If you have a more coordinated effort… if you can provide preventative care to this person… the cost differential is tremendous,” said Jeanie Lunsford, communications manager for CareOregon.

“CCOs give communities an unprecedented opportunity to have ownership in the transformation of health care,” Campbell said. “With formation of the Columbia Pacific CCO, we have achieved our goal of making the CCO local enough to be relevant while still large enough to maintain solvency so we can continue to provide excellent health care services into the future.”

Residents in the Columbia Pacific CCO service area with current Medicaid plans will automatically be rolled over into the CCO plan. People with both Medicare and Medicaid coverage (dual-eligiblility) may chose to join the CCO or opt out, Curran said.

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Southern Oregon Providers Work to Embed Behavioral Health into Primary Clinics

Posted by admin2 on 25th March 2012

By Amanda Waldroupe, for The Lund Report, March 24, 2012

The effort, initially funded by a 2006 grant, is now being extended to Coordinated Care Organizations in southern Oregon

Douglas County, courtesy of Jimmy Emerson under CC BY-NC-ND 2.0 license

A quick, 15-minute appointment with a mental health counselor to talk about the effects of stress and anxiety when a person has an ulcer is radically different than a traditional hour long appointment with a counselor. But providers in southern Oregon are discovering that such appointments, which integrate mental healthcare in the same primary care setting, go a long way toward improving a patient’s health.

For the last three years, a licensed clinical social worker has been seeing patients at the Harvard Medical Park primary care office under a joint arrangement between Douglas County Independent Practice Association, the managed care plan providing care to Oregon Health Plan patients in Douglas County, and ADAPT, a Roseburg-based nonprofit offering substance abuse and mental health services.

Last year, a similar model got under way in Coos County by Doctors of the Oregon Coast South, which also contracts with ADAPT.

Both managed care plans, which are intent on becoming Coordinated Care Organizations (CCOs) in southern Oregon, are working with ADAPT to bolster the integration between mental and physical health.

John Gardin (from ADAPT website)

John Gardin (from ADAPT website)

“It’s obvious that this [type of integration] is the mandate of desire relative to CCOs,” said John Gardin, ADAPT’s chief clinical officer and research director.

In August, CCOs are expected to replace the state’s managed care organizations, and integrate the physical, mental and dental healthcare for the 650,000 people on the Oregon Health Plan and emphasize preventive care, decrease hospital utilization and reduce costs.

In the clinics run by these two managed care plans, social workers work directly with primary care physicians to integrate physical and mental healthcare. When a physician believes a patient might have a mental health or chemical dependency problem, they’re referred directly to a social worker, who sees them for brief fifteen minute appointments.

“Typically, embedding mental health and substance abuse counselors in primary care has occurred in umbrella systems like Kaiser, HMOs, and federally qualified health centers,” Gardin said. “It’s very rare to have this kind of service in a private practice.”

Although rare, such a concept is becoming increasingly common elsewhere in Oregon. Central Oregon embeds mental health workers in primary care clinics, as well as the Old Town Clinic run by Central City Concern and other Portland-area nonprofits that serve vulnerable patients.

In 2006, after receiving a three-year $375,000 grant from the Health Resources and Health Management Administration, ADAPT began embedding licensed clinical social workers in a primary care clinic.

Within three years, that social worker saw 2,000 patients, half of which were Oregon Health Plan patients. Of that group, 15 percent saw the social worker more than five times, and their utilization including hospital visits decreased by 30 percent.

The short appointments patients had with the social worker were designed to target specific mental health problems that had exacerbated their physical health issues. “It’s just effective to give some basic tools, skills, training and development about what you can do,” Gardin said. “It’s way more practical.”

That way, there’s a higher probability of a patient seeing a mental health provider at the same clinic rather than being referred elsewhere. “Referrals just don’t work,” Gardin said. “They just won’t go.”

Physicians have responded positively to the program. “They can hand off problems for which they’re not well-equipped or well-trained to do,” Gardin said. “They can do what they went to medical school to do.”

However, integrating mental and physical healthcare does require a certain amount of flexibility by providers, Gardin said. “The medical environment is a very different environment from the counseling environment. The model is dependent on the physicians understanding that the social worker is there to help.”


