| Board
Meeting Minutes - January 12, 2004 |
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| Meeting held at 800 Preston Avenue Charlottesville, Virginia Members Present Susan Garrett, Chairman Members Absent Carol Johnston Others Present James R. Peterson, Executive Director Marcia Becker, Rural Services Director I. CALL TO ORDER Ms. Garrett, chairman, called the meeting to order at 6:02 p.m.
Ms. Garrett welcomed everyone to the meeting. There were no introductions.
Ms. Garrett asked if there were any comments from the public. There were none.
Ms. Garrett said that action would be taken on the previous report from the Personnel Committee, and also there will be a report from the Search Committee and also an announcement from Mr. Trippel regarding the Annual Visual Arts Show.
Ms. Garrett recalled that Rev. Cameron and Ms. Miller had both spoken about the wonderful works of David Goodwin, and she suggested that a letter from the board should be sent to him in recognition of his service to the community. Ms. Miller said that Mr. Goodwin has helped to serve at every Thanksgiving dinner held at Blue Ridge House, that he arranged for the funeral of an indigent consumer in mental retardation services, and he made a contribution toward the purchase of Fourth Street Station. Ms. Garrett said that she would arrange for a letter to be sent. Ms. Garrett noted that the minutes of the Search Committee meetings had been distributed, and that they have discussed engaging a consultant to help with the recruitment. Staff from the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) have also said that they could assist, and so the committee will meet tomorrow to decide the course of action. A survey was sent to all Region Ten staff and the committee members met with the members of the Quality Management Council (the management team). Ms. Garrett said that there was an excellent response from many. Ms. Barrett commented that the board would need to approve the funds for the consultant, and Ms. Garrett said that Since Mr. Brown was working on the Request for proposals, the board could vote on it at the next meeting. Mr. Belair said that the board should authorize the expenditure now, and that was not to say that the committee would have to engage a consultant, but if they decided to go in that direction, they would not have to wait another month for authorization. MR. BELAIR MOVED THAT THE BOARD ALLOCATE UP TO $25,000.00 FOR THE RECRUITMENT OF THE EXECUTIVE DIRECTOR. REV. CAMERON SECONDED THE MOTION. Ms. Barrett said that she had been assured by Mr. Paul Gilding at DMHMRSAS that someone would be designated to work with the board if a request were made to Commissioner Reinhard. There was then some discussion that $25,000.00 may be an insufficient amount for the committee to work with, and Mr. Murphy offered an amendment to the motion raising the ceiling amount to $30,000.00. Mr. Belair and Rev. Cameron accepted the amendment to the motion. Ms. Wernstrom asked what the purpose of the Search Committee was if a consultant is engaged to do the recruitment. Mr. Murphy said the board would spend at least $10,000.00 or more just to advertise, and so the difference was worth it to get someone with expertise and to assure an effective national search. Dr. Sheras said that another function of the committee would be to select the consultant. Ms. Garrett added that the full board would be involved in the interviewing. Ms. Barrett asked if a bidding process would be required, and Mr. Brown responded that it was, and also said that in order to conduct a guided process, it is a huge human resources effort, that they could easily receive over 1,000 applications and resumes, and the consultants would be able to match the applicants with criteria established by the board. Ms. Wernstrom suggested that it would be important to establish the criteria up front. Ms. Garrett asked if the members were ready for the vote. IT WAS UNANIMOUSLY VOTED TO ALLOCATE UP TO $30,000.00 FOR THE RECRUITMENT OF THE EXECUTIVE DIRECTOR.
ON A MOTION BY MS. BARRETT, SECONDED BY MS. HAMMOND, THE MINUTES OF THE DECEMBER 8, 2003, BOARD MEETING WERE UNANIMOUSLY APPROVED AS DISTRIBUTED.
