Members Present

Susan B. Garrett, Vice Chair
Barbara Barrett
Paul Belair
Carol Johnston
Michael C. Murphy
Irene S. Rebholz
John J. Trippel
Roxanne White
Stephen Wunsh

Members Absent

Peter L. Sheras, Ph.D.
Rev. David M. Cameron
Rudolf A. Kaufmann, Ph.D.
Rodney D. Kibler, Ph.D.
Carole Z. Wernstrom, RN, MSN

Others Present

James R. Peterson, Executive Director
Downing Miller, Director, Access and Quality Assurance
David T. Moody, M.D., Medical Director
John Pezzoli, Director, Behavioral Health Services
Ann White, Director, Habilitative Services

Reed Banks, Director, Rehabilitative Services
Michael Costanzo, Director, Mohr Center
Evelyn Cotton, Mental Retardation Residential Services
Program Manager
Evadne Deeds, Director, Blue Ridge House
Melissa Garth, Employment Services Program Manager

James M. Bowling IV, Esquire

I. CALL TO ORDER

Ms. Garrett, vice chairman, called the meeting to order at 6:04 p.m.

II. WELCOME AND INTRODUCTIONS

Ms. Garrett welcomed everyone. She noted that Dr. Sheras is traveling to London and India, and that several other board members had called to say they would be unable to attend the meeting.

III. COMMENTS FROM THE PUBLIC ON ITEMS NOT ON THE AGENDA

Ms. Garrett asked if there were any comments from the public. Hearing none, she proceeded to the next agenda item.

IV. SPECIFICATION OF OTHER ITEMS TO BE ADDED TO THE AGENDA

Ms. Garrett asked if there were other items to add to the agenda. No items were added to the agenda.

V. VICE CHAIRMAN’S REMARKS

Ms. Garrett distributed copies of the Winter 2003 edition of The Virginia Quarterly Review which contains an article by C. Knight Aldrich, M.D., entitled “A National Disgrace.”
The article describes the status of the public care of the chronically mentally ill in the United States as “a national disgrace, and it has been for most of the last two centuries.” Ms. Garrett said that she has also sent copies of the Review to six legislators.

VI. APPROVAL OF THE DECEMBER 9, 2002, BOARD MEETING MINUTES

ON A MOTION BY MS. REBHOLZ, SECONDED BY MS. BARRETT, THE MINUTES OF THE DECEMBER 9, 2002, BOARD MEETING WERE UNANIMOUSLY APPROVED AS DISTRIBUTED.

VII. REPORT ON THE OUTCOME OF THE MOHR CENTER LAWSUIT

Mr. Jim Bowling, the attorney representing Region Ten through the Virginia Risk insurance program, said that the board members had earlier received copies of the opinion issued by Judge Hogshire that Region Ten was immune from tort liability under the doctrine of sovereign immunity. Although this was a circuit court decision, it should be of help to other Community Services Boards. The Mohr Center staff member, Ms. Daisy Ross, is still on trial for the gross negligence claim, but the facts of the case do not rise to even the level of simple negligence let alone gross negligence. Indeed, the staff did everything they could to help protect the woman from the assault by her boyfriend. The trail for Ms. Ross will be held on Thursday, February 27, 9:30 a.m., in the Charlottesville Circuit Court, 315 East High Street, Charlottesville. Mr. Peterson was asked to send a reminder of the trial to the board members so that they could attend to show support for Ms. Ross.

VIII. PRESENTATION ON REGION TEN’S EMPLOYMENT SERVICES PROGRAM

Mr. Reed Banks noted that he had presented the outcomes management report to the board at its October meeting (copy attached), and so the brief presentation this evening would be to provide an update on the services. He distributed copies of a handout entitled, “Employment Services and CARF.” Employment services are provided out of Blue Ridge House and the PACT program (Program of Assertive Community Treatment) at the Fourth Street Station. Mr. Banks referred to the CARF Survey Prep Guide and said that the on-site CARF survey will look at a large amount of documentation.

Mr. Banks introduced Ms. Melissa Garth, Employment Services program manager at Blue Ridge House. She said that the Employment Services program consists of three staff, Ms. Lisa Churchman, Ms. Judy Byers (half-time) and herself. They meet first thing every morning to review the status of the program participants. They then conduct visits and complete paperwork. Everything must be documented for DRS (Department of Rehabilitative Services). Much of their activity is involved in putting out fires. Also, it is difficult to get jobs in the Charlottesville area. They would also like to expand the disabilities, and take on more clients who are not members of Blue Ridge House.

Ms. Rebholz asked for a clarification as to what is involved in the “visits,” and Ms. Garth responded that they check with clients and supervisors to see how they are doing. For example, just prior to the board meeting, they visited a client who is working as a cashier to see how he was interacting with customers. The staff will often speak with supervisors to see what they can do. They also try to foster independence by being more heavily involved at the outset and then tapering off as time goes by.

Ms. Garrett asked about how efforts to try to expand the number of employers is conducted. Ms. Garth said that this is something they do, but the main dilemma is to determine how much information to give out to perspective employers. Some of this is through word of mouth where a satisfied employer tells another employer and then they contact the Employment Services. The staff are planning to do more job development and also community presentations to raise awareness. Mr. Belair asked who pays, and Ms. Garth said that the employers pay the clients and DRS pays Region Ten. Mr. Belair asked if any of the clients are employed full-time, and Ms. Garth replied that most work for 20 to 30 hours per week but that a few clients have full-time positions. Mr. Banks referred to the Outcomes Management Report noting that 100 percent of workers earn at or above the minimum wage of $5.50 per hour. The range is from two workers at minimum wage to one consumer making $15.00 an hour. Most consumers made between $6 and $11 per hour (15 Members). The overall average hourly wage is $8.07 per hour.

