1. Rolling Hills Community Services Region
Stakeholder Workgroup Meeting
August 3, 2017

2. 14 Regions in Iowa

3. Rolling Hills Community Services Region Counties: Buena Vista, Sac, Ida, Cherokee, Carroll, Crawford and Calhoun Population: Employees: CEO 3 Coordinators of Disability Services 1 Part-time Social Worker 1.5 Administrative Assistants

4. MISSION STATEMENT Rolling Hills Community Services Region is committed to ensuring access to high quality, value-added community-based services for all eligible citizens within our communities that encourage resiliency, stability and growth.

5. VISION System of Care that is characterized by the following principles and values: *Welcoming and customer-oriented *Person and family driven *Recovery oriented *Trauma-informed *Culturally competent *Multi-occurring capable

6. To that end….
Since 2014, Rolling Hills has developed and invested in the following services to align with our Mission:
24 Hour Crisis Stabilization Home in Sac City (Turning Point)
24 Hour Transition Home (Stepping Stones)
Established Family and Peer Support programs within the Region
Invested in two peer run Drop In Centers within the Region
Implemented Jail Diversion in all 7 counties
Crisis Intervention Training for Law Enforcment
Increased local access to mental health services in rural areas
Multi-agency Supported Employment Grant

7. Mental Health Redesign – Legislative Action in 2012
Regions have been lobbying for equitable funding since the inception of Regionalization.
Senate File 504 was passed in the 2017 Legislative Session

8. Senate File 504 Equalized levies across the Regions
Requires Regions to spend down fund balances to 25% by 2020
Fiscal Viability 2018 Interim Study Committee
Regional Stakeholder Meetings by July 1st, 2017 and ongoing
Regions must enter into an MOU with the MCO’s

9. OUR CHARGE Requires Regions to develop a Community Service Plan
Collaboration with judicial system, hospitals, law enforcement, mental health and substance abuse providers, NAMI, crisis service providers, MCOs and others
Community Service Plan due to DHS by October 16th, 2017

10. WHERE DO WE GO FROM HERE?

11. Workgroup Outcome
Create collaborative policies and processes relating to the delivery of, access to, and continuity of services and supports for individuals with mental health, disability, and substance abuse disorders
Individuals with Complex Needs
Review Resources currently available
Identify additional services and supports needed

12. Outcomes for Success
Individuals who present in the emergency room receive inpatient psychiatric services or community based services within 24 hours
Individuals with complex needs are discharged from a psychiatric hospitalization within 7 days from the date they are determined ready for discharge
Inmates that have a mental health or substance use disorder will receive a screening within 3 days, will have mental health and substance use disorder services in jail, and a full array of services identified and in place upon release from jail to prevent recidivism
Individuals with complex needs are not involuntarily discharged from current service provider without a new provider in place
As identified by DHS

13. Outcomes for Success
Individuals with complex needs who are homeless have access to stable housing
Availability of crisis services (24 hour crisis line, mobile response, 23 hour observation and holding, crisis stabilization community based, crisis stabilization residential
Availability of Assertive Community Treatment
Availability of Subacute Services

14. SF 504 Section 18.5: DHS will submit a report to the Governor and general assembly by December 3, 2018, providing a summary of services implemented by each mental health and disability services region and an assessment of each region in achieving the department’s identified outcomes.

15. QUESTIONS?

16. COMMENTS FROM 8/3/17 PLANNING SESSION- NEEDED SERVICES
DHS proposed outcomes do not include anything related to individuals with intellectual disabilities
Psych services - psychiatrist services availability needs to be increased
Availability of beds still an issue
Availability of appropriate beds
Professional services (psych) who understands people w intellectual disability & co-occurring issues
Access to board certified behavior analyst needed
Overall big issue – funding of services/reimbursement
Current system not well oiled system yet – Managed Care system not working well

17. NEEDED SERVICES – (continued)
Telepsych at ER’s for MH to decrease Law Enforcment time
Availability of funding
Sustainability of maintaining services after fund reserve target is reached
Sustainability of services not only in region but throughout Iowa – (financial sustainability)

18. 8/3/17 – under consideration - services to be provided
Providing substance abuse co-occurring disorder services – 7/1/18
Exploring mobile crisis response
Implement tele-psych services within hospital emergency departments and on out-patient basis
Exploring Illness Management and Recovery
Community-based peer support service

19. DHS Outcomes
1. Indivs presenting at ER – receive services w/in hrs:
How to provide 24/7 basis the actual community-based service
Comm-based svs not currently available on 24/7 basis
Sitting in ER for days waiting for services – not receiving any treatment
Definition of “services”
Need to enhance awareness of what services are available

20. DHS Outcomes
Differences between those involved court system & non-court system
Concern from ER doctors not wanting to take on liability dealing with indivs
Transportation from ER to hospital – who takes them if voluntary
Providing the continuum of care – all outcomes

21. DHS Outcomes _
DHS – Outcome #2 – indivs w complex needs discharged from psych hosp w/in 7 days from date determined to be ready for discharge
Need for someone to advocate/support follow idivs w complex needs through the system
Increasing training to providers/staff

22. OUTCOME #3 Outcome #3 – Inmates receive assessment within 3 days
Psych services in the jail
Currently do service assessment – but need to do full psych assessment
Need for experts to provide services
Should jail diversion process be evaluated /revised?
What happens when they need jail - & dealing w the courts & attorneys

23. DHS Outcome #4
Need to do more to assist providers in addressing indivs w/ complex needs
Basic issue is currently addressed
Issue – not admitting indivs w complex needs because there is no place for them to be discharged to & no addl funds available for this purpose

24. OUTCOME #5 – Indivs w complex needs - homelessness
Not as much as a problem w/ services now available
Income as issue for paying for housing
Some people may not want stable housing
Have been working on housing as an evidence based practice

25. OUTCOME #6 – Availability of crisis services
24 hour crisis line – available
Mobile response – in development (tele-health)
23 hour observation & holding – not currently provided
Crisis stabilization comm-based – not currently provided
Crisis stabilization residential – currently being offered - Turning Point
State had promised this would be funded by Medicaid – but not yet implemented – funding issues > pre-authorization

26. OUTCOME #7 – Availability of ACT
Alternative Community Treatment – RH just contracted w provider out of Spencer -

27. OUTCOME #8- AVAILABILITY OF SUBACUTE SERVICES
Currently not provided -

28. OTHER ISSUES, CONCERNS
Have facilities, staffing – but system all jammed up
Providing services for individuals who are over income
Maintaining supportive employment program – future funding
Low unemployment rate – ability to find & retain staff for facilities