HomeMy WebLinkAboutResolutions - 1989.02.09 - 17221MISCELLANEOUS RESOLUTION NO. 89024 . February 9, 1989
BY: HEALTH AND HUMAN SERVICES COMMITTEE - SUSAN KUHN, CHAIRPERSON
IN RE: DEPARTMENT OF INSTITUTIONAL AND HUMAN SERVICES -
COMMUNITY MENTAL HEALTH - SERVICES FOR CITIZENS DUALLY DIAGNOSED
AS MENTALLY RETARDED AND MENTALLY ILL
(NEW PROGRAM APPLICATION)
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS:
Mr. Chairperson, Ladies and Gentlemen:
Whereas in the entire public mental health system in Michigan, services
for those persons who are diagnosed as both mentally retarded and mentally
ill have been extremely inadequate, owing to confusion of responsibility
between agencies which have been designed to work principally with one
diagnostic group or the other, and a lack of expertise on either part to
assess and treat both aspects of these citizens disabilities; and
Whereas Oakland County CMH Services to the Developmentally Disabled has
learned that State Department of Mental Health funding is available to
establish a two -year program that would identify those "dually diagnosed"
citizens in the county through an inter-agency needs assessment, and develop
a continuum of specialized services for these individuals to meet their
unique needs; and
Whereas such a program would, if successful, become a model for
Community Mental Health programs across the State; and
Whereas the Community Mental Services Board has approved a program
proposal to the Michigan Deptment of Mental Health for this purpose, for a
time -limited grant in the amount of $192,221 total for two years, which would
require no County matching dollars; and
Whereas this program would combine directly operated and contractual
services, requiring new County positions in the form of one Project
Coordinator and one Typist I, who would be hired with the understanding that
the program is funded only for two years, and any continuation beyond that
period -- based on the value of the program demonstrated through a formal
evaluation -- would depend on availability of State and matching local funds
within the Community Mental Health Services budget; and
Whereas Commissioners Resolution No. 86186 requires that all new program
applications receive Board of Commissioners approval:
MISCELLANEOUS RESOLUTION
Page 2
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners approve the Community Mental Health ''Services for Citizens
Dually Diagnosed as Mentally Retarded and Mentally Ill" New Program
Application Request as recommended by the Community Mental Health Services
Board, for submission to the Michigan Department of Mental Health.
Mr. Chairperson, on behalf of the Health and Human Services Committee, I
move the adoption of the foregoing resolution.
c.
HEALTH AND HUMAN SOICES COMMITTEE--
REPORT TO THE HEALTH AND HUMAN SERVICES COMITEE
BY: DEPARTYENT CF MONVEVENT AND BUDGET
IN RE: DEPARTMENT OF 1NSTITUTICN1I, AND HUMAN SERVICES/CCMINITY MENTAL
HEALTH - SERVICES FOR CITIZENS DUALLY DaAGNIOSED AS MENTALLY
RETARDED AND MENTALLY ILL (NEW PROGRAM APPLICATION)
The Eepartment of Management and Budget has reviewed the application for
fands for a Community Mental Health program to serve citizens Who are
diagnosed as both mentally retarded and mentally ill and finds:
1) The application is for a new two-year grant in the amount of
$192,221 to be funded 100% by the Michigan Department of Mental
Health with no additional County dollars required;
2) TWo additional County positions are proposed in the application
(one Mental Health Clinician and one Typist 1) as special revenue
positions;
3) After the two-year period, the program will be evaluated and
continuation of the program would he subject to the availability
of State and matdhing County funds;
4) Application for the funds does not obligate the County to any
future commitment.
In accordance with Miscellaneous Resolution #86186, Revised Federal and
State Grant Application and Reimbursement Contract Procedures, this report
is being sdbmitted to the Health and Human Services Committee.
Informational Copies: Finance Cankttee
Personnel Committee
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OAKLAND COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
DUALLY DIAGNOSED PROJECT
APPLICATION GRANT BUDGET
Personae/.