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Financial crisis hits hard at the county level, too

Posted by admin2 on 5th December 2010

From The Oregonian, December 2, 2010

When timber was king, harvest receipts in southwest Oregon’s coastal counties filled municipal coffers, and residents enjoyed the state’s lowest property tax rates.

These days, balancing county budgets has become an exercise in backfilling a sinkhole, one that threatens to swallow the levers of government whole.

In early November, voters in Curry County overwhelmingly rejected a public-safety levy to fund the sheriff’s office, the Juvenile Department and the district attorney’s office. As things stand, even if the county eliminates every service it provides from its general fund budget over the next two years — juvenile, patrol deputies, 9-1-1, the DA, commissioners, the treasurer’s office, the county clerk and so on — the $1.3 million raised annually from property taxes may be insufficient to cover just the cost of running its jail.

“There has to be some form of government in rural coastal Oregon,” Curry County Commissioner Bill Waddle said. “Is it going to be Curry County or some form that the state of Oregon imposes? I don’t know.”

Curry and neighboring Josephine are among the handful of Oregon counties facing an unprecedented collapse in revenues because of the loss of federal timber payments.

But counties’ budget woes aren’t limited to timber problems, and fiscal cracks have spread throughout the state. The ongoing recession and housing busts mean that property taxes and development-driven fee revenue — permits, inspections, etc. — have stagnated everywhere.

And there’s more — or less — to come as the state Legislature prepares to balance its own budget by slashing through a projected $3.5 billion deficit. Many of those cuts will target services that counties provide under shared funding or that they contract with state and federal authorities.

The list includes services for the state’s neediest residents — children, the elderly and people with disabilities, veterans, those needing alcohol and drug treatment, or family planning. With voters in no mood for new taxes, balance sheets weakened by previous years of budget cutting and increasing expenses to fund retirement and medical benefits, counties are left with few choices.

“Counties can’t go bankrupt,” said Mike McArthur, executive director of the Association of Oregon Counties. “There’s no provision for municipal bankruptcy under Oregon law. They simply ratchet back services to the point the budget is balanced.”

Structural problems

Cities are the geographic stars. States have the broad mandate. But when it comes to fixing aging bridges, providing drug and alcohol treatment for juvenile offenders, or aiding the elderly and disabled, counties are where the social safety net hits Main Street.

County budgets are a tangle of revenue streams, programs, contracts and mandates. There are property taxes, fees, sin-tax receipts, state contracts, federal matching dollars and so on. Some services are mandated, others aren’t. No two counties are alike.

Counties everywhere, however, rely on property taxes for discretionary revenue, the lion’s share of which supports public-safety functions such as sheriff’s deputies, jails and parole officers. With the passage of Measures 47 and 50 in 1996 and 1997, Oregon voters tied counties’ hands by limiting assessed valuations and putting a 3 percent lid on their annual growth.

Still, in theory that provides slow and steady revenue growth to underwrite programs.

In practice, however, the limit creates structural deficits, as revenues fail to keep pace with payroll costs, including spiraling pension and medical benefits.

Booming construction temporarily spiked property taxes and fees for many counties, masking the problem. But the real estate crash closed that spigot. Counties across the state have responded with pay freezes, furlough days and layoffs.

Lincoln County Commissioner Don Lindly says his coastal county has been through the full menu of budget reductions: prioritizing services, freezing pay, laying off 25 percent of the county staff, making employees cover two jobs. Nothing, he said, has been held harmless.

The county considered shutting the animal shelter, but voters passed a five-year levy that actually increased the staff. Lindly notes that no similar groundswell resulted when the county decided to eliminate mental health specialists.

“I’m not saying anything against animals. … I’ve got a yellow Lab that pretty much runs our family,” he said. “But it’s interesting what people will choose to support.”

Timber time bomb

Declining timber harvests on federal forestlands is an old story, as is the threatened elimination of safety-net payments to compensate rural counties for their loss. Those payments are currently in a four-year step-down and will sunset in 2012, carving big holes in the budgets of 18 Oregon counties.