Dr. Becker said that county services operate out of seven locations in five counties with 43 staff providing case management to 350 clients, mental health support services to 62 clients, and psycho-social rehabilitation to 70. The services generate $1.3 million in Medicaid reimbursements which is one-fourth of Region Ten’s total Medicaid revenues. Dr. Becker then gave a PowerPoint presentation “tour” (see attached) of the county services beginning with Nelson County and the former Nelson Laundromat that has been Region Ten’s offices for 25 years. This was followed by a PowerPoint presentation (see attached) by Mr. Pezzoli providing information on the value of services provided to each locality and the distribution of staff in the counties. Ms. Barrett asked if there were mental retardation services in Nelson County, and D. Becker responded that case management and consultation are provided out of the central case management office, and that Horizon House also serves persons with mental retardation. Since eligibility is based on a functional model, persons with mental retardation do not have to be dually diagnosed in order to be served.
Mr. Murphy cited the apparent paradox that although Fluvanna County is one of the fastest growing areas in Virginia, the office remains the smallest. Dr. Becker agreed that was so, but the demand is not there as it is in the other counties and indeed, the office is not turning clients away. It is likely that some seek services in Region Ten’s central offices. Mr. Pezzoli said that a related question that is often asked is why aren’t there more services in the counties. He said that the development of services over the years was not the product of a systematic resource allocation, but rather are subject to real difficulties such as population densities, economies of scale and transportation. Differences in wealth and poverty levels are also factors as is the reality that persons in need of services gravitate to Charlottesville. Mr. Trippel asked about the role of the educational services in Nelson County, and Dr. Becker said that behavioral specialists give one-on-one attention in the classroom, lunch time and after school. Ms. Hammond asked if it was a behavioral model, and Mr. Pezzoli clarified that under Medicaid, it is actually classified as day treatment. Mr. Belair asked who identifies the students, and Mr. Pezzoli said that the school personnel do, that Region Ten had visited programs in Roanoke and Lynchburg, and then approached special education directors and principals here. Ms. White asked if the student must be Medicaid eligible, and Mr. Pezzoli responded that they do, but that the eligibility for children is much better than that for adults in Virginia. Ms. Wernstrom asked what grades were served and if they were in special education classrooms. All grades are served both in special education and regular classrooms. Mr. Trippel asked if there were substance abuse services for adults, and Dr. Becker said there were limited services through ASAP (Alcohol Safety Action Program) and voluntary. Mr. Kelley asked if the counties were contrasted to Charlottesville, what would be the greatest disparity. Dr. Becker said that good services are provided in the counties except for the most intensive services where larger numbers are needed, and also residential services. Mr. Belair asked how effective the substance abuse services were if they weren’t intensive, and Dr. Becker said that clients requiring that level of service come into Charlottesville for service. Mr. Belair followed up by asking what can or will be done for substance abuse in the schools because if anyone should be doing prevention, it should be Region Ten. Mr. Pezzoli said that Ms. Miller had been instrumental in developing a range of school-based and prevention services, and perhaps a future board presentation could be made on that. Mr. Pezzoli concluded by saying that the growth and creativity of services for the counties has come during the period of Dr. Becker’s leadership.
Ms. Garrett said that some of the topics have already or will be covered, but she called the members’ attention to the strategic plan, and the Quality Management Council will provide a set of suggested goals for consideration by the Executive Committee and the board in March.
Ms. Maltais said that the committee met on January 8 and adopted two initiatives. First, in response to the committee’s goal of improving the quality of life for consumers in our community, the committee decided to host a time of games and socialization (Bingo) with some snacks and prizes at the Meadowcreek Center on February 28. The target group would be apartment consumers. Second, in response to identify ways to increase the consumer participation within the local neighborhood/community, Ms. Carol Cutler will take some consumers hiking on the Rivanna Trail and adopt part of the trail for clean up. Ms. Maltais will create a list of some interested consumers for the committee to invite for participation. Members noted that this would be an excellent photo opportunity as well so community members can see that individuals with disabilities can give back to the community.
Mr. Brown distributed financial reports for the period ending November 30, 2003. He also included an “exception” report which addresses any revenue variances falling ten percent or more below target, and any expense variations in excess of ten percent of target. The most significant revenue item was Medicaid fees reported at only 72 percent of target, but Mr. Brown said that a late payment voucher had been received in the amount of $978,000 and that would bring Medicaid to within 98 percent of target. Ms. Maltais said that she is continuing to work with Finnegan
& Associates Members were reminded that the retirement party for Ms. Miller will be held at noon on February 25 at Fourth Street Station.