Ms. Deeds commented that the older persons have lost the ability to be in a work environment, and do not know how to respond properly in the social situation. Mr. Trippel asked how successful were they in matching clients with jobs recognizing that some clients may have as much as two to four years of college. Ms. Garth responded that clients with that level of educational background typically left high stress jobs and did not want to get back into those kinds of positions. They associate the jobs and the high stress level with their illness. Instead, DRS helps to redirect their employment goals. The staff do the best they can to matching clients and jobs, but the more educated, the more stressful the job. Ms. Deeds noted that some clients jump in with both feet, but then find the stress too high. It is better to get acclimated, and then step up from there. Ms. Garth added that clients will also lose their benefits--including medications--if the income is too high, and it is very difficult to get the benefits back once they are lost.

With regard to billing for the service, Ms. Garth said that DRS only allows billings for service above and beyond the regular program. Mr. Murphy noted that Ms. Garth had mentioned earlier the desire to expand the number of clients, and he asked if DRS funding would be available for that. Ms. Garth replied that funding was available, especially for persons with mental retardation.

Ms. Deeds said that she would like to add a psychosocial rehabilitation position to the Blue Ridge House staff in order to remove that service from the workload of the Employment Services staff who now divide their time between the two services. Ms. Cotton asked if they knew how much they could expand, the Ms. Garth said that they would be able to aggressive seek new clients whereas now they just take referrals that come to them. Ms. Cotton asked how the rate of reimbursement compares to that for residential services, and Mr. Banks responded that the maximum rate for residential is $72.00 compared to $46.71 for DRS. The rate for medical MHSS (mental health support services) is $83.00. Since DRS bases the success rate on case closures after 90 days of success on the job, the funding is short-term compared with Medicaid.

IX. EXECUTIVE COMMITTEE REPORT

Ms. Garrett referred to the minutes of the Executive Committee meeting and reported that the Executive Committee had discussed the upcoming CARF visit and also transportation problems in Nelson County. Mr. Belair said that JAUNT had provided good service but it was expensive, but now with a change in providers, the service is very poor. Mr. Pezzoli said that what we are experiencing locally with the changes in the transportation service is reflective of what is happening throughout Virginia, and that since the issues are very involved, perhaps it should be addressed more comprehensively at a future board meeting. Ms. Ann White said that the problems have been very difficult for mental retardation day support and residential services, and that Senator Creigh Deeds and Delegate Mitch Van Yahres met with Medicaid last week to find out what’s going on. She thought that some solutions would come out of this process. Mr. Belair said that it is clear that Medicaid funds are being cut nationwide, and so he is not at all hopeful about a resolution to this problem. Ms. Barrett reported that transportation has been a major issue addressed by the Virginia Association of Community Services Boards (VACSB), and that they have been working with DMAS (Department of Medical Assistance Services). Mr. Belair said that we could provide transportation in-house using our staff, but it really is not cost effective to have professional staff serving as drivers. Ms. Rebholz asked about the use of Region Ten vehicles, and Mr. Pezzoli replied that the staff have the option to use agency vehicles or their own. Mr. Belair said that the problem goes down to the fact that if consumers aren’t at the clubhouse, Region Ten can’t bill for services. Mr. Murphy said that the decision to build the clubhouse facilities was based on anticipated expansion, and now he asked if we are at the point where we can’t bill. Mr. Pezzoli replied that the attendance at Horizon House in Lovingston is even higher that projected, but since the population in Louisa is so disbursed, the numbers are not where we would like them to be, but not to a dangerous degree financially. Ms. Rebholz added that consumers in Fluvanna also use the Friendly Oaks Clubhouse in Mineral.
Ms. Garrett mentioned the letter that Mr. Peterson had sent to local and state legislators explaining the Commissioner’s reinvestment initiative and our support for it. Ms. Rebholz asked if all of the funds would be transferred to the Community Services Boards when wards in the institutions were closed, and Mr. Peterson responded that the full cost of care in the community would follow the clients out of the facilities, but that did not mean that all of the funds would be withdrawn from the facilities because there are certain fixed costs that remain. Mr. Murphy asked about the magnitude of the impact for Region Ten and Mr. Peterson said that given the home localities of the patients affected in the first year, the impact would be minor. However, if this reinvestment strategy were continued into future years, more Region Ten consumers would be served.

X. FINANCE COMMITTEE REPORT

Mr. Wunsh said that the Finance Committee met with the auditors from Hantzmon, Wiebel & Company just prior to the board meeting. Mr. Brown distributed copies of the auditor’s reports. Region Ten received a clean opinion, but the report articulates concerns that were identified. The reports consist of three parts, (1) the numbers and actual financials; (2) the notes which describe how we record our data and other issues; and (3) the auditors comments on areas where we could improve. The timeliness of the audit report remains a problem, because the state deadline for the receipt of the report is December 15.

Mr. Wunsh said that the committee recommends that the board accept the report, but that this be kept as an agenda item for the next board meeting in case board members had any further questions or comments after they had time to study the reports in more detail. Also, Mr. Wunsh said that he would be happy to respond to any questions that board members may have prior to the next board meeting, and that they should call him with any questions.

