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Behavioral health commission ups its involvement to improve programs

Becoming more involved with the communities and residents they serve is just one of the positive points mentioned in the annual report of the Plumas County Behavioral Health Commission.

Supervisor Lori Simpson, and chairperson of the commission, made a presentation of the results of the July 2018 to June 2019 annual report.

Simpson told other supervisors Feb. 4 that commission members set priorities for themselves and were working to carry those goals out. “We have a good working commission and get things done,” Simpson said. “And we’re achieving that.”

One of the biggest changes is with the number of commissioners on the board. There used to be 20 members, Simpson said. Through attrition there are now seven members. “That’s a good number,” she added.

Members include family members of those with behavioral health needs, consumers, a supervisor and community members.

Simpson has long represented the board of supervisors on the commission, she reminded other supervisors. “A supervisor is always assigned to this position; for next year you just better be prepared,” Simpson said, reminding supervisors that her term in office was coming to a close.

And they have new bylaws. Last June, an ad hoc committee worked on the new bylaws. There is a need for annual involvement because the California Welfare and Institutions Code could change laws and the local commission needs to reflect those changes. According to those bylaws, the commission needs to meet nine times a year. They traditionally meet the first Wednesday of each month at the Plumas County Library in Quincy.

During meetings, commissioners have heard special guest speakers, Simpson explained. At other times, commissioners will give presentations. Some of those include being a peer advocate specialist as a consumer or in one of the county’s Wellness Centers.

As part of the commitment to becoming more involved, Simpson said that commissioners not only attend more countywide meetings, but serve on the behavioral health assurance and improvement committee, NorCal Continuum of Care for Plumas and Sierra counties’ No Place Like Home meetings, Plumas County’s 20,000 Lives meeting, the Gay-Straight Alliance and the county’s Community Corrections Partnership. One commissioner also volunteered as an Interim Patients’ Rights Advocate.

While three commissioners attended behavioral health’s Mental Health Services Act Stakeholder meeting last March-April, others have also been busy. Four commissioners attended a suicide prevention, assessment and intervention workshop in Plumas, another attended Lassen’s California Association of Mental Health Peer Run Organization’s training.

“The increased involvement by commission members reflects a desire to identify and understand Plumas County citizens’ mental health, alcohol, drug and other substances needs,” Simpson said. “This helps to assure that the needs of the SMI-MediCal (seriously mentally ill) insured population are being addressed by PCBH.”

Trainings are also a regular part of being a commissioner. Last April Simpson participated in a conference call with the California Association of Local Behavioral Health Boards/Commissions. That call included co-occurring diagnoses, employment, homelessness, disaster preparedness and the lack of mental health professionals.

Although the commission has been involved in many trainings, more are needed, according to Simpson. These include the Brown Act, Health Insurance Portability and Accountability Act and the ethics for commissioners that haven’t completed the requirements online.

Simpson said that the commissioners are working with Plumas County counsel to fulfill those training needs.

Among the tasks the commission took on last year, Simpson said that last July they worked with the board of supervisors in closing the Sierra House. “This was a very difficult decision to make since this eliminated essential services for the seriously mentally ill population,” she explained.

However, commissioners heeded PCBH Director Tony Hobson’s compelling concerns about the costly maintenance and safety of the operation, Simpson explained about Sierra House and the decision to close it.

By the time Sierra House closed, it was down to two clients, Simpson said. The decline reflected a decision of a behavioral health director before Hobson to stop accepting clients there. With only two clients, “This made the operation of the 24-hour facility financially detrimental,” Simpson explained.

Although a PCHB working group spent more than a-year-and-a-half discussing various options for the Sierra House’s difficulties, no one could come up with any workable solutions, Simpson said. The Sierra House closed June, 30, 2018.

Steps forward

“The commission has found Dr. Hobson informative, striving for Departmental transparency,” Simpson said in her report. “He has also been a positive addition to the leadership of the department, as well as boosting employees’ morale with his emphasis on teambuilding, and with his open-door management style.”