Congress has twice reinstated the payments, avoiding a budget meltdown for many rural counties. But their decline gradually is sapping services and reserves, particularly in counties where Measure 47 froze permanent property tax rates at low levels. Those counties have had a few years to wean themselves from the payments, establish reserves and go to voters for local levies to backstop services. But the prospect of reauthorization has created a cry-wolf scenario, where voters refuse to make up the gap until it’s certain the government money has dried up.

If the federal payments expire, some counties simply won’t be viable. The payments already have declined from $265 million in 2007 to about $200 million today, and if they end in 2012 counties will be left with only a trickle of the river of money that once flowed — about 10 percent of the peak payments.

As recently as 2008, the payments made up two-thirds of the general fund in Curry, Douglas and Josephine counties, 40 percent in Coos County, a third in Jackson and Lane counties.

“We’re past cutting,” said Dave Toler, a commissioner in neighboring Josephine County, which eliminated 250 of its 650 employees during the last five years. “We’re talking about providing what normal American citizens would expect in a First World nation.”

Thirty-three of 36 counties received some portion of the $200 million distributed this year. And even those that escape any direct impact could feel the loss as the state tries to backfill funding by redistributing its own budget pie.

Columbia County would lose $2 million a year — roughly 20 percent of discretionary funds.

“By discretionary I don’t mean money for lattes,” Columbia County Commissioner Tony Hyde said. “This is money we use to supplement law enforcement and criminal justice. It’s pretty sad when you can’t call a cop and get an answer.”

State cuts

State and federal money accounts for $3 of every $10 counties spend on veterans and economic development, $4 of every $10 on community corrections and public health, $5 of every $10 for roads and nearly $7 of every $10 on mental health, according to Association of Oregon Counties.

Most counties are in wait-and-see mode until the governor and Legislature reveal specific strategies for coping with the state’s own shortfall. But cuts are coming.

State cuts can have a multiplier effect, reducing federal matching funds — say for Medicaid reimbursements or family planning. Counties also fear cuts in cigarette and liquor revenues they share with the state.

Officials expect the deepest cuts in human services — public health, mental health, children and family services. Those programs have seen big caseload increases during the recession and were supported by the biggest chunk of federal stimulus dollars, which are unlikely to recur. Various mandates preclude the Legislature from making across-the-board cuts, so they are likely to be concentrated in specific programs.

If cuts go deep enough, and counties can’t provide a minimum level of mandated service, they simply can hand the obligation back to the state. Douglas and Linn counties already have done so with community corrections. The state, officials say, generally spends more to provide the same service levels.

Mary Shortall, director of aging and disabilities services for Multnomah County, expects state cuts to include in-home services for the elderly and people with disabilities. In Multnomah County, that includes 2,800 residents who qualify for state-paid nursing home care, but who can be served more economically at home if they have help with bathing, eating or continence care. Shortall says her division’s caseload grew 13 percent during the recession, while staffing shrank 5 percent.

If the state cuts payments to home health aides, some clients can manage with help from family. But the burden eventually will fall to taxpayers again, as clients apply for more expensive nursing home care that the state is obligated to cover.

Joanne Fuller, human services director in Multnomah County, says she doesn’t even want to speculate on what the Legislature will do.

“This is a lot bigger hole than we’ve seen before,” she said. “We’re cutting deeper at a time when there are a lot more needs in the community. There’s no replacement for these services. It’s not like there’s some way we can do them cheaper.”

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Roseburg’s Telecare Recovery Center to close

Posted by admin2 on 18th May 2010

From the Roseburg News-Review, May 18, 2010

People who need mental health care will have one less option in Douglas County on or about June 15.

Telecare Recovery Center @ Roseburg is set to close its doors by that date, administrator Jay Harris said Monday.

The residential psychiatric facility is working to place its 10 residents in other appropriate placements as smoothly and safely as possible, he added.

John Gardin, director of behavioral health and research for ADAPT, said the loss of Telecare is “huge” for the community.

“As far as I’m aware there is no other 24-hour care for individuals with chronic mental health needs (in the community),” he said.

Telecare opened in September 2008. Harris said Telecare is closing because the facility has had significant challenges over the years in a number of areas.

The facility has found it difficult to recruit support staff, recruit and retrain management professionals and retain the psychiatric staff, Harris said. He said he suspects this challenge stems from a lack of psychiatric health care professionals in the area from which to draw.