Ms. Barrett asked if the contract for the audit services is up for renewal, and Mr. Brown said he will review the contract to see what it calls for.

Ms. Johnston said that what jumped out of the reports to her was that last year we showed a loss, and this year we closed with a surplus. She asked if there were any other aspects in the reports that were this significant. Mr. Caruso responded that he suggested that members begin by reading the notes in the reports, because they will focus on the most significant items.

Ms. Garrett asked if the members were ready to vote on the recommendation of the Finance Committee.

IT WAS UNANIMOUSLY VOTED TO ACCEPT THE AUDIT REPORTS FOR FY 2002 AS PREPARED BY HANTZMON, WIEBEL & COMPANY.

XI. RISK MANAGEMENT POLICY AND PREPARATION FOR CARF VISIT

Mr. Peterson referred to the policy on risk management that was included with the minutes of the Executive Committee and noted that elements of the policy were contained in other policies, but this brought all aspects of risk exposure and who is responsible for what into one policy.

ON A MOTION BY MR. BELAIR, SECONDED BY MS. BARRETT, THE BOARD POLICY ON RISK MANAGEMENT WAS UNANIMOUSLY ADOPTED AS DISTRIBUTED.

Discussion was given to the upcoming CARF survey review, and who would participate. Mr. Peterson said that the survey will begin with an orientation conference for one hour (Monday, February 24, 8:30 a.m.). All board members may wish to attend this session, and then a little later the CARF reviewer will meet with the board chairman and one or more other board members (to be decided by the board) to respond to questions about board and program operations. CARF has provided a list of likely questions, and it was agreed that responses would be prepared. The board’s CARF committee will meet to go over the status of the preparation and to prepare any final information prior to the next board meeting.

XII. STRATEGIC PLAN UPDATE

Mr. Peterson said that the update of the plan incorporating the suggestions made by Ms. Garrett at the Executive Committee and the last board meeting has not been completed, and asked that this item be rescheduled for the next board meeting.

XIII. MENTAL RETARDATION SERVICES ADVISORY COMMITTEE REPORT

Ms. Ann White reported that the meeting of the Mental Retardation Advisory Committee was canceled so that the members could attend the legislative budget forum at the Performing Arts Center, and that several members provided very moving remarks at the forum.

XIV. DIVISION UPDATES

Ms. Ann White confirmed that she will be leaving at the end of February, and that she is both excited about the future but sad to leave such a good group of people. She has pent over 26 years in the field, and of that, almost 14 years at Region Ten. She has held many positions here, from relief worker to division director, and so she is able to tell new staff that there is definitely room for advancement at Region Ten, and that Region Ten is a wonderful agency.

Mr. Pezzoli said that the things he will miss most about Ms. White are her steadiness, decency and sheer competency. He noted that with Ms. White’s departure and the consolidation of the two service divisions into one, a person will be hired to continue to direct the programs at Meadowcreek and the residential programs. The standardization of records, performance standards, etc., across the agency growing out of the David Lloyd process will make this transition possible. Ms. Garrett commented that when the board is asked about the process of strategic planning, they should be aware that the work with David Lloyd is a major piece of the strategic planning.

Ms. Miller reported that the waiting time for new intakes has been dramatically reduced with the hiring of a new and experienced intake worker. This will be further improved with the initiation of an Access Clinic intake offered twice weekly beginning next week. This week there were 26 appointments for intakes of which 15 showed up. Specific individual intake appoints are still provided for those consumers with typically low no-show rates. Ms. Miller concluded by saying that many of the program directors in her division have been out for maternity leave or other reasons, and so she has been providing much of the coverage herself.

XV. VIRGINIA ASSOCIATION OF COMMUNITY SERVICES BOARDS (VACSB)
REPORT

The annual VACSB legislative meeting will be held in Richmond on January 21-22. Visits to the Richmond offices of the legislators will be made at that time and also the Region Ten representatives will be seated in the General Assembly gallery.

XVI. BOARD MEMBERS’ REPORTS ON PROGRAM VISITS AND OTHER
REGION TEN ACTIVITIES

Ms. Rebholz reported on her visits over the holidays to the Friendly Oaks Clubhouse in Mineral and to Blue Ridge House. Mr. Belair visited Horizon House in Lovingston and delivered a 4 foot by 10 foot shed to Friendly Oaks. Ms. Johnston said that she and Rev. Cameron, Ms. Rebholz, and Dr. Sheras attended the staff recognition party. Ms. Rebholz said that it was good to see that so many Region Ten staff had attended the legislative budget forum and the meeting on Virginia’s fiscal dilemma sponsored by the Senior Statesmen of Virginia.

XVII. OTHER BUSINESS

Ms. Rebholz suggested that the paper that was developed on board member expectations be included in the board member notebooks.

The meeting was adjourned at 7:40 p.m.

Respectfully submitted,

Paul Belair
Secretary

Region Ten Community Service Board
Employment Services Outcomes Management Summary
FY 2002: July 1, 2001- June 30, 2002

Region Ten Community Services Board provides vocational training, placement and support for consumers with psychiatric disabilities. The agency has long recognized both the strong interest consumers express for paid employment as well as the potential that such employment manifests in the rehabilitation and recovery of persons experiencing severe and persistent mental illnesses. For more than two decades the agency’s psychosocial clubhouse program, Blue Ridge House, effectively functioned as the most appropriate site for this service. The Virginia Department of Rehabilitative Services (DRS) continues to recognize the advantage of this co-location of psychiatric and vocational rehabilitation efforts as well. More than a decade ago, DRS and Region Ten initiated the LTMI (Long Term Mentally Ill) projects which are often characterized by the officing of counselors with specialized caseloads within psychosocial clubhouse programs. In addition, in the last three years the agency has implemented a PACT program (Program of Assertive Community Treatment) which integrates a vocational specialist position and vocational services into this intensive mental health treatment team.