In the fall of 2018, Behavioral Health began walk-in intake assessments at Wellness Centers in Chester, Greenville and Portola. Each is held a different day of the week for staffing purposes. Intake assessments at the annex in Quincy are on Mondays and Wednesdays. “By April 2019, with open access for intake appointments happening in all four communities, intakes have increased 100 percent (from 30 a month to 61 each month),” reported Simpson.

The No Place Like Home working group, that meets monthy, began in November 2018. This is affiliated with NorCal Counties Continuum of Care for Plumas and Sierra counties.

When Hobson accepted his position as director of Behavioral Health, it was to learn that the department was seriously over budget. By December of his first year he was able to announce that although the department still had financial problems they were less serious than before. “This is due to billing for more services with improved staff documentation,” Simpson said.

Hobson made sure that specific programs, including Mental Health Services Act subcontractors, Environmental Alternatives and Plumas Rural Services, were certified to bill MediCal directly for services they provide to the department.

Simpson also indicated some of the hard-working administrative staff that is making differences within Behavioral Health. Systems Analyst Jessica McGill was promoted to the quality assurance officer position. “This position is vital to the department’s assessment of services as it complies with state and federal ever-changing regulations,” Simpson explained.

Aimee Heaney, MHSA coordinator, not only attends regular commission meetings, but also reports on ongoing MHSA-funded programs.

And former case management specialist Tori Brown began her duties as the interim Alcohol and Other Drugs administrator. “She has worked diligently on getting PCBH’s paperwork application completed and submitted for AOD-MediCal approval,” Simpson said.

This allows the department to bill for AOD services already being provided in the county.

Other changes include having therapists and case managers — some who have worked for the department for decades — go through documentation training. “This increased billing for the multitude of services they provide consumers,” Simpson said.

“The support staff has been essential and steadfast in providing up front customer services, computer assistance in generating departmental statistics that go into state mandated reports, and the daily support of the department,” Simpson said.

In March 2019, Elizabeth McAllister took on the task of becoming a patient’s rights advocate. This isn’t an employee position, but one that receives a stipend for services as an advocate for PCBH consumer who have complaints or grievances about services.

In an effort to create a Community Justice Court for Behavioral Health for seriously mentally ill and veteran offenders, the commission has been meeting with representatives of the sheriff’s office and the probation department.

“With the start of Assembly bill 1810 in August 2018, Plumas County is the only small county diverting BH/SMI offenders from jail by having court-ordered treatment for their illness,” Simpson explained. “PCBH is now participating in Plumas County jail’s quality improvement meetings.”

Jail administrators have requested that the commission do a full assessment of inmates who have been incarcerated for more than 14 days.

Last April, the department went through an External Quality Review. Reviewers noted changes that were made from one review period to the next. Also a Triennial Department of Health Care Services review occurred over two days last June.

Hobson told the commission that the reviewers were impressed with changes and the direction the department is heading. Weaknesses showed in remaining outdated policies and procedures and those are being made current.

Needs assessment

Each year the state Behavioral Health Planning Council and CALBHB/C asks all counties questions about the previous year’s services provided to each county. This is called the Data Notebook and provides a report that goes to the state legislature. The last Data Notebook surveyed types of services and needs for children, adults and older adults, Simpson said.

Answers to the questions were  reviewed from Plumas County’s MHSA Three-Year Program and Expenditure Plan for 2017-2020, and Plumas County’s MHSA 2017-2018 Annual Update.

According to the review, the areas where there is an ongoing need for behavioral health pre-crisis and crisis services are with the 16 to 25-year-old youth, also called TAY or transitional-age youth,” Simpson said.

With older adults there is a need for pre-crisis and crisis services, assessment, medication education and management, case management, and rehabilitation and support services.

Barriers to meeting these needs are inadequate program funding, lack of specialized professional expertise in geriatrics, lack of workforce/providers, lack of transportation especially in the winter, and culturally relevant needs for Maidu, the LGBTQ and veteran populations.

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