Advisory Groups, Authorities, & Commissions

Final CSB Minutes 1-19-11 7:00 p.m.

 

Members Present: Carol Skelly, Susan Lowry, Barbara Jones, Jenette O’Keefe, James Mack, Kathleen Donovan, David Kidwell, Cynthia Fagnoni, Barry Gale, Linda Kelleher, Scott Brannon, Anne Hermann, Janice Macdonald, Judith Deane
Members Excused: Brian Berke, David O’Connor, Naomi Verdugo
Staff Present: Cynthia Kemp, Farah Shakour, Joe Bullock, Alan Orenstein, Joanna Wise-Barnes, Michael Peter, Heather Stowe


The January 19, 2011 Arlington County Community Services Board meeting was convened at 7:10 p.m. by ACCSB Chair Carol Skelly. The meeting was held at The Department of Human Services Sequoia Building, 2100 Washington Boulevard – Auditorium, Arlington, VA.

Public Comment (s):
There were no public comments.

CSB Staff Recognition Award (s):
The January staff recognition award was presented to Sarah Shrum, a member of the Forensic Team. Ms. Shrum was nominated by Grace Langebeck, the Supervisor of the Forensic Team. Ms. Langebeck stated that Ms. Shrum was instrumental in implementing Crisis Intervention Team (CIT) training in Arlington. Ms. Shrum took the lead on developing this important police training and began with the first training in January 2008. Through her diligent work, attention to details, and perseverance, Ms. Shrum and the CIT team trained 108 law enforcement officers, dispatchers and probation officers between January 2008 and March 2010. She performed this work while simultaneously carrying out her primary functions as a forensic discharge planner and the Arlington CSB NGRI (Not Guilty by Reason of Insanity) Coordinator. Chair Skelly conferred the award. Ms. Shrum thanked the CSB Members for the award.


Approval of the December 15, 2010 Minutes:
ACCSB Chair Skelly called for a motion to approve the December 15, 2010 minutes. Mr. Gale made a motion to approve the minutes and Ms. Jones seconded the motion. The minutes were approved without correction.

Presentation
– “A Day in the Life of a Mental Health Therapist in the Arlington County Detention Facility”:
Ms. Kemp introduced Suzanne Somerville, Supervisor of the Mental Health program in the Arlington Detention Facility (ACDF). Ms. Kemp stated that Ms. Somerville’s work is critical. Major Kidwell characterized Ms. Somerville as a “major artery” in the system. Ms. Somerville distributed a handout detailing the team’s work (Refer to Handout). Ms. Somerville told the board that no day is typical and that the unpredictable nature of the work keeps the staff sharp. Ms. Somerville stated that because this is a jail environment, the mental health and jail staff work closely as a team to keep all parties safe. She also noted that the jail staff is the “eyes and ears” in the jail and that there has been an effort to be as accommodating as possible in the jail environment. Ms. Somerville described the specialized mental health unit that can accommodate up to 32 people; however, because of the number of seriously mentally ill people in the jail, staff are continually assessing people and moving those who are most stable into General Population and moving who are most unstable into the unit. To assist in the transition out of the mental health unit, staff developed a “Step Down” unit in collaboration with the Sheriff Deputies. The Step Down program helps clients build skills such as anger management, life skills, and substance abuse treatment. Ms. Somerville stated that the team works well together and collaborates with the medical team as well.
Mr. Gale asked about the percentage of individuals who enter the jail that have mental health and / or substance abuse issues. Ms. Somerville stated that 120 of the 500 individuals entering the jail are on medications and that about 75% of the 500 have substance abuse issues with roughly 80% of those with substance abuse issues having co-occurring serious mental illness (SMI). Mr. Gale asked how long individuals typically stay in the jail. Major Kidwell stated that the average length of stay is about 28 days, although individuals may stay much longer depending on the charge and how ill they are. Mr. Gale asked about the transfer protocol from the jail to other facilities to ensure that individuals obtain proper mental health services in the next facility. Major Kidwell stated that Ms. Somerville compiles a package of information outlining the individual’s health and behavioral history while in the jail to ensure that the receiving facility has the most comprehensive information available. Mr. Gale asked about juvenile detention center capabilities. Ms. Somerville stated that she does not work with juveniles often, except when a juvenile is charged as an adult and therefore can not answer that question. Ms. Jones asked how the staff handles individuals with limited language or communication abilities. Ms. Somerville stated that the language line services are available for individuals with limited English proficiency. She said that when there are issues of psychosis involved in preventing communication, the staff attempts to contact family members or medical providers to obtain a more detailed history. Mr. Gale asked how crises are handled in the community when an individual is deemed a threat to themselves or others. Ms. Kemp stated that a staff person from the Emergency Services unit and the police will go onsite to evaluate the person. If a person is deemed a danger to themselves or others or is substantially unable to care for themselves due to their mental illness, the person is detained by the staff. The individual then receives a court date within 72 hours to determine whether they should be committed to a hospital. If the person has committed a crime, sometimes an arrest is made. The Emergency Services team is available 24 hours a day. Ms. Kelleher asked what happens after people are discharged from the jail. Ms. Somerville stated that there is a re-entry committee comprised of DHS staff, Sheriff deputies and several nonprofit organizations such as OAR and A-SPAN, to help coordinate services for individuals prior to release. If the individual is an Arlingtonian and has a mental health issue, they are referred to mental health services in Arlington. She stated that these services do not apply to non-Arlington residents and that the committee is seeking grant funding to hire a re-entry coordinator. The staff attempts to connect individuals to services in their own jurisdiction of residence. Ms. Donovan asked about the gaps in services. Ms. Somerville stated that the primary gaps are the need for quickly assessments, expansion of group work, and greater capacity to handle individuals with higher security risks..
Action Item – Request for Approval to Apply for a DOJ Grant for a Re-Entry Coordinator:
Ms. Kemp presented a request for approval to apply for a U.S. Department of Justice (DOJ) grant to hire a re-entry coordinator to help inmates transition successfully into the community through linkage to services. The
total request is $200,000 over two years. Ms. Kemp stated that she is seeking approval to go forward with the application.
Action Item –
Request for Approval to Apply for a DOJ Grant for Expansion of the Crisis Intervention Center:
Ms. Kemp presented a request for approval to apply for a U.S. Department of Justice grant to expand the Crisis Intervention Center (CIC) and to make facility enhancements. The total request is $250,000 over two years. Ms. Kemp stated that she is seeking approval to go forward with the application. Mr. Mack asked why six staff is needed. Ms. Kemp stated that the funds will be used to hire a pool of staff that will provide extended coverage.
Ms. Deane asked if there is a County-level commitment to continue funding for the staff beyond the two years. Ms. Kemp stated that in order to apply, there must be no county funding involved; however, DOJ may decide to continue funding beyond the two year period. Currently, there is no commitment from the County beyond the grant. Mr. Gale asked if DOJ will fund both applications. Ms. Kemp said yes and stated that the two grant applications may be in competition. Ms. Kemp also stated that if the funds are not awarded this time, the applications will be revised for possible future submission.
Mr. Gale motioned that the Members approve to move forward with both grant applications and Ms. Hermann seconded the motion. The motion was unanimously approved.