This report represents the agency’s effort to summarize outcomes of its Employment Services from a variety of measures and to begin to use these measures more effectively in evaluation and planning for future service development. Outcome measures are certainly not new to program staff who have been collecting outcome data for Employment as well as for several associated program services for many years. For instance, the agency has several years of data from the state-required POMS (Performance Outcome Measurement System). In addition agency-wide satisfaction data exist from annual surveys. Survey data more specific still to Employment Service recipient outcomes is seven years of annual data from the IAPSRS (International Association of Psycho Social Rehabilitation Services) Outcomes Toolkit, discussed later. Moreover, the program conducts an annual review and evaluation of its mutual work with DRS on behalf of persons with psychiatric disabilities. In addition, staff review monthly progress on goals for individual employment service recipients. Most of this data has consistently indicated generally very positive outcomes and trends. Staff have been gratified by these generally positive indicators but recognize as well that opportunities exist for improved evaluation of these various results. The following summary is an effort to report data as well as to begin more concerted efforts to understand these results and to improve the employment services to persons with serious mental illnesses.

A. Accomplishments since the last Summary Review of Employment Services

Summary of FY 02 Goals:

1) Relocate (with the move of Blue Ridge Clubhouse psychosocial rehabilitation program) the Employment Services program offices and enhance the Employment Resource office.

2) Set and achieve collaborative employment service goals with Virginia Department of Rehabilitative Services/ Long Term Mentally Ill Project (LTMI):

a) Evaluate and refer 15 persons with serious mental illness for DRS enrollment. b) Coordinate with DRS counselor to complete 10 Individual Plans for Employment
c) Continue to develop Volunteer/Unpaid Work Experiences for consumers with SMI as skill development and job-readiness training resources.
d) Train and support at least seven (7) consumers to the point of successful case closure with DRS.
e) Assist in the integration of employment services with essential mental health treatment needs (case management, psychiatric, residential) of employment service recipients.

3) Conduct Job Club and Employment Dinner activities monthly.

4) Disseminate Information Packet for DRS and Region Ten LTMI joint project services.

5) Coordinate with the Virginia Human Services Training Project to identify potential job-training participants.

6) Develop the knowledge base, skill, and agency Employment Services procedures of the PACT program vocational specialist position.

Review of FY 02 Goal Accomplishment:

1) Goal accomplished. Region Ten CSB completed the construction of a new Blue Ridge Clubhouse facility in the spring of 2001 and relocated the agency’s psychosocial rehabilitation services in July 2001. Employment services --- integral to the rehabilitation efforts of this program ---completed the move as well into this larger and enhanced environment. The space has allowed and will continue to allow the expansion of vocational training opportunities, job placement and support for persons with psychiatric disabilities.

2) Representatives of DRS and Region Ten CSB met in late April 2002 for the annual review of employment services goals in the collaborative LTMI project for the Fiscal year 2002 to date. The positive results are as follows:

a) Goal accomplished: Fourteen of the 15 referrals for DRS enrollment by agency Employment Services were completed. This statistic included four referrals from the PACT Team, ten from the employment service at Blue Ridge House and six (uncounted) from agency mental health case managers.

b) Goal accomplished: Staff assisted DRS counselor and ten Employment Services recipients to develop IWRPs (Individual Written Rehabilitation Plans).

c) Goal accomplished: Employment Services staff continue to identify volunteer and unpaid work experiences for mutual consumers. At the time of this review placements included volunteering at five community location (public schools, Dual Recovery Center, MS Society, Independence Resource Center, and the SPCA).

d) Goal accomplished: At the April review five of seven cases have reached DRS successful case closure criteria with the training and ongoing support of agency employment staff.

e) Goal accomplished: Employment service staff, PACT employment staff, and Blue Ridge Clubhouse staff assure on an ongoing basis the integration of the consumer’s psychiatric care and support needs with his/her vocational needs. As indicated later in this report, outcome data describing the hospitalization rates for employed consumers indicate success in assisting consumers to manage their illnesses as they obtain and retain employment.

3) Staff continue to conduct Job Club weekly and Employment Dinner monthly. In addition, by routinely attending the Employer Networking and Interagency JOBS meetings, staff expand the employer base for consumer opportunities.

4) Staff of DRS and agency Employment Services completed a handout of information regarding the joint project services available to consumers.

5) Staff have actively encouraged and assisted consumers to consider application to the Virginia Human Services Training Project. This statewide project implemented by the agency has been successful in training and placing consumers in human service jobs. Employment Service staff were successful this last year in assisting a consumer to effectively complete this program and initiate employment.

6) This position, a vocational specialist integrated into the agency’s assertive community treatment team, has experienced significant disruption with turnover during the implementation year. Significant work remains to train this staff and assure that long-standing, effective practices of the Employment Service Team are followed.

