Multnomah County Mental Health and Addiction Services Division Adult Mental Health & Substance Abuse Advisory Council Meeting June 3rd, 2015 Community Representatives (bold = present) Amy Anderson,Stephen Arnold, Debra “Tess” Hubbard, Essie Mae Morphis, Kenneth Biggs, Ryan Hamit, Tam An Trân, Victoria Taylor, Carolyn Anderson, Shon Pruitt, Cheryl Lewis

Agenda Item Call to Order Introductions 10:00 Review of Meeting Minutes 10:05

Public Service Representatives

Guest

Staff

Bill Waters (NorthStar), Erin Fischer (Luke-Dorf), Dave Keohler (Cascadia Behavioral Health Care), Kathleen Roy (Central City Concern), Nancy Griffith (Corrections Health), Tressa Kovachevich (MultCo Sheriff’s Office), Lt. Tashia Hager (Portland Police Bureau), Donna Anderson (Lifeworks NW), Brad Taylor (City of Portland)

Alison Goldstein, (MultCo), Ann Kasper, Lawerence Johnson (Highland Church HARRP), Michelle Childers (NorthStar),Patty Arvizu (NorthStar)

Andrea Quicksall, Joan Rice

Discussion Co-chairs Amy Anderson and Stephen Arnold welcomed the group, and those present introduced themselves. The presentation on crisis services was removed from the meeting agenda. The group reviewed the minutes of the previous meeting. Revisions to the May 2015 meeting minutes:     

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Action/Assigned

The amended May 2015 meeting minutes were Cheryl Lewis and June Howard Johnson need to be added to the unanimously approved. list of those who attended the meeting Election of new members – add phrase at the end of the section: “All nominees were elected.” Guest list – Patty Arvizu guest of Bill Waters with Northstar Kurt Holland needs to be removed from the roster (he is erroneously on the list as attending the May meeting) Alena Vazquez also needs to be removed from the roster

Agenda Item

Announcements 10:15

Discussion

Announcements: 

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Department Updates

Personal request to providers o Amy Anderson currently working with Healthy Willamette Community Collaborative (HWCC) group o Working on survey to hand out to patients o If you’re interested in handing out these surveys, talk to AMY after meeting Personal statement by Tam An Tran o As of yesterday, I currently came out as gender queer o Planning to actively campaign for rights of LBGTQ population, especially when it comes to demographic choices in documents Health Share Advisory Committee this Friday o Located at new Health Share building (2121 SW Broadway, Suite 200) 12:30 – 4:00 o Open to public – hoping as many of you can come as possible

Updates by Joan Rice: Budget information  The budget has already been taken to board of county commissioners (being presented as we speak)  Department of County Human Services (DCHS) budget (see PowerPoint handout) o This is first year that this budget excludes Mental Health and Addiction Services Division (MHASD) – formal move to Health Department will occur July 1 o Citizens Budget Advisory Committee for DCHS budget – includes Stephen Arnold, as well as mental health provider Mark Lewinson. Comment from Stephen:  We have been advocating for funding for Public Guardian program, but we don’t know if this additional funding will be approved by County  Currently 1 FTE (full time equivalent) functioning as Public

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Action/Assigned

Agenda Item

Discussion

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Guardian, but program has many more applications than they can fill o All but one of the programs have gotten the same or more money in this year’s budget o Developmental Disabilities budget was cut  Not a large cut  More of their budget comes from other sources  May have had increase last year Chair’s budget does increase School Based Mental Health (SBMH), maintains one-time-only investment for Mental Health justice triage Unclear what state funding will be coming

Other MHASD updates  MHASD hiring for DCS manager, who oversees Wraparound, SBMH, CARES NW, Early Childhood, and Early Assessment and Support Alliance)  Still working on transition to Health Department, focusing on internal functions (Human Resources, Business Services) Division Updates (Addiction Services)

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Andrea Quicksall, interim Program Supervisor for Addiction Services Unit, provided the group with an update on Addiction Services. 

