A Report to the Community Regarding Services at Family Service, Division of North Central Behavioral Health

May 29, 2012 Sandy W. Lewis, Ed.D., Executive Director

Background:
For the past two years, the McHenry County Mental Health Board has been assisting the Board and staff of Family Service and Community Mental Health Center to continue its long legacy of providing substance abuse and mental health services to the residents of McHenry County through consultation, direct funding of services and administrative support, and most recently, cash flow loans and advances. At its peak, Family Service reported serving 6,000 clients per year. Their recent FY11 report indicates that individuals were served primarily through psychiatric and outpatient mental health services. Their building houses not only the operations of their staff, but a pharmacy and offices for the Greater Elgin Community Health Center, which provides primary health services to clients. Together, this model represents the most innovative and integrated model of care this community offers. However, reduced state funding, reductions to services to those not covered by Medicaid, additional costs to maintain electronic health/service records and financial reporting infrastructure continued to take tolls on the sustainability of Family Service. Additionally, their building was heavily financed and their debt structure through their bank further weakened Family Service. In order to continue to make services accessible at the same location, a unique collaboration emerged between Family Service and North Central Behavioral Health (NCBHS), which provides similar services in seven other central and western Illinois locations. In early 2012, Family Service and NCBHS announced the intention to transition Family Service systems and programs to North Central effective May 1st through a “Transition of Services” agreement. This was not a traditional merger but an effort to sustain services through a seamless delivery model where North Central would hire Family Service staff and use their building to deliver services. The agreement was contingent on several conditions, including continued access to the Family Service building and unencumbered use of equipment and furnishings; the transfer of current contracts from State and local funding sources; and the ability to sustain operations at a break even financial position so as to not jeopardize current NCBHS services. Based on verbal commitments from these parties, North Central moved ahead on good faith to stabilize services on May 1st. Recent events affecting these conditions in all three areas (contracts/licensure

assignments; facility; and revenue targets) make it impossible for North Central to continue moving forward on the agreement, despite their dedicated efforts to do so. Due to relinquishment of current contracts and employees, and the lack of sufficient infrastructure, it is also not possible for Family Service to reinstate employment and continue services. Therefore, a May 25, 2012 announcement by NCBHS was released announcing the closure of services and employment of staff effective June 30, 2012 or sooner. Leadership staff of the Mental Health Board was informed of the potential for this action earlier in the week and committed to assist the North Central and Family Service staff and Board members in helping with communication with the State Department of Human Services, Division of Mental Health; the Department of Alcohol and Substance Abuse; and the community agencies funded by the MHB.

Impact
Service Demand: Noting that transition of services to North Central had just begun in May, the number of active clients seen in the last 90 days is estimated at 2,000, and the first month’s formal registration of clients to North Central acknowledged by the Division of Mental Health is approximately 600 clients. To base the impact solely on these numbers is faulty because, due to the announcement of the transition of services this past spring, and the reduction in force that Family Service had to implement over the last two years, some clients have been seen on an emergency response basis only, and others have chosen not to formally register or have not had the opportunity to re-register with North Central. Therefore, the Mental Health Board’s assessment is that the impact will continue over the next months, and it is preparing to target the incidence of crisis calls and assessments, and the increased number of potential incidents with law enforcement resulting in arrest or, for the youth population, the increased truancy and/or drop out and expulsion rate as indicators of impact. There is no single agency in McHenry County that possesses the appropriate licensures and contracts to serve all the substance abuse and mental health services provided by Family Service. Therefore, the obligation and responsibility for identifying service transition plans for clients is complex. Clients seeking mental health services at Family Service and North Central were primarily funded by Medicaid or recently discharged from state operated facilities. These clients are therefore the responsibility of the Division of Mental Health through their Medicaid Rule 132 funding; limited funding for non-Medicaid (target population); or through the Department of Alcohol and Substance Abuse Services. Based on recent discussions with the Division of Mental Health, it is their intention to reach out to their certified Medicaid providers to determine which providers have the capacity to accept new clients and will ensure that clients have at least two alternative sources of services. We have agreed to assist in helping the Division of Mental Health in coordinating questions from clients who are seeking to remain in treatment with other