B. Demographic Data for Employment Services

Typically staff conduct the IAPSRS Outcomes Toolkit Survey in January of each year for the previous calendar year. Staff have completed this survey for the last seven years. The Outcomes Toolkit was produced by the Research Committee of the International Association of Psychosocial Rehabilitation Services in 1994. It is designed to measure outcomes for persons with psychiatric illnesses across eight different domains. The following information indicates the available baseline demographic data for 21 consumers who completed this survey. Arrayed for comparison (in some cases) are the comparable data for the general psychosocial rehabilitation (PSR) Clubhouse membership.

Demographic Employment Services Blue Ridge House general population
Average age 45.2 years 47.8 years
Average time in PSR Program 8.9 years 7.4 years
Average education (highest grade completed 12.05 11.64

There are no apparent significant differences in age, educational level, or time in the PSR program for the Employment Service respondents vs. PSR respondents. It is noted that both groups have been long-standing participants in the PSR program. What is not clear from this data (and a potentially informative piece of information to know and track for the future) are the correlations (if any) of the levels of participation in the PSR program and job-readiness or job retention of the employment service recipients.

Service Recipients Male Female Total Race
White 8 4 12
Black 7 2 9
Total Gender 15 6 21

Residential Status of Employment Service Recipients
Independent (lives in apartment with minimal assistance) 10 consumers 43.5%
Assisted /supported (periodic visits by MH staff to assist) 6 consumers 26.1%
Supervised Facility (some degree of 24 hr supervision/assistance) 7 consumers 30.4%

More than half the respondents report living arrangements characterized by significant mental health staff assistance. The overall numbers are small but suggestive of questions for the future: Are referrals being generated as a consequence of an overall intensive engagement by staff of mental health clients, for instance?

C. Report of Data Collected and Analysis of Data for Employment Services Planning

Effectiveness:

a) Employment Service staff track a number of indicators believed important to evaluating the overall effectiveness of the service. Through its LTMI project and its vendorship for Supported Employment Services and Long-Term Employment Support Services, staff participate in continuous case-by-case review with DRS to assure that individual consumer needs and interests are addressed effectively. Week-by-week and month-by-month collaboration reinforces this effort. Annually, the overall employment service effort is formally reviewed and mutual goals established. As reviewed above, the consistent achievement of these goals continues to be a good indicator of effective services. Staff assist referrals to enroll with DRS and access a variety of employment-related resources.

b) In addition, staff have set goals for monitoring a variety of other important effectiveness measures. These are tracked and reported using an outcomes measurement package developed by the International Association of Rehabilitation Services referred to as the IAPSRS Outcomes Toolkit. These results and other staff collection of data are reviewed below:

Employment Domain Measures:

The annual snapshot survey of the PSR program membership is routinely conducted as these consumers attend the program. Unfortunately, some of the data do not reflect information from each of the 31 workers receiving Employment Service assistance this last year. In some cases, these employees were not available (4) or did not complete the employment section of the survey (3). Of 23 Employment Service recipients, results show this breakdown of work locations:

Job Locations
Independent or Assisted competitive employment: 15 65.2%
Job Coach model: 2 8.7%
Sporadic or Casual employment: 4 17.4%
Non-paid Work experience: 2 8.7%
Total: 23

Hourly Wages/ Weekly Hours:

Wage information is available on 19 Workers. One hundred percent of workers earn at or above minimum wage. The range is from one consumer making $15.00 an hour to two workers making minimum wage, $5.50/hour. Most consumers made between $6 and $11 per hour (15 Members). An overall average hourly wage is $8.07/hour.

Hourly information is available on 18 workers. For the sporadic employment category hours worked are not very relevant. Most consumers work part-time. Only one reported 40 hours a week. Eleven consumers work fewer than 20 hours/week, and 7 work more than 20 hours/week. The average hours/week equals 16.1 hrs. This combined with average wage ($8.07) equals around $130 per week work earnings (a generalized picture) for Employment Service recipients.

Time Employed:

Of 21 consumers with Survey information, all stayed employed greater than 2 months. As of the date of the survey, 10 consumers have been working at their current jobs less than 14 months. Another nine consumers have retained their jobs between 2 and 7 years; and two members reported being on the job greater than 8 years. This demographic underscores the success of Service recipients, their care providers, and the Employment Services staff in extending job retention. The data confirms a real strength of the program--- strong preparatory work with the consumer prior to job placement combined with long-term follow-up results in good job retention. It is evident that some employed consumers did not complete the Toolkit Survey this last January. Employment Services staff will need to make a more concerted effort to assure that all workers’ data is included.

Financial Benefits and Education:

Of 23 consumers surveyed, two reported receiving some sort of financial benefits, and 21 reported receiving no benefits. This demographic requires clarification and evaluation.

One consumer of the 23 reported current attendance at school (for GED) as well as working.

Efficiency

Annually, staff complete a Purchase of Service Contract with the Virginia Department of Rehabilitative Services. The review process entails a thorough analysis of prior year, current year, and projected year costs for the provision of supported and long-term employment support services. Through FY 2001 data demonstrate that the Region Ten CSB reimbursement rate for the vended services has fallen well within the range of rates approved for 16 other Employment Service Organizations within the region. Since this is a rate based on a ratio of service units delivered to the cost of delivery, this appears to be a good indicator that the organization continues to provide a cost-efficient service.