Mental Health Clinician
Typist I
Fringe Benefits(41%)
Total Personnel
Year 1 Year 2 =Ai
$26,422 $ 27,479 $ 53,901
15,060 15,662 30,722
_17A0a 17,688 34,69k
58,490 60,829 119,319
Operating
Clinical Services 13,261 41,641 54,902
Client Services 2,300 1,800 4,100
Publications 100 100 200
Rent 4,000 4,000 8,000
Personal Mileage 700 700 1,400
Stationary Stock 300 300 600
Equipment Rental 400 100 800
Total Operating 21,061 48,941 70,002
Furniture & Fixtures 2,900 0 2,900
Grand Total $82,451 $109,770 $192,221
Revenue
$109,770 $192,221 100% State $82,451
Approved by Budget Division
lv 1/30/89
A Proposal to Serve
Individuals Diagnosed Mentally
Retarded and Mentally Ill
Community Mental Health
10/88
Introduction
The Oakland County Community Mental Health Services Board was initially established
in 1963 as an official county agency pursuant to Public Act 54 of 1963. In 1974 the
Michigan legislature recidified the mental health laws and County Community Mental
Health programs became part of Public Act.258 of 1974. The mental health code
requires that the twelve member board, appointed by a majority vote of the Oakland
Board of Commissioners, is to be representative of the providers of mental health
services, recipients or consumers of mental health services, agencies and occupations
having a working involvement with mental health services, and the general public,
although such representation not be in any fixed proportion. The code also directs
that each community mental health board shall:
a) Examine and evaluate the mental health needs of the county or counties
it represents and the public and nonpublic services necessary to meet those
needs.
b) Review and approve an annual plan and budget for the county program. The
format and documentation of the annual plan and budget shall be specified
by the department.
c) Submit the annual plan and budget, after approval by each board of comm-
issioners, to the department by such date as is specified by the department.
Such submission shall constitute the county program's official application
for state funds.
d) Provide and advertise a public hearing on the annual plan and budget prior
to submitting it to the county board of commissioners.
e) Submit to each board of commissioners an annual request for county funds
to support the county program. Such request shall be in the form and at the
time determined by the board or boards of commissioners.
f) Take such actions as it deems necessary and appropriate to secure private,
federal, and other public funds to help support the county program.
g) Approve and authorize all contracts for the providing of services.
h) Review and evaluate the quality, effectiveness, and efficiency of services
being provided by the county program.
i) Appoint a director of the county community mental health program who shall
meet standards of training and experience established by the department.
The department shall establish standards for individuals who are physicians
and for individuals who are not physicians. The choice of appointing a physician
or nonphysician as county director shall rest with the board, and in making
such choice the board shall consider the duties that the county director can
be expected to perform. Any individual who may reasonably be regarded as
serving as a county director on the date that this chapter becomes effective
shall be exempt from the standards of training and experience herein referred to.
j) Establish general policy guidelines within which the county director shall
execute the county program.
Subject to provisions stated in the code community mental health boards are impowered
and either directly operate or contract for the provision of mental health services.
As regards the responsibility the Oakland County Community Mental Health Services
Board has for providing mental health services for the developmentally disabled it
has chosen to directly operate a portion of the total services and contract with
private non-profit agencies for the provision of others.
Board Operated
The Director of Oakland County Community Mental Health has appointed a Chief of
Services to the developmentally disabled who with his staff provide all hoard
operated services from the Oakland County Community Mental Health Center which is
a nonresidential facility centrally located in the/county at 1200 North Telegraph
Road, Pontiac, Michigan.
Services for Developmentally Disabled is organized as follows:
1) Administration
Includes the directors office, clerical, bookkeeping, case record
maintenance, purchasing, data collection.