Last year (FY14-15) when addiction services unit updated contracts with our community providers (DePaul Treatment Centers, Lifeworks, VOA (Veterans of America), NARA (Native American Rehabilitation Association), Impact Northwest, Cascadia, Central City Concern), wanted to focus on recovery-oriented system of care o Wraparound services for clients went through treatment, needed added support after discharge o Injected money o Very slow start for providers, because it was a large change – has taken most of this year to help them figure out how to staff, how to bill for this type of system o A couple have really taken this on and done a great job o Have encouraged excelling providers to come forward at alcohol and drug providers meeting to share how they did it – staffing,

Action/Assigned

Agenda Item

Discussion treatment, classes For 2015-2016, we are continuing with that funding and messaging – increase recovery support services as they discharge from formal treatment so we can keep them engaged in a recovery system Health Share agreed on dual diagnosis rate (enhanced dollar amount) for residential program o Just kicked off pilot project with DePaul Treatment Centers adult residential treatment program – they will be admitting clients who are dually diagnosed into residential treatment o Criteria for mental health taken largely from outpatient Level C, and also from ASAM (American Society of Addiction Medicine) criteria regarding how to run dual diagnosis residential care o Intention to provide mental health and addiction treatment in one place o Goal is to open access, and also to maintain them (dual diagnosis clients have previously had issues with being admitted then rapidly discharged due to inability to control symptoms in regimented environment of addiction services) o Eliminates need for programs to submit separate mental health authorization and separate bill for mental health services o Definition of dual diagnosis can include multiple mental health diagnoses and multiple substance use diagnoses o Medical complexities would be “tri”, can be admitted as well  We are working on another level of residential treatment that is higher  Address medical complexities  Clients experiencing hallucinations  Need to maintain medication regimens  Just got out of hospital and not ready to go straight into standard residential treatment Question: Is there some reason why we don’t separate trauma clients and start using the ACE (Adverse Childhood Experiences) study questions? We don’t have any data upstream (in county jails). Can you start screening clients for an ACE study? o Trauma is coming up and replacing previous mental health o

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Action/Assigned

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Discussion diagnoses Bi-polar with psychotic features Schizophrenia Seeing a lot of trauma with disassociative features, trauma with PTSD (Post Traumatic Stress Disorder) o We struggle with how to roll out trauma informed care with providers o Will hopefully be put forward as standard of care very soon o Very different model of treating and speaking with people Question: Are you also working toward outpatient dual diagnosis rate o Working on what needs are for integrated rate o Until there is more work at higher policy level within Health Share, cannot move more toward integrated rate for outpatient o You have to look at where the preponderance of services comes from, or if it is truly split o Stay tuned Emergency Department Outreach Project o 2 alcohol and drug treatment providers in community o Legacy Health (Good Samaritan and Emmanuel), OHSU (Oregon Health Sciences University) and Adventist Hospital o Emergency Department (ED) outreach staff will be a team within themselves o Goal is to capture patients who present to ED when they are in crisis related to A&D disorder  Intoxicated person comes to ED  ED will reach out to outreach worker  Worker will come to ED and talk to patient, try to engage them in what they might want to do about their substance use disorder  If person is not interested in treatment but willing to talk, outreach worker will remain engaged o DePaul Treatment Centers and NARA have hired outreach workers o This project will have outreach workers working as a team to do what client is asking for regarding treatment – person-centered treatment, trauma informed treatment – focusing on what person o o o

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Action/Assigned

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Discussion 

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wants rather than what worker wants regarding treatment Question: How are you meeting the needs of non-English speakers? And how are you meeting clients’ needs for spiritual guidance? Need to address all of the things that make them feel connected to their community. o Specific language programs  Have contracted provider for Burmese-specific treatment  Several for Latino  Have men’s mono-lingual treatment for Latinos o African American specific treatment o NARA does a really good job with native American group o NARA has done really well with adding spirituality – some clients from other cultures relate to Native American spirituality component and will choose this program o Hearing-impaired program in Washington – working on how to pay for it o We honor (accommodate) spiritual practice, but we don’t necessarily host it – programs are very willing to work with people on spiritual needs Work on integrating substance use care coordination with mental health, aging & disabilities services o Hub project  Working with non-service eligible ADVS clients to wrap around them with peer mentors and re-screen them for longterm services  Hoping to renew that project for another year because it fills a gap Question: Full cycle of care case management? Is that being looked at? o ED outreach manager would be responsible to bringing that person into detox, then tracking them to next step o Through Health Share benefit, we are trying to put together a care coordination team that would take people through from detox through outpatient What do you want to know about Addiction Services? Andrea Quicksall will take requests and bring back answers.