Ms. Barrett said that the Coalition Rally would be held in Richmond from 10:00 a.m. to 11:00 a.m. starting at St. Paul’s Church and then walking over to the General Assembly Building. Visits will be made to the legislators. Ms. Barrett service on Delegate Steve Landes’ advisory committee.
Ms. Wernstrom reported that she and Mr. Peterson visited the new clubhouse program held at the Crozet Baptist Church. She talked with Dr. Joe Oliver who directs the program, and she will meet with him again later this month. Lunch was provided and she had the opportunity to interact with a number of the consumers. There was a very positive spirit. Two of the consumers are planning to marry. Dr. Sheras said that he attended the Christmas dinner at Blue Ridge House. There was lots of spirit and the good will was truly remarkable. He added that Mr. Pezzoli has been attending this for 23 years. Ms. Hammond reported that she attended the holiday brunch at Friendly Oaks. Ms. Wernstrom visited the PACT (Program of Assertive Community Treatment), and also met with Mr. Pezzoli. Mr. Kelley reported that he had visited Horizon House the Friday before Christmas, and described it as a phenomenal thing watching the individuals working together in a positive social structure. He spoke with a family member who was very proud of their relative who is a participant in the program. Mr. Peterson said that he attended the Senate Finance and House Appropriations budget hearing held in Verona on January 6. There were only a couple of speakers who addressed issues for Community Services Boards, and Mr. Peterson was the last speaker at the hearing.
Ms. Hammond said that the Personnel Committee had recommended at the November 10, 2003, board meeting that the employment contract with the executive director be extended with September 30, 2004, as the last active work day, but that the motion had been tabled. Ms. Garrett said that this action would be taken up for a vote at this time. UPON THE RECOMMENDATION OF THE PERSONNEL COMMITTEE, IT WAS UNANIMOUSLY VOTED TO EXTEND THE EMPLOYMENT AGREEMENT WITH THE EXECUTIVE DIRECTOR WITH THE LAST ACTIVE WORK DAY ENDING SEPTEMBER 30, 2004. Mr. Trippel reported that in 1988 he was asked to participate in an art show in Richmond, the “Very Special Art,” which was then shown in other cities. Last year a project was started by Ms. Mildred Spicer and Ms. Jean Wilhelm with the Piedmont Council of Arts to get students in the studios with artists. This started the Very Special Art of Charlottesville. There was an opening last Friday showing Mr. Trippel’s work and that of special education students from Albemarle High School. The work is on display at the Charlottesville Performing Arts Center. Ms. Barrett added that Mr. Trippel will have a show in June at the Kennedy Center in Washington, D.C., and Mr. Trippel said that he would have more about that at a future meeting. The meeting was adjourned at 7:45 p.m. Respectfully submitted, Carol Johnston REGION TEN COMMUNITY SERVICES BOARD PERSONNEL COMMITTEE MEETING Angela Hammond, Chair
James Peterson Three policies were reviewed: Hours of Work and Absences (two minor changes for wording clarification); HIPAA (Health Insurance Portability and Accountability Act) Sanctions (no changes); and Minimum Necessary Rule (a new policy relating to HIPAA requirement for covered entities to take reasonable steps to limit the use or disclosure of Protected Health Information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request). All staff have been trained in the application of these policies, and all new staff are trained as they come on. On a motion by Mr. Trippel, seconded by Ms. Hammond, it was unanimously voted to accept the policies as presented on Hours of Work, HIPAA (Health Insurance Portability and Accountability Act) Sanctions, and Minimum Necessary Rule.