2) Adult Day Program
This program serves developmentally disabled persons who are not eligible
for day programming from some other source such as special education or
Michigan Rehabilitation Services. It is comprised of a licensed and
nationally accredited work activity center and an activity of daily living
program consisting of instruction in affective, personal awareness, special
interest, community awareness and home skills. Transportation is arranged
and provided for through financial and/or cooperative agreements with Servi-
Car (a proprietary operation), SEMTA (public) OCART (public) and Pontiac
Schools. Clients served are those residing in the northern and western
regions of the county.
3) Social Services
This unit is comprised of professional social workers at the MSW level.
Services provided include:
a. Counseling
1) Individual
2) Family
3) Group
b. Respite Care
1) 1n-home
2) Out-of-home
c. Intake and Referral
d. Guardianship Assistance
e. Residential Placement
f. Life Consultation
g. MR-MI Treatment (Specialized Residential Facility)
h. Evaluation & Screening (general)
i. Pre Admission screening for institutionalization
j. Advocacy and Recipient Rights
k. Emergency Intervention
4) Community Placement and Residential Services
This section concentrates case management services on those individuals
having institutional linkage. Clients served reside in their natural homes
or in licensed facilities under contract with the Macomb-Oakland Regional
Center. Services provided include:
a. Pre placement planning
b. Residential placement
c. Individual program planning
d. Behavior program planning
e. Monitoring of training programs
f. Coordination of services between home and day program
g. Emergency intervention
h. Foster Parent training
i. Guardianship Assistance
j. Coordination of all mental health services
5) Psychological and Health Services
This section is comprised of three full time staff; two psychologists and
a registered nurse. In addition we contract for three part time physicians;
a Board Certified Internist (M.D.), a Board Certified Psychiatrist (M.D.) an
expert in autism, and a Board Eligible Psychiatrist (M.D.) having special
interest in emotional disorders within a developmentally disabled population.
Services provided include:
a. Diagnosis and evaluation
b. Routine and emergency medical care for day program
clients at the Community Mental Health Center.
c. Physical examinations for pre-admission to Adult Day
Program clients at the Community Mental Health Center.
d. Physical examinations for specil olympics and for those
developmentally disabled clients not having access to a
physician.
e. Psychiatric evaluation and treatment (general)
f. Psychiatric evaluation and treatment (autism)
g. Consultation (psychological, medical, medical-psychaitric)
An organization chart is attached as exhibit I.
Identified Problem
For many years the mental health system in Michigan has been struggling with
providing services to the dually-diagnosed person. While this term, dual-
diagnosis, has many definitions, in this instance we are speaking of persons who
fall into one or both of the following categories:
1. Persons with a primary diagnosis of mental
retardation (MR) and a secondary diagnosis
of mental illness (M.I.).
2. Persons with a primary diagnosis of M.R. and
exhibiting severe behavioral problems.
Due to the complexity of the diagnosis, these individuals often find themselves
bouncing between two systems of service, one being the developmentally disabled
side and the other the mental illness (MA.). Each of these utilizes a particular
method of treatment that merely addresses one aspect of the person, while in essence
a dual approach must be employed. In this way the whole person is addressed by a
blending of the two systems. Beyond the actual treatment of the person, many
systems' issues impact upon the success of community placement. Issues such as
stability of placement, appropriateness of day activity or work programs and training
opportunities are typically riddled with problems making these clients difficult to
serve from two perspectives; the persons' behavior/illness and the lack of services
specifically designed to address this population's particular needs. This phenomenon
has been documented throughout the professional journals and the state of Michigan's
own efforts to develop potential projects that may be the examples for the future
direction of services. (See Behavior Management Quarterly: The Dually-Diagnosed,
Vol. 2, Winter, 1986).
Withing Oakland County we are continually made aware of the problems in serving
the dually-diagnosed due to the lack of resources available in the area. Often
we provide a "band-aid approach" that serves to temporarily relieve a particular
problem without being able to effect a long range solution, thereby perpetuating
the well-documented revolving door syndrome.
Proposal
Oakland County Community Mental Health Services for Developmentally Disabled is
seeking to develop a continuum of services and form linkages with other agencies
serving the dually diagnosed. Since no information is currently available as to
the numbers of persons falling into the two previously mentioned categories, a
needs assessment will be our starting point. By acquiring specific information
on both children and adults currently in our system and those outside of our agency,
we can better determine the direction of future services.