On the other hand, this same analysis demonstrates that Employment Services staff spend considerable amounts of service time in activities or with consumers for which there is no reimbursement. A relatively small percentage of overall available staff time actually permits billing to DRS. There are good and important potential explanations for this. Heavy engagement in job-readiness activities; service to unenrolled DRS clients; prolonged, unreimbursed employment supports to achieve the agency’s primary purpose of psychiatric stabilization, all come to mind as possible explanations. Nevertheless, it is important to pursue this to a point of greater clarity. Analysis may confirm that staff productivity is exactly where it should be to achieve the agency’s goals with consumers. Or, it may reveal opportunities for the expansion of vended service time with consequent increased revenue and enhanced employment services.

Employment Service Stakeholder Satisfaction

1) Virginia Department of Rehabilitation Services: In addition to an annual mutual Project review with the agency, discussed elsewhere in this report, DRS to whom the agency vends supported and long-term employment services for mutual clients completes an end of the fiscal year Contractor Performance Evaluation Report. Results from this report indicate a high degree of satisfaction with Employment Services.

2) Mental Health Case Managers: Responses from surveys to this referral group are not complete at this writing. However, available responses to date indicate an overall high satisfaction for services provided to their mental health service recipients. Case managers applaud the responsiveness of Employment staff to concerns case managers identify where psychiatric stability and job retention concerns coincide. Case managers give high marks for the collaborative efforts of Employment staff. Frequently identified concerns are for greater range of potential job placements and easier access to services by non-PSR program participants.

3) Employers: Responses from surveys to this stakeholder group are not complete at this writing. However, available responses indicate thus far a high degree of satisfaction.
Employers consistently select 4 on a 0 to 4 scale for such statements as Employment staff a) provide services our employees need, b) have the capacity to accommodate our needs, c) seem to help the people we hire, d) seek job placements that are appropriate for the employee and company, e) are knowledgeable in the field, and f) provide consistent follow-up.

Employment Service Recipient Satisfaction

The following table displays the results of the Consumer Satisfaction Survey from the IAPSRS Toolkit. Respondents indicate their satisfaction on 20 statements on a scale of 1 to 4. The survey questions are designed to focus questions of satisfaction in four categories:

Subjective Quality of Life (overall perception of well-being);

Empowerment (degree to which the consumer believes he/she has rights and opportunities to control his/her life and services);

Mastery (degree to which the consumer believes he/she is competent and in control of his her life);

Program Satisfaction (degree of satisfaction with the program’s help).

Consumer Satisfaction Survey (January 02)

Employment Service PSR program composite
Subjective quality of life 3.11 2.93
Empowerment 2.55 3.04
Mastery 3.30 2.98
Program Satisfaction 3.24 3.18
TOTAL SCORE 3.19 3.06

Scale: 1 = strongly disagree 2 = disagree 3 = agree 4 = strongly agree

Staff conduct the Toolkit survey annually (seven years of data are available). The table above reflects the results for the FY 2002 Survey of 23 Employment Service respondents and compares these responses to those of the general PSR program consumers who completed the survey.

This year, as in previous survey years, consumers indicate a consistently high overall satisfaction with services. In each field, workers completing the survey indicate a higher level of satisfaction than their unemployed counterparts in the larger PSR program. This is true with one exception: Empowerment. Though staff have not been concerned to date with statistical significance issues, this comparison at least bears some further exploration with specific interviews with employed consumers to better understand this indicator.

Follow-up surveys more specific to work concerns of Employment Service recipients also indicate a high degree of job satisfaction. Respondents indicate satisfaction with the job-site assistance by Employment staff, and find useful the forum for ongoing supports such as Job Club and monthly employment dinner groups.

D. Conclusion and Action Recommendations for FY 03

The Employment Service continues to be a critical service for agency consumers experiencing serious mental illnesses. Data collection from surveys and ongoing service evaluations continue to reflect the value and effectiveness of the service. It is apparent that additional effort to elicit evaluation by stakeholders and consumers will contribute to constructive change and improved access and quality for the service offered to job-seeking consumers. The agency generally is beginning to implement this fiscal year a comprehensive agency-wide management initiative characterized by an array of service quality indicators: comprehensive integrated treatment and supports, staff and team performance standards, and thorough outcomes measurement systems, among other intended improvements. Employment Services will be, along with other service teams, the beneficiary of even greater systematic attention to service quality.

The re-location of Employment Services to new facilities on Elliot Avenue offers great new potential for enhancing the service offerings. Long a goal of the program, the development of an Employment Resource Center is now possible in excellent expansive surroundings. Staff are now seeking to identify computer and programming resources to facilitate greater options to increase the employment potential and interests of agency referrals.
As indicated, the overall downturn in the economy this year has continued to impact the availability of job openings for referrals. A trend over the last several years as well continues with the steady decline in interest of consumers in a long staple of the Blue Ridge Clubhouse vocational options: the TEP, or Transitional Employment Positions. Staff will analyze the continuing value of this mode of vocational skill development. Management and staff will evaluate the possibilities and potential for defining new employment services that may be vended to DRS (situational assessments, for instance).

Goals and Strategies for FY 03

1) Provide Training and Development opportunities of Employment Services staff;

2) Continue to develop the vocational specialist position within the PACT Team.

3) Explore the merit and feasibility of continuing an active Transitional Employment Program service (TEP). Evaluate with DRS the merit, feasibility, appropriateness of work enclaves or work crews as additional employment options for the referral population.

4) Refine the data collection processes for identifying and enhancing employment outcome measures. Assure greater return rate and follow-up discussions with both referrals and employed consumers. Add follow-up interviews with discharged employment service consumers.