The draft “Strategic Plan Components” (see attached) which relate to the responsibilities of the Personnel Committee were discussed. The Components were developed by Ms. Hammond and Ms. Lewis, and provide a framework to “Maintain a highly qualified, productive and satisfied staff.” There was discussion about whether the various items would be undertaken one at a time or concurrently, and it was agreed that some study could proceed concurrently. The committee members requested copies of the final Hendricks Classification and Compensation Report, and also agreed that a staff survey regarding benefits would be conducted. The committee recommends that the board adopt the “Strategic
Plan Components.” The meeting was adjourned. REGION TEN COMMUNITY SERVICES BOARD EXECUTIVE COMMITTEE MEETING February 2, 2004 Susan Garrett, Chairman Other Board Members Present Barbara Barrett
James Peterson, Executive Director
1. Region Ten’s 35th Anniversary Ms. Barrett announced that today, February 2, was Region Ten’s 35th Anniversary. Members suggested that some observance be planned.
Committee members reviewed the minutes of the of the January 12 board meetings and the proposed agenda for the February 9 meeting. As a follow up to last month’s presentation on rural services and school-based treatment services, a presentation will be made on Region Ten’s prevention services.
Dr. Sheras suggested that the items in the personnel components for the strategic plan should be added to the management calendar with time lines established.
The Executive Committee reviewed the status of the completion of the retreat goals. The status of the board appointment from Fluvanna to fill the vacancy of Ms. Rebholz was discussed. A telephone inquiry had been made earlier in the day to the county administrator’s office (update: the county administrator subsequently returned the call and confirmed that Ms. Bondy Gibson, a former Region Ten employee in the mental retardation services division, had been appointed).
Ms. Garrett asked Mr. Peterson to provide an update at the February 9 board meeting on the status and implementation schedule for the remaining CARF accreditation process.
The next meeting of the Executive Committee will be held on Monday, March 1, 12:00 noon, at the Hardware Store Restaurant, 316 East Main Street, Charlottesville. The meeting was adjourned. Background In the year 2000, Region Ten initiated a strategic planning process to address the major mental health, mental retardation and substance addiction issues in the City of Charlottesville and the Counties of Albemarle, Fluvanna, Greene, Louisa and Nelson. The current plan for the years 2004-2010 is a revision of the original plan and represents Region Ten CSB’s commitment to providing the highest quality service. The plan is built on surveys and consultations with members of the Region Ten community--staff, Board members, consumers, families, and community partners. We recognize the vital importance of the views and concerns of our constituents in our planning for a future of enhanced services and a well-developed continuum of care. We are committed to an annual review and revision, as necessary, of the Region Ten CSB Strategic Plan, to assure that it addresses the major issues that affect quality service in a changing environment. Self-Assessment The following is an assessment of Region Ten’s past performance and capacity to respond to its mission, statutory mandates, and state performance contract requirements. 1. History: In the early 1970s, Region Ten was one of only three community services boards to receive federal operations grants under the Comprehensive Community Mental Health Services Center funding. (Federal?) This funding led to several long-term results. First, the acceptance of these grants by the localities (City Council and Albemarle Board of Supervisors) required that a full continuum of services be available, including, at a minimum, emergency, outpatient, partial hospitalization, access to inpatient services, and consultation and education to other community agencies and the general public. This meant that Region Ten would offer the most complete continuum of services available in Virginia dating back to 1974. Concurrent to the development of mental health services, the Association of Retarded Citizens Charlottesville-Albemarle (now the ARC of the Piedmont) developed a group home for women with mild mental retardation and an adult activity center. Some individuals who were active in ARC were also instrumental in establishing Workshop V (now WorkSource Enterprises, Inc.) and in advocating for establishment of the Community Services Board. Of the 40 CSBs in Virginia, Region Ten was among the first to develop
innovative and appropriate services to fulfill its mission, including
emergency services, prevention, clubhouse model, and residential
services. Even before the advent of Medicaid, Region Ten had developed