McHenry County providers. These providers are Pioneer Center/YSB, Family Alliance and Thresholds. The Mental Health Board is also a certified Medicaid provider and subcontracts with the Crisis Team (Centegra) for additional services. Clients seeking substance abuse outpatient services must be referred to providers licensed with the Department of Alcohol and Substance Abuse for specific populations. While The Advantage Group and YSB have licensure for services to youth, the community has no adult service provider licensed for outpatient substance abuse services. To respond to critical needs, Centegra’s Behavioral Health Program has an intensive outpatient program. The Mathers Group and other private providers may have licensed clinicians, but they are not certified as Medicaid providers. They could, however, apply to be Medicaid providers. Those clients without a payer source (such as Medicaid and Medicare) and residents of McHenry County have been provided services through funding from the Mental Health Board. Because the MHB could not replace all services lost by state funding reductions, service funding was prioritized and limited to funding certain positions such as psychiatry and nursing or funding for group activities as a means of stabilizing the highest prioritized needs in substance use and mental health services. Additionally the Mental Health Board also funded specific positions to assist with evidence based care (Co-Occurring Integrated Treatment, Wraparound, Traumatic Brain Injury) or positions to help other projects such as the Mental Health Court Social Worker and nurse and Drug Court Clinician. Additionally, the MHB had responsibility for the children/adolescent crisis response program, SASS in which Family Service and YSB were both contracted providers. Clients and services affected by these areas will be the responsibility of the Mental Health Board. The Mental Health Board has also supported the recruitment of psychiatrists and advanced practice nurses to increase and maintain access to psychiatry and medication. This is one of our highest prioritized areas to stabilize. Psychiatric services represent almost 50% of the client services provided by Family Services. Facility Impact: Family Services owns the main building at Veterans Parkway (approximately 34,000 square feet) and their original facility on Elm Street, both in McHenry. The Elm Street facility was renovated during a time when the MHB occupied their building temporarily with our staff. It is now fully occupied through leases with Home of the Sparrow, Transitional Living Services, and Prairie State Legal Services. The Veterans Parkway building was to have housed North Central staff as part of the Transition of Service plan, which would have occupied the second floor. The building is partially leased by a pharmacy and the Greater Elgin Community Health Clinic. The facility has space available for additional tenants. However, due to the end of the North Central transition, the building will be vacated except for the pharmacy and the few exam rooms used by the Greater Elgin Health Clinic. The future of both facilities is in question and the Family Service Board will need to resolve their dispositions and current lease arrangements. Both facilities are financed by separate banking institutions. The facility may be needed by providers (current or new) that may want to expand their capacity to respond to the client demand but have no existing space.

Community Impact: Understanding that no single existing McHenry County provider has the capacity or licensure status to assume responsibility for all the clients in a seamless transition, the dissemination of services to a variety of local and regional providers is expected. This will cause confusion for clients, delays in treatment, lack of coordination and demand for additional supports such as transportation, emergency medications assistance, and emergency housing needs. Due to the delay in securing stable outpatient services, we can predict increases in crisis demand and inpatient care. Inpatient care at Centegra is already strained in responding to the current demand without expanding bed capacity, securing additional psychiatric leadership and relying on additional Mental Health Board financial resources. Our community has no inpatient child/adolescent psychiatric beds, nor any residential treatment or detox facility for substance use. Therefore, individuals and families will travel outside the county for these services. Regional providers will need to be contacted to assist with the demand for services. United Way and Mental Health Board resources may be needed for emergency medications, transportation, and housing.

Mental Health Board Action Steps:
Understanding that nearly half of the impacted clients are covered by Medicaid, the MHB will continue to assist the Division of Mental Health and Department of Alcohol and Substance Abuse to respond these needs. Focusing on the urgent needs of community safety net services (crisis, psychiatry, medications, integrated care) for those without a payer source and to stabilize services, the Mental Health Board will hold emergency public meetings to seek input from consumers and providers to stabilize service and further coordinate communication among all parties. These meetings begin on Wednesday, May 30 at 6:00 pm at the Mental Health Board, 620 Dakota Street Crystal Lake. Additionally, the Mental Health Board will meet with funded agencies prior to the Board meeting. In order to stabilize the SASS contract services to adolescents/children, and transition employment for positions that support TBI, Mental Health and Drug Court and psychiatric/nursing services, the leadership staff is engaged in discussions with key partner agencies to encourage those agencies to offer employment to Family Service staff. The Mental Health Board staff will identify specific recommendations to the MH Board at the May 30th and subsequent meetings. We will work with the Family Service /North Central staff to assist with communication to clients and to make MHB and crisis staff available to assist with coordination and crisis response. This includes helping those without other public funding to seek services through the MHB’s “warrant of need” referrals to other private providers, such as Horizons, Mathers, Professional Consultations group. Finally, the MHB will explore how redirected resources can improve the community’s crisis response with alternative and new program approaches with input from providers and

consumers. The MHB may also need to stabilize services using their location for temporary delivery of services. Additional action steps will be taken once the publicly funded clients (Medicaid) begin to seek services and are registered at the various other McHenry county provider agencies. At that time, we will continue to assess the most appropriate and available assistance as longer term responses. It is important to remember that without adequate and timely payments from the State to respond to the Medicaid population, providers will be challenged with this responsibility and it may further weaken the sustainability of other organizations.

The Mental Health Board acknowledges the diligent work of the Board and staff at Family Service and North Central Behavioral Health. Their efforts to ensure an innovative and seamless delivery system were heroic in the face of significant challenges and barriers. For more information on the MHB’s response to this announcement, contact Sandy Lewis 815-455-2828 or Lori Nelson, Director of Family Services Division of North Central Behavioral Health at 815669-2500.

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