More recently, the Oregon Addiction and Mental Health Division placed sanctions on the facility in late 2009 or early 2010. Harris said he cannot comment on the exact nature of the state agency’s regulatory concerns.

“It appeared to us, the regulatory issues we were dealing with were not close to coming to an end,” he said, “and the (Telecare) Corporation ultimately made the decision it is in everybody’s best interest to close the facility.”

Once the state agency imposed sanctions on the facility, it could no longer admit new residents, Harris said. Prior to that, however, the facility had been filling all 16 of its beds.

Most of its residents are referred to the facility through the state, mainly from state psychiatric hospitals. The locked-down facility’s job has been to try to reintegrate residents back into the community, Harris said.

The facility’s closure also will effectively result in the layoff of its 34 employees. Harris said California-based Telecare will try to find them work at its other facilities. The closest such facilities are in the Woodburn area.

When Telecare opened its doors here, many hoped it would fill the gap left when Mercy Medical Center’s Behavioral Health Unit closed in 2007. Telecare actually moved into a wing of the then-deserted BHU building behind the Community Cancer Center.

“When BHU closed at Mercy that was a huge blow,” said Gardin, who holds a doctorate in psychology. “We assumed when Telecare moved in, it would fill that gap.”

In response to BHU’s closure, ADAPT had agreed to a Douglas County Mental Health request to house people with mental health needs in a housing complex ADAPT runs for those with substance abuse issues. Patients would have to have substance abuse issues as well to be housed there.

County funding for those beds ran out awhile ago, Gardin said. Since then, ADAPT has continued to try to meet that need by housing those with mental health issues in its substance abuse housing complex.

But Gardin said that creates challenges for providing treatment to those with mental health needs and also doesn’t provide an optimum living environment for them.

And now with the closure of Telecare, helping those with mental health needs will become more challenging, he said.

“It’s difficult in the community,” he said. “They can go to the ER (at Mercy) and be treated as best as ER can treat them. If they’re acutely suicidal or of harm to others or themselves or unable to take care of themselves, they can go to Douglas County Mental Health.”

“But having no acute or no chronic mental health beds here is going to make life a little more challenging,” he said.

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Riverside closes children’s day treatment center

Posted by admin2 on 28th December 2008

From the Roseburg News Register, December 23 2008

Winston, Oregon – After more than 20 years of providing mental health services to Douglas County children, the Riverside Center will halt its day treatment program next month.

As of Jan. 30, the center will offer only a few small therapeutic outpatient groups, sending 16 students in treatment back into public schools and leaving 10 employees without jobs, said Dan Strasser, executive director of the Riverside Center. Strasser said he will continue to look for other types of mental health services the center could offer.

Outpatient therapy team Heidi Luckman, from left, Sarah Becker, Dan Strasser and Kathryn Gailey work to serve children at the Riverside Center in Winston.

Outpatient therapy team Heidi Luckman, from left, Sarah Becker, Dan Strasser and Kathryn Gailey work to serve children at the Riverside Center in Winston.

“It’s kind of sad for me that this county’s decided — not due to lack of funds but their therapeutic philosophy — they’re going to allot the money elsewhere,” said Strasser, who has been director of the center for nearly two years.

For more than two decades, children and adolescents who have been diagnosed with serious mental health issues have attended the center daily — in place of attending a public school — to receive treatment, he said.

The day treatment program needs 24 students enrolled to keep it financially viable; currently, only 16 attend the center. Nine of the students are Oregon Health Plan recipients; they have to be authorized for the program by Douglas County Mental Health, Strasser said.

Despite the lower enrollment numbers, Strasser said he believes there is still a need for the treatment. In fact, he suspects the need has increased because of growing unemployment and poverty rates.

Statistics compiled by the U.S. Department of Health and Human Services show that 21 percent of children have a diagnosable mental illness, and 5 percent of those children have extreme functional impairment. By applying those percentages to Douglas County, Strasser estimates that 500 children have extreme functional impairment and more than 200 of them should be receiving some type of high-level services.

But lately, Strasser said the county has been authorizing fewer students for the program, which means denying families who want to use the treatment center. Strasser said he believes the funding is available but the county has decided to use the money for other programs.