the most extensive system of residential services in Virginia. Region Ten CSB services are generally perceived by the public as high quality, and it has consistently met and exceeded the required standards of licensure and Medicaid reviews. Region Ten CSB enjoys the support of the six local governments of which it is an agency, as evidenced by the higher than average per capita local funding support provided to it when compared to the other multi-jurisdictional community services boards. Local support is also evidenced by the substantial amount of private contributions received by Region Ten. 2. Service Process Quality Management Initiative: An ever expanding dependence on fee revenues for program support, and Medicaid reimbursements in particular, led the board to adopt the Service Process Quality Management Initiative in December 2001. This approach is utilized by more than 290 behavioral health centers throughout the country. It is a total system of data-based decision making with processes for continuous outcome measurement across all services. The purpose of the Initiative is -- to enhance development and implementation of more person-centered services in the areas of documentation/paperwork reductions, choice, service planning and increased emphasis on a resiliency/recovery model. -- to facilitate increased accessibility to services. -- to support the measurement of quality outcome-based services. -- to support the full integration of outcomes and satisfaction data into clinical and non-clinical service delivery decision-making. -- to identify and support more cost effective services. As part of this initiative, we made major changes in the way services are organized. These changes affected access, utilization management, and quality assurance. Results of the changes are for the most part beneficial; however, some results have been disappointing. We are now in the process of examining carefully the gains and losses of this initiative, and planning further changes to enhance the continuum and quality of all our services. One change is to reestablish the divisions of mental health, mental retardation and substance use disorders, and at the same time keep the division of access and quality assurance. 3. CARF accreditation for Employment Services In 2002, Region Ten CSB received full accreditation by CARF for its Supported Employment Service. It is one of the goals stated in this plan to achieve CARF accreditation for the agency as a whole.
a. A supported apartment living program, with 200 rent subsidies,
extensive mental health support services, multiple sites and models. a. High hospital use, along with a continuing need to find private
acute beds in a time of closing of state hospital beds and redirection
of funds to communities.
1. Maintain a highly qualified, productive and satisfied staff. A. Continue to bring salaries and benefits up to a competitive
level, develop recommendations and incorporate them into the budget. (Measure: staff turnover, staff surveys, employee benefits manual. 2. Assure consumer, family and community input into services planning. A. Prepare and follow a plan for regular, systematic and effective input by consumers, family members, community leaders and advocates. B. Continue and increase participation of consumers and family members on Board of Directors, local Human Rights Committee, Advisory Committees. (Measure: written plan completed 3. Assess, improve and maintain a continuum of high quality services that meets the needs of our community. A. Identify the funding amounts and sources necessary for maintenance of existing services. B. From the “Services Development” section of the
plan (Appendix A), identify the most critical and essential services
for immediate and near-term implementation. (Measure: financial statements, reports on implemented services. 4. Assure equitable distribution of services throughout the Region Ten service area. A. Establish a matrix by locality of available services, services actually provided, costs, and levels of local support. (Measure: reports from Region Ten service providers in Charlottesville
and the five rural counties; information and reports from Board
representatives of each jurisdiction. 5. Assure adequate inpatient beds in the area. A. Strengthen mechanisms to monitor bed usage at the state facilities. B. Seek to expand private inpatient alternatives in the area. 6. Achieve greater efficiency, more direct consumer time, streamlined administrative processes. A. Continue or modify David Lloyd process as needed to benefit
consumers. January 12, 2004, BOARD MEETING MINUTES Members Present Susan Garrett, Chairman Members Absent Carol Johnston Others Present James R. Peterson, Executive Director
Ms. Garrett, chairman, called the meeting to order at 7:45 p.m.
On a motion by Mr. Belair, seconded by Ms. Hammond, the minutes of the December 8, 2003, board meeting were unanimously approved as distributed.
Mr. Peterson reiterated from the remarks of Ms. Martha Maltais at the preceding meeting of Region Ten, that Finnegan & Associates is pursuing a grant for a wheelchair equipped van. Pursuit of larger grants is pending the approval of the federal budget.
Mr. Peterson reported that the architects have indicated that the Lovingston project will go before the Planning Commission in February, and assuming there are no unforseen problems, the bids for the construction would go out shortly thereafter. With regard to the group home for persons with mental retardation, Ms. Maltais met with Mr. Bob Smith to clarify the importance of a spacious, rural site for the residence, and Mr. Smith says he hopes to have something specific to recommend withing two weeks. The meeting was adjourned at 7:48 p.m. Respectfully submitted,
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