ACCSB Executive Director’s Report:
ACCSB Executive Director Cynthia Kemp reported the following:
Ms. Kemp reviewed the data on the Group Home Report with the Board Members (Refer to Handout). She reported that there were 39 total incidents, with one major incident. The major incident involved a client accusing a staff member of pushing her. Ms. Kemp stated that there was an incident report generated for the client’s injured foot, but not for the act of pushing. The vendor conducted an internal investigation and found the accusation unfounded; however State Licensing and APS were notified and APS is conducting a separate investigation. Chair Skelly asked how investigators make determinations of fault when it is a client’s word against a staff person’s word. Ms. Kemp stated that it is difficult but that the credibility of the individuals involved is considered. In the case of this incident, there were witnesses. Ms. Kemp stated that she has implemented an incident reporting system to track incidents and that there is a health and safety committee that examines trends.

Ms. Kemp stated the financial report is in the CSB packets (Refer to Packet). She reported that revenue is at 40%, and it should be at 42%. She stated that this is attributed to three main things – staff vacancies, low revenue in one particular program and the Department of Medical Assistance Service’s (DMAS) denial of seemingly valid claims, even though the billing is up to date. There are corrective actions underway in the program with lower revenue and staff are being retrained. Ms. Kemp stated that a team has been assembled including program, revenue and administrative staff to continue to monitor issues. Ms. Kemp will continue to report on this matter.

Ms. Kemp noted that Financial Disclosure Forms are over due and that Members may not vote until their forms have been submitted. Ms. Shakour had additional forms for Members if needed.

Ms. Kemp noted that the CSB Interagency Agreements will be slightly delayed and may not be ready for the April meeting as usual, because the County Attorney is reviewing each agreement and will make recommendations regarding consolidating and editing agreements.


Ms. Kemp turned the floor over to Ms. Stowe to update the Members on the five vacancies in Child and Family Services. Ms. Stowe stated that there are two school-based, two youth transition, and one full time psychologist position vacant. A candidate has accepted the psychologist position and interviews have been conducted and reference checks are in progress for the remaining four positions. One additional vacancy in the Central Intake Unit (a non-CSB position) has gone out for recruitment. Ms. Deane asked for an update on the waiting list for services. Ms. Stowe responded that there are 53 children on the waiting list. Ms. Deane asked for turn around time for services. Ms. Stowe stated that this depends on severity of need.

Ms. Kemp stated that she sent the Members an article written by the Commissioner of the Department of Behavioral Health and Developmental Services, James Stewart, supporting transition from institutional care to community-based services. She encouraged the board members to review the document when they get a chance. She stated that it gives good insight into the direction of the Department.