Action/Assigned

Agenda Item

Election of New Executive Members

Discussion

Nominations for Executive Committee positions:   

Co-chair (Stephen taking on another position) – Shon Pruitt Secretary – Ryan Hamit (Ryan will relinquish seat as Member-AtLarge) Member-At-Large (to serve along with current Members-At-Large Carolyn Anderson and Essie Morphis) – June Howard Johnson

Nominations for AMHSAAC member positions: 

Consumer Survivor position – Cheryl Lewis

All nominees running unopposed. Police Behavioral Health Unit

Tashia Hager presented on the Portland Police Behavioral Health Unit: 

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City of Portland and Portland Police Bureau are unique in how we are structured o National standard – Memphis model: Take a police dept, ask for volunteers, give 40 hours training, build relationships with community, those officers go out and handle mental health calls o Portland Police (PP) went away from Memphis model in 2007 o Community said we want every officer to have crisis intervention training, PP agreed to do that o Department of Justice (DOJ) wanted PP to use Memphis model o PP finds great value in crisis intervention as core competency, so did not want to go back to old way, so PP added a new layer: All officers get 40 hours of crisis intervention training, but also have Crisis Intervention Team who get additional 40 hours o “Probably the best trained police officers across the nation” o Not enough to deal with things at moment of crisis, so PP added another layer: Behavioral Health Unit Behavioral Health Unit

Action/Assigned

All nominees were elected.

Agenda Item

Discussion o

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History: Started with one car (Mobile Crisis Unit) with one clinician (from Cascadia – Project Respond) and police officer o Has become much more structured o Now have three units, one assigned to each precinct o Entire job is to work with people in community who have been in crisis and try to get some resolution before that crisis either increases or comes around again o Each unit has 10-15 people they work with at any time o All come from referrals from patrol officers o We have a process by which sergeants evaluate and assign them o Anecdotally very successful, working on providing data o Eventually guess that Behavioral Health Unit will grow o We do many presentations, both to community and to outside law enforcement Service Coordination Team o Have been around for a very long time o Work primarily with people who have drug and alcohol addiction & high criminality o Started as way to reduce crime, but found program really works for the people: When people are committing crimes to feed addiction, treat addiction and they will stop committing crimes. o Getting new Service Coordination Team Manager  Billy Cammer got sworn in as police officer, no longer manager  Emily Rochon (formerly of Central City Conern) starts tomorrow morning as Service Coordination Team Manager Comment: All of this is Portland Police; I would like to see all of tricounty doing these trainings. o A: I agree  Behavioral Health Unit going to Spokane to present at crisis intervention training  We have applied to present at regional crisis intervention training in Vancouver WA (in September?)  A couple of those agencies have come to see us.  What will convince nation of this model is when community

Action/Assigned

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Discussion 

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agrees that this works well. Comment: mental health advance directive or similar? Also, WRAP (Wellness Recovery Action Program) we were doing inside jail, but due to lack of help could not keep going, but saw interest of inmates. Why don’t we look at creat you the best?” o A: DAR (Disability Accommodation Registry) – self-reporting to police bureau about who you are and whatever info you feel comfortable sharing: possibly diagnosis or medications, but ideally counselors, who you trust, who you will listen to in crisis, what might not work. The completed form goes into police data system, which now goes into larger system shared by 46 agencies in Multnomah, Clackamas, Washington, and Clark counties. Pilot project with Central City Concern (CCC) o 6 beds dedicated to people who have co-occurring mental health and addictions who have been referred by Portland Police Behavioral Health Unit o Something we could see was lacking o Change in contract with CCC giving us access to drug and alcohol treatment and housing for women; cultural piece to it as well o We get twice as many referrals as we can actually handle o Referral process for 6 mental health stabilization beds same as housing rapid response beds (not walk in, not police drop off; beds will be gatekept by Service Coordination Team of Behavioral Health Unit) Question: you’re getting twice as many referrals as you can handle – what are the expansion plans? o Police Bureau not doing any expanding for at least 2 years o We are in a personnel crisis, and will be for some time  We froze hiring for over a year  Takes 9 months to 1 year to hire someone, another year before able to drive police car by themselves o When there are people, Tashia will be asking

Action/Assigned

Agenda Item Legislative Update Public or invited guest comment 11:55 Adjourn

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Discussion No legislative updates. No public comments.

Meeting ended at 12:00 PM.

Action/Assigned