5) Establish staff productivity standards specific to employment service staff in accordance with new agency initiatives. These standards should reflect decisions concerning the delivery of services which are revenue-producing vs. non-billable, essential services to the employed consumer.

6) Increase marketing of employment services to Region Ten CSB case managers and program directors regarding service options available, referral information, and admissions criteria.

7) Explore possible resources with the Ticket to Work options to increase employment for individuals enrolled to Social Security.

8) Continue to develop and utilize handouts, brochures, program information and other marketing tools for prospective new employers.

9) Continue high level of achievement on Contract performance goals in the DRS Region Ten CSB LTMI project.

Submitted To: Region Ten CSB Executive Director, Mental Health Services Director
and the Board

Submitted by: Reed Banks, Director Community Support Services

Date: July 2002

Employment Services and CARF

What is CARF?

CARF (Commission on the Accreditation of Rehabilitation Facilities) is the premier, nationally recognized accrediting body which reviews and grants accreditation to a wide array of behavioral health, rehabilitation, and community services.
Which Region Ten services are seeking accreditation this February 03?

Employment services for persons with psychiatric disabilities, including dually disordered consumers. Services are provided as an integral component of Blue Ridge Clubhouse psychosocial rehabilitation program and within the PACT (Program of Assertive Community Treatment) service.

The specific services provided are Job Development and Placement; Job-Site Training; and ongoing Job Supports

Why CARF for Region Ten employment services now?

Accreditation by CARF is an indicator of program excellence and conformance with nationally recognized standards.

DRS (the Virginia Department of Rehabilitation Services) has made CARF accreditation mandatory for all ESOs (Employment Service Organizations) doing business with it.
What happens if we do not pursue accreditation by CARF?

DRS would no longer purchase supported employment services from Region Ten. The agency could no longer bill for this component of the overall treatment and rehabilitation of persons with psychiatric disabilities.

The agency would lose a modest but important $50,000 to $75,000 annually billed at $47.61 per service unit.

When is the CARF Survey visit?

Two surveyors come February 24th and 25th. The format is an Orientation conference, two days of interviews, documentation reviews, and observations, ending with an Exit Interview.

How is the Region Ten Board involved in the Survey?

It is generally up to the Board or Executive Director to determine the extent of Board involvement in the site survey itself; at a minimum the Administrative surveyor interviews the Chair of the Board or other designated Board member.

The Board has received and reviewed a number of policies and practices including the Outcomes Management report for Employment services. A list of commonly asked questions of the Board representative(s) is available.

What are current summary stats for Employment services?

Thirty-three consumers are being served; twenty-two are employed. Eight of these consumers have jobs at a Region Ten CSB location. Ten consumers have obtained new positions this year with support of Employment staff. DRS is currently paying for eleven consumers’ services; soon this number will be fourteen.

Exception Report: Thru December, 2002

Revenue/Expense line items that are under or over 15% of target.

Total Region Ten

Federal Funds

HUD funding- received to date is 65,214 short. These funds are typically billed on a quarterly basis, Full receipt is not deemed questionable.

Part C Funds Early Intervention funds - funding received to date is 145,194 short. Billed on a quarterly basis, funds are in transit.

Other Expenses

Professional Liability Insurance -paid to date is 17,100 over budget. Premiums are paid in one annual payment. Total amount paid is within annual budget.

Personal Property Taxes – paid to date is 12,500 over budget. Taxes not paid on a monthly basis. Projected expenses are within budget.

* Mental Health Medicaid Actual to budget percent dropped this month due to a large Medicaid payment that would typically be received in December was not received until January. This obviously affected the total year to date revenue over expenses as well.







February 10, 2003, Board Meeting Agenda Item XI.

REGION TEN COMMUNITY SERVICES BOARD

CARF COMMITTEE MEETING
800 Preston Avenue, Charlottesville, VA
January 29, 2003

Committee Members Present

Michael Murphy, Chair
Susan Garrett

Others Present

James Peterson
Reed Banks
Karen O’Rourke
The committee reviewed the draft responses to the questions listing in the CARF survey guide as those frequently posed to members of the board. Suggested revisions were made to some of the responses, and these have been incorporated (see attached).

Ms. O’Rourke distributed updated pages for the CARF Survey Prep Guide, and the committee members identified items needing revision.

As part of the survey process, the CARF surveyors will meet with representatives of the board to ask questions of them. Mr. Peterson suggested that in addition to the board chairman, Mr. Murphy and Ms. Garrett should be involved in the interview process.

The meeting was adjourned.

February 10, 2003, Board Meeting Agenda Item XII.

REGION TEN COMMUNITY SERVICES BOARD

PERSONNEL COMMITTEE MEETING
800 Preston Avenue, Charlottesville, VA
January 30, 2003

Committee Members Present

Carol Johnston, Chair
John Trippel
Carole Wernstrom

Others Present

James Peterson
Jane Lewis

1. Review of Policies

Ms. Johnston distributed an agenda and asked Ms. Lewis, human resources director, if she would like to first cover the agenda items she has prepared.

Ms. Lewis reviewed the changes to Region Ten’s 17 page OSHA (Occupational Safety and Health Administration) Exposure Control Plan. The purpose of the plan is to minimize and to prevent, when possible, the exposure of employees to disease causing micro-organisms transmitted through human blood and other potentially infectious materials, and as a means of complying with the Bloodborne Pathogens Standard. The proposed revisions to the Exposure Control Plan take into account Region Ten’s recent organizational changes, revisions to OSHA laws passed by Congress, changes in required procedures for follow up to exposure incidents, a contract with UVa’s Occupational Health Services to serve employees who were involved in an exposure incident, and also as part of the routine review of policies conducted on an ongoing basis by the Personnel Committee.