Ms. Kemp highlighted an article by Pete Earley titled “Don’t Blame the Parents of Jared Loughner” that discusses the perception of parental involvement in violent acts by their mentally ill adult children. Jared Loughner is the shooter involved in the Tuscon, Arizona shootings.
ACCSB Chair’s Report:
ACCSB Chair Carol Skelly reported the following:


Chair Skelly reported that she wants to send a letter to the state legislators outlining the CSB’s priorities for the 2011 Virginia legislative session. Chair Skelly received feedback from Ms. Verdugo to include more focus on children’s issues and has added this to the letter. Chair Skelly would like to issue the letter by the end of the week. Chair Skelly asked Ms. Kemp to elaborate on Senator Barker’s amendment so that this can be included in the letter. Ms. Kemp gave an overview of the need for regional crisis stabilization and community alternatives to psychiatric beds. Ms. Kemp stated that Senator Barker has put in a budget amendment for $1M. $500,000 of the funding is to extend the beds at NVMHI for six months through December 31, 2011 and $500,000 for a regional facility for temporary detention orders and crisis stabilization. This would be one-time funding with the hope that the state would provide ongoing funds once services are implemented. Ms. Kemp stated that the psychiatric bed at NVMHI will decrease from 129 to 110 beds by July 1, 2011. Ms. Kemp noted that one third of the beds are utilized by Arlington residents, therefore, her staff is examining other options to hospitalization. Chair Skelly stated that more clarification is needed on a bill related to community-based mental health services for children and youth. Ms. O’Keefe stated that she would like to provide more language to strengthen the portion of the letter related to substance abuse, and Ms. Hermann will send revisions to the portion on services for older adults with mental illness. Ms. Jones suggested adding the number of individuals or dollar amounts needed for services for substance abuse and older adult mental health services. Chair Skelly noted that the restorations are included towards the end of the letter in order to highlight the children’s issues, though typically restoration requests are placed first.

Chair Skelly announced that she and Kathy Donovan will be meeting with the Arlington County Department of Human Services Director Susanne Eisner and her staff regarding the Mary Marshall Assisted Living Facility next week.


Chair Skelly announced that she and several other people including CSb members will meet with Theo Stamos, a candidate for the Commonwealth Attorney position, on January 27 at 5:00 p.m. to discuss drug courts and other issues affecting CSB clients. Chair Skelly will attempt to set up meetings with the other candidates as well. Mr. Gale stated that his wife would like to attend this meeting.

Chair Skelly thanked new Member, Linda Kelleher, for her commitment to serve on the Ten Year Task Force to End Homelessness. Ms. Kelleher will attend the full committee meeting and the Ten Year Plan Committee and will report back information related to affordable housing and permanent supportive housing.
ACCSB Priority Initiatives:


Employment –
Chair Skelly reported that the Employment Committee will meet again next week and will soon convene a larger group. The focus of the group is opening up job opportunities for people with disabilities in Arlington. The meeting is on January 27 at 8:30 a.m. at the Drewry Center and all Members are welcome.


Group Home –
No report this week.


Communications – Ms. Fagnoni reported that she has researched the drug court issue and that there is support for the strategy. Ms. Fagnoni sent a PowerPoint presentation to the substance abuse committee members that was developed by an outside agency and that contained valuable information on drug courts.

Youth in Transition – Ms. Deane reported that the committee has met with Arlington staff members Heather Stowe, Alan Orenstein and Joe Bullock. The committee is examining whether or not the staff can interview a wider group of families as well as young people themselves, and is seeking additional staff input.


Children and Adolescents – Ms. Kemp stated that Ms. Verdugo has expressed concerns about children’s issues and is setting up a meeting with Joan Planell, Assistant Director of the Arlington County Department of Human Services to discuss the issues. Ms. Kemp and Ms. Stowe have embarked on a strategic planning process to analyze the services, service gaps, client needs, and evidence-based practices. Ms. Kemp and Ms. Stowe will be making recommendations on resource utilization and will keep the child and youth committee involved in the process.


BHC and VHC Continuum of Care Issues – Ms. Kemp stated that she met with Ms. O’Keefe and Ms. Donovan on January 5 to develop a plan to address the issues. She also reported that the staff has established regular meetings with the VHC staff every other month. Ms. Kemp, at the request of Ms. O’Keefe and Ms. Donovan, has established a meeting with the head of the psychiatric unit at the hospital to communicate the concerns and ask them for their input on next steps.
Informational Items:


Mr. Mack distributed a flyer regarding a presentation by Reed Forman from the Substance Abuse and Mental Health Services Administration (SAMHSA) on SBIRT, an effective new drug and alcohol prevention tool used to identify individuals at risk of developing substance abuse disorders. The tool is designed for use in primary care centers, hospital emergency rooms, trauma center, and other community settings. The presentation will occur on January 24, 2011 from 7:00 – 8:00 p.m. at 1801 N. George Mason Drive, Room 254, in Arlington, Virginia.
The Arlington Community Services Board meeting was adjourned at 8:55 p.m.


Respectfully submitted by Farah Shakour


Last Modified: April 07, 2011
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