Mental Health Association of Portland

Douglas County soon will have a mental health court

Posted by Jenny on 7th August 2014

The Lund Report, August 4, 2014

Mental Health Court graphicBeginning this month, Douglas County will join at least 12 other Oregon counties and two cities in establishing a mental health court to divert the mentally ill away from jail and into needed healthcare services.

It took half a dozen years after a local judge started pushing for its creation. This spring, Greater Oregon Behavioral Health, which is involved in the mental health component of the local coordinated care organization, is paying $305,000 to create the mental health court.

“It gets people into services and resources that they wouldn’t otherwise have access to,” said National Alliance on Mental Illness (NAMI) — Oregon Executive Director Chris Bouneff, who supports the creation of mental health courts, noting there are plenty of obstacles in Oregon. “The state doesn’t issue money for mental health court. Counties and courts struggle to put this all together in ways that are sustainable.”

A recent survey by NAMI found 14 courts existed in Oregon — in Clackamas, Clatsop, Coos, Deschutes, Jefferson, Lincoln, Malheur, Marion, Multnomah, Yamhill, Josephine. and Washington Counties as well as in Eugene and the Dalles.

For the new court, funds also came from Douglas County, the city of Roseburg and the medical group Architrave with each pitching in another $25,000 for the first year of operations to help restore a funding cut to the Douglas County District Attorney’s Office — said Judge Randy Garrison, the man behind the push.

Garrison declined to go into the specifics on the obstacles he’s faced in the last six years to create the court.

“I’m intending to be deliberately vague,” he said. “It’s rather negative talk….Some impediments were removed more recently. The sun, the star and the moon aligned.”

Garrison said he is “very excited and hopeful” that the court will facilitate better treatment for the county’s mental ill and improve public safety by allowing law enforcement to focus their resources on serious crime while making “better use of public funds.” He’s currently working to set the first court date.

In Douglas County, there are no specific requirements related to which mental illnesses the court will serve, but to participate, the crimes committed have to be  “below   the  line” felonies or lesser misdemeanors — where there is not mandated prison time.

Unlike some mental health courts, the one in Douglas  County will focus both on people who have already been sentenced to a crime and people who will go to the court in lieu of being sentenced.

Community Health Alliance, the newly formed mental healthcare nonprofit in Douglas County, will provide the services.

“It’s helping to get people the treatment they need,”  said Janet Holland, head of the Community Health Alliance. “These are often people who get clogged in the criminal justice  system, and there’s this revolving door.”

Holland noted the court aims to make the most of the criminal justice and mental health care funding available. “We’re all trying to do more with less.”

Since the national efforts to close down mental institutions in the 1960s and move mental health care to community-based programs, the mentally ill have fallen into the criminal justice system in staggering numbers.

Just over half of prison inmates in Oregon are officially identified as in need of mental health treatment, and, following the national trend, significantly more people in county jails have mental healthcare needs.

Ari Basil-Wagner, a data and training analyst with Greater Oregon Behavioral Health, said Douglas County had identified upwards of 65% of jail inmates as having some kind of mental health issues.

“It might be higher in Douglas because they’re keeping a strong eye on that,” she said, once prisons and juvenile institutions “became a surrogate mental institution.”

“The national agenda has been in the more recent years to provide better services  and reduce recidivism,” she said. “We’re very representative of the national trend.”

Mental health courts, like drug courts, link the judge, a probation officer, the district attorney’s office and providers to address the underlying problems of defendants.

The hope is to provide largely outpatient mental health services for people who would otherwise cycle through the jail system and to allow law enforcement to focus on dangerous criminals.

Often the mental health courts have been started at the impetus of judges and other law enforcement officials hoping to end the cycle of  the mentally ill who  end up in jail repeatedly. Ultimately, the hope is to save money for law enforcement as well as public health.

Officials and advocates working toward the creation of the Douglas County mental health court looked to other Oregon counties’ experiences.

“We have experience in Malheur County, where mental health court has almost eliminated their need for acute care,” said Kevin Campbell, of Greater Oregon Behavioral Health, noting that while his group will make a substantial investment toward the first year of the court, he expects to see savings on the treatment side.

“It’s only a matter of time before folks with mental illness get involved in law enforcement,” said Campbell. “if they go into the state mental health system and into the state mental hospital system, it’s extremely expensive — $300,000 a year. “

In Clackamas County, where mental health court began in 2001, then-Judge Robert Selander started the court after learning of the extraordinary number of mentally ill defendants before him.

Selander said there can be challenges to setting up a mental health court and getting all the agencies working together to provide the resources necessary.

“I think anytime you’re dealing with different agencies. everyone seems to have their own silo,” he said.

In Clackamas all the agencies were ultimately pleased to have come together — and there were some promising results, he said.

“Our first class we followed for three years after; the people in that class we had 1.5 incarcerations per year. Three years after, they had none.” said Selander, while acknowledging there were some failures in treating mental illness, including some suicides.

Selander also argued it’s critical to focus criminal justice resources where they’re needed.

“In Lane County they were releasing burglars on the street. Many counties don’t have enough jail cells,” he said. “To fill them with people that have mental health problems just seems ludicrous or ridiculous.”

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Douglas County Quits Mental Health Services

Posted by CoffeeX3 on 22nd May 2014

From the Lund Report, May 20, 2014

Douglas County is getting out of the business of providing mental healthcare — joining the majority of Oregon counties where private nonprofits are in charge.

But the county is going one step further than all but two – Umatilla and Klamath – in ending its role as the local mental health authority, which means they’ll no longer have any hand, as most counties do, in planning for mental healthcare.

Roseburg, Oregon

Roseburg, Oregon

Officials in Douglas County cited a careful decision designed to merge physical and mental healthcare for residents by handing off responsibility to the local coordinated care organization — Umpqua Health Alliance.