The proposed revisions were accepted by the committee as presented.

2. Health Insurance

Ms. Lewis distributed a schedule detailing the time line leading up to board approval on May 12, 2003, of the new contract for employee health insurance (see copy attached). Bids will go out at the end of February and returned at the end of March. The Insurance Committee will make a recommendation in mid-April for review by the Personnel Committee at its April meeting with final action by the board in May. The new rates would become effective with the September 2003 payroll.

A report entitled “Region Ten Membership Report” was distributed which shows the number of staff who have elected the various plans, and how that has changed since the time prior to last October when Region Ten’s contribution and that of the employees with dependent coverage increased, and the contributions for single subscribers was reduced to zero. In general, there was a migration away from the Gold plan (“PPO 3"--the highest option and most costly) to the Platinum plan (“PPO 1"--the standard plan).

In planning for the FY 2004 budget, the board included funds anticipating a 15 percent increase in premiums. This would provide $168,494 on an annualized basis (or $140,412 for the 10 months of the new rates during FY 2004). Industry-wide increases are now reported to be 18 percent, and given Region Ten’s negotiations last year to hold the down the increase, and the very early indications of actual use, it would appear that an increase of 20 to 25 percent would be more likely. If the employees’ contribution to single coverage remains at zero, and if any increases are applied in the same proportions as exist for the current plans, then Region Ten’s share on an annualized basis could increase from $210,728 (for an 18 percent increase) to $292,685 (for a 25 percent increase). These computations are shown on the attached spreadsheet entitled “Insurance Projections 2003.”

3. Performance Evaluation Process of the Executive Director

Ms. Johnston presented the schedule for the annual performance evaluation of the executive director. Any changes to the evaluation survey form will be completed now and then the survey will be sent to board members (14), QMC (Quality Management Council) members (5), and director-level staff (30) the first of the week. These will be returned to Ms. Johnston by February 18, and then at the next committee meeting on February 27, the committee will meet with the executive director to establish performance objectives for next year and also review the evaluation surveys and prepare notes for the evaluation. An extra meeting may be needed in March to draft the evaluation and discuss it before the final report is completed. The committee will meet with the executive director at the March 27 meeting, and will then present its recommendation to the board at the April 14 meeting for action by the board at that time on the annual contract renewal with the executive director.

Ms. Johnston said that she had a couple of proposed revisions to the survey form based on her comparison of the job description to the items on the survey, and the extent to which the survey items directly related to items in the job description. There was also discussion about how realistic it was for staff to have a knowledge of the specific performance aspects, and so it was agreed that the survey form for the directors would not include numerical ratings, but rather solicit written comments on the four major performance areas. Ms. Wernstom suggested considering more extensive revisions to the survey used for the board and QMC members, but given the need to move ahead on this year’s process, it was agreed that this could be considered for next year.

The next meeting of the Personnel Committee will be held on Thursday, February 27, 2003, 4:15 p.m.

The meeting was adjourned.

REGION TEN COMMUNITY SERVICES BOARD, INC.

January 13, 2003, BOARD MEETING MINUTES
Blue Ridge House
100 Burnet Street
Charlottesville, VA 22903
Members Present

Susan B. Garrett, Vice Chair
Barbara Barrett
Paul Belair
Carol Johnston
Michael C. Murphy
Irene S. Rebholz
John J. Trippel
Roxanne White
Stephen Wunsh

Members Absent

Peter L. Sheras, Ph.D.
Rev. David M. Cameron
Rudolf A. Kaufmann, Ph.D.
Rodney D. Kibler, Ph.D.
Carole Z. Wernstrom, RN, MSN

Others Present

James R. Peterson, Executive Director
Downing Miller, Director, Access and Quality Assurance
David T. Moody, M.D., Medical Director
John Pezzoli, Director, Behavioral Health Services
Ann White, Director, Habilitative Services

I. Call to Order

Ms. Garrett, vice chairman, called the meeting to order at 7:40 p.m.

II. Approval of the December 9, 2002, Board Meeting Minutes

On a motion by Mr. Belair, seconded by Ms. Rebholz, the minutes of the December 9, 2002, board meeting were unanimously approved as distributed.

III. FY 2002 Audit Report

Upon recommendation of the Finance Committee, it was unanimously voted to accept the FY 2002 audit report as prepared by Hantzmon, Wiebel & Company.

Mr. Wunsh said that if the board members had any questions about the report prior to the next board meeting, they could call him or Mr. Caruso Brown for clarification.

IV. Nelson County Office Space

Both the architect and the representative from the Rural Development Fund were away for periods of time over the holidays, and so there was nothing new to report.

V. Group Home for Persons with Mental Retardation

Mr. Peterson reported that Mr. Bob Smith took the floor plan changes suggested by staff back to Keeney and Co. Architects, and they subsequently incorporated the changes and provided the revised plans back to staff for their review.

VI. Use of Region Ten Properties

Mr. Belair expressed concern that the best use of the facilities was not always evident. In two of the buildings he designed, there are rooms that are not being used now for the purpose they were designed. He wanted the board to be aware of this to assure maximum utilization of its facilities.
The meeting was adjourned at 8:47 p.m.

Respectfully submitted,

Paul Belair
Secretary