Peggy Kennerly, Douglas County Health Department administrator, said the method of providing mental health treatment for children has shifted, which has resulted in the money being distributed to a wider range of services.

In 2005, 60 percent of mental health funding was being used to treat 6 percent of children needing care, Kennerly said. Most of that funding was going to day and residential treatment centers for children who had reached near-crisis levels, Kennerly said.

A state initiative implemented a couple of years ago, though, required health departments to create a continuum of care that would reach kids at levels across the spectrum, she said. More and more services are being created and funded at the lower levels of the spectrum in order to reach and treat kids before they reach crisis levels, Kennerly said.

As a result, Kennerly said fewer kids need the services offered at day treatment centers and residential care facilities. Now those students needing higher levels of care may have to look outside of the county.

Kennerly said Health Department employees will work with families with children at Riverside Center to create transition plans, but kids who need day treatment will have to find care in Eugene, Grants Pass or other areas in the state. But Kennerly insists that the closure of the center does not reflect the quality of services that have been provided by Riverside.

“We really appreciate what Riverside has provided for mental health services,” she said. “And we’re sad to see them not provide day services.”

EXTRA – Riverside Center in Winston quietly changing lives, April 11 2008, KPIC.com
EXTRA – Mental health care for kids, Roseburg News-Register, September 2 2008

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Editorial: Douglas County Mental Health

Posted by admin2 on 10th July 2008

From the Roseburg News Review, July 9 2008

Latest failure highlights a system still in crisis

There’s talking about doing something, and then there’s actually doing something.

Unfortunately, a third option exists, which is talking about doing something and then doing nothing.

That seems to be where we are these days in the field of bolstering Douglas County’s mental health infrastructure, crippled last year with the closure of Mercy Medical Center’s Behavioral Health Unit.

A series of articles in this newspaper detailed the fallout of that decision — fewer people getting care at early stages of mental health needs, an increase in the number of people incarcerated because there is no place to send them to get help, children falling by the wayside, families forced to travel long distances to get help for a loved one, or unable to get there at all.

Two companies had announced plans to step in and fill the gap in Douglas County, one on the adult side of the equation and one providing services for children, adolescents and younger adults.

Months later, the provider of adult services, Telecare Corp., remains in contract talks with the state. And the second company, ChristieCare, announced last week that it has been unable to develop the range of services it wanted to provide in the county, including a planned treatment program for children in foster care and a transition home for young adults.

The problem for all of the entities interested in filling the mental health gap has largely been one of funding.

Mercy closed the BHU after years of losing money, and other providers have been unable to make the numbers work either, citing an underfunded state mental health system that provides reimbursement rates that simply are not high enough to allow private providers to run an operation.

The bottom line issue remains this: Those who control the state budget in Salem simply are not making it a priority to fund a viable mental health system in Oregon.

The governor is aware of it. State legislators are aware of it.

There’s been a lot of talk about building a system that provides services across a wide spectrum of the mental health field, catching those who need help at whatever stage they need it, keeping them out of that last grim resort — long-term care at the state hospital in Salem.

Erinn Kelley-Siel, Gov. Ted Kulongoski’s human services policy adviser, earlier said the governor’s office has told the state Legislature that the millions now being spent on rebuilding the state hospital will not correct the shortfalls in mental health care.

“We need to transition,” Kelley-Siel said. “We need care to prevent patients from ending up in the hospital in the first place.”

What better place to start than with children who need help? And we couldn’t even do that.

So the talking about doing something continues. Unfortunately, so does the doing nothing.

EXTRA – ChristieCare scraps mental health plan, Roseburg News Review, June 29 2008
EXTRA – Editorial: Mental Health – Flexibility may result from finding new provider, Roseburg News Review, April 9 2008
EXTRA – County to cut ties to mental health group Jefferson Behavioral Health, Roseburg News Review, March 26, 2008
EXTRA – Negotiations for mental health services [Telecare] continue, Roseburg News Review, March 4, 2008
EXTRA – Gaps in local care a concern [Carol Halley], Roseburg News Review, December 26 2007
EXTRA – State struggles to meet needs of mentally ill, Roseburg News Review, December 26 2007

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