At the same time, the decision, which came in late March, surprised Umpqua Health Alliance board chair Dr. Robert Dannenhoffer, he said, and set off a hectic three-month push to set up a new nonprofit and hire workers to provide the same services.

“It’s somewhat of surprise,” Dannenhoffer said. “We didn’t know anything about it until February of this year.”

The Umpqua Health Alliance covers most of Douglas County.

“To bring this about in three and half months is really a lot of work,” Dannenhoffer added. “We had to do everything. We didn’t have anything.”

But Dannenhoffer said that the new, independent nonprofit would be able to handle the work. “From the CCO we’re confident they’re going to do a good job,” he said.

Just over 100 workers are being laid off by the county as part of the decision, county officials said.

But “90%” will be hired by Community Health Association, the new nonprofit, said Oregon Health Authority (OHA) spokeswoman Rebeka Gipson-King.

“We are confident we’ll have a successful transition within the 90 days,” Gipson-King said in an email.

“One thing that gives us confidence is that Community Health Alliance (CHA) was going to offer positions to approximately 90% of the Douglas County Mental Health employees, meaning that much of the leadership and clinical staff would remain the same and a much more seamless transition for clients.”

The change in structure will represent a chance to improve healthcare, integrating physical and mental health, said Kevin Campbell of Greater Oregon Behavioral Health, which is helping to set up the CHA.

“None of us want to be told we want to go to mental health service,” he said, noting that the ideal is to address mental and physical healthcare at the same time.

“In any given year, 20% of the population can benefit from mental health services…. In reality, our mental condition or behavior conditions are paramount to our overall health.”

Douglas County is also going to “be the first in the state” to use an integrated system for electronic records on physical and mental health, he said. “It’s better patient care from my perspective.”

The majority of Oregon counties have already privatized mental healthcare. The state contracts with nonprofits, instead in those cases.

Within the last two years, Klamath and Curry counties also contracted out their mental health, though Lake County took back over the care, according to OHA data.

According to OHA, 21 Oregon counties contract out the work to nonprofits: Mountain Valley Mental Health (Baker), Clatsop Behavioral Healthcare (Clatsop), Columbia Community Mental Health, Inc. (Columbia), Lutheran Community Services (Crook), Curry Community Health (Curry), Community Counseling Solutions (Grant, Gilliam, Morrow, Wheeler), Symmetry Care (Harney), Mid-Columbia Center for Living (Hood River, Sherman, Wasco), Best Care Treatment Services (Jefferson), Options for Southern Oregon, Inc. (Josephine), Klamath Youth Development Center (Klamath), Lifeways, Inc. (Malheur, Umatilla), Tillamook Family Counseling, Inc. (Tillamook), Center for Human Development for Union County (Union) and Wallowa Valley Center for Wellness (Wallowa).

Two other counties — Multnomah and Washington –subcontract out almost all the work but maintain responsibility for it, according to OHA. And the remaining 13 countries do most of the work, but may subcontract out some of the work: Clackamas, Coos, Benton, Deschutes, Douglas, Jackson, Lane, Lake, Lincoln, Linn, Marion, Polk, Yamhill as well as the Confederated Tribes of Warm Spring.

“The change has to do with the new CCO and the way of doing healthcare in Oregon. The advent of CCO’s has created an opportunity to look at healthcare differently,” said Douglas County Health Administrator Peggy Madison, echoing Campbell’s comments.

Madison said the decision was “definitely not budgetary” and that Douglas County’s mental healthcare program was “self-supporting.”

Asked about the decision to cease being the local mental health authority, she wrote in an email sent to The Lund Report, “This was a Board of Commissioners’ decision.”

Unlike in Douglas, some county officials believe in maintaining their role as a mental healthcare provider as well as supplementing the federal and state resources to address the needs of local residents.

Cindy Becker, Director of the Clackamas County Department of Health, Housing and Human Services, said there’s a reason for at least some counties can do a better job of mental health than CCO’s.

“CCO’s come from the physical health world. That’s the wheelhouse,” she said, adding counties have developed an expertise and have the “local relationships” with homeless services, foster care and police.

Clackamas has a good working relationship with their CCO — as do many counties, she said.

“We try to take the best of both worlds capitalizing on the expertise that each of us bring to it,” she said, noting in addition the county has invested financial resources as have other counties. “They’ve done it for a long time. They are vested.”

According to the Community Health Assessment for Douglas County conducted by the CCO, which was previously covered by The Lund Report, Douglas County has more than its share of mental health problems. Proportionally fewer Douglas County residents said they were in good mental health between 2006 and 2009 than Oregonians over all. Rates of suicide deaths were higher in the last decade than in Oregon over all. And the problems affect Douglas County youth “with one in four 8th graders reporting a depressive episode in the past year,” according to the assessment.

Chris Bouneff, executive director of National Alliance on Mental Illness–Oregon, said he was hopeful that efforts to improve mental healthcare in Douglas County would prove fruitful.

“You’re seeing people tinker, try to do a better job. I think people are doing it with the best intentions,” he said. “We are hopeful as an organization that these changes will pay dividends. It’s initially encouraging. They’re working with entities that have some expertise in delivering healthcare.”

“Mental health was not working in this state,” he added. “I don’t think anyone can say one way’s better than the other. At this point, nothing’s worked.”

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Douglas County gives up mental health programs

Posted by CoffeeX3 on 30th March 2014

From, 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 ( ) 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 CoffeeX3 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 CoffeeX3 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 CoffeeX3 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 CoffeeX3 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 CoffeeX3 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,
EXTRA – Mental health care for kids, Roseburg News-Register, September 2 2008

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