For the purposes of this program, two diagnostic categories will be utilizd to
define the dually-diagnosed person:
I. Persons with a primary diagnosis of M.R. with a
secondary of MA.
2, Persons that are M.R. and exhibiting severe behavior problems.
page 2
This shall be accomplished by the following referral network:
1. Community Mental Health (CMH) ca,,e managers, social workers
and psychologists referring potential dually-diagnosed for
screening, based upon the previously stated diagnostic
categories.
2. Extending the same referral process to community agencies.
3. Developing firm interagency cooperation with Clinton Valley
Center (CVC), and Community Mental Health Screening Services
in order to identify the individuals currently in the hospital
and those found inappropriate for admission to CVC.
The five phases of this service delivery system will focus on the person accessing
the service and the network of services and professionals that interact with the
dually-diagnosed individual.
Phase I
This phase represents the referral and initial information component Referrals
will be received from a variety of agencies serving the developmentally disabled.
The initial referral information will list general information on the individual
as well as the presenting problem or suspected diagnosis. Following the receipt
of the referral, the Reiss Screen will be sent to the para-professional or care
giver who is familiar with the individual. Since the Reiss Screen is a diagnostic
tool written in laymans terms, it will be self-explanatory to the evaluator, however,
if additional asistance is required, the program coordinator will provide help as
necessary.
Scoring for the screen will be done by CMH psychologist and the results will be
given to the program coordinator for compiling the characteristic information on
the dually-diagnosed in Oakland County,
It is estimated that this phase will involve at least the first quarter and
possibly one-half of the second quarter of the program. As this phase involves
a component of outreach to introduce the service, the first month will be directed
at disseminating the information to various agencies.
Phase II
Once we have compiled the list from the first quarter into the two categories
mentioned previously, a small group will be selected to participate in the program.
Persons will be selected based upon the following variables:
Current status of mental illness
a. Under medical control
b. maintenance
c. active
2. Current placement setting
a. own home
b. group home
c. SIP
d. institutional/hospital
page 3
A screening committee which will include a psychiatrist will rate each person
according to a numerical scale of 1-5. This will allow us to identify a group
of 20-25 persons for the next phase of the program. Due to the intensive nature
of this program, a small"g[roup is best in order to maintain strong coordination
throughout the length of the program. The program will look for individuals who
are currently stable from a medical and behavioral perspective. These persons
may have a past history that tends to exclude them from placement or movement
to a less restrictive environment.
Phase III - Social Skills Training
A major deficit in our current practice with community placement is inadequately
preparing the dually diagnosed with the skills they need to succeed. Recently
Thad A. Eckman, Ph. D. presented at the Behavior Management Seminar hosted by
the Department of Mental Health. It is h-is approach that the program will utilize.
The training of skills is presented in the following manner:
1. Goal setting - what do we hope to achieve in the module?
2. Overlearning - presenting information from a variety of
perspectives that are aimed at one goal
3. Multi-media approach
4. Clear instruction and expectation
5. Confirmation of assimilation of information
6. Abundant positive reinforcement
7. Shaping desired skills - small successive step toward
an end goal
8. Role playing and behavioral rehersal
9. Coaching and prompting
10. Immediate and positive feedback
11. Modeling
12. Generalization or transfer of skills to real life
opportunities to practice skills in the community and
without interpersonal relationships.
Training modules will cover areas such as self-medication, recognizing symptom
warning signs, developing leisure skills, personal grooming, etc
This training will be carried out by the program trainer and assistant. The full
curriculum will extend through the third and fourth quarter. Persons who continue
with the program in the fourth quarter will be evaluated by Adult Learning Systems
for adaptability to Supported Independence Placement (SIP).*
Phase IV
Based upon the results from the SIP screenings, it is estimated that ten persons
will be designated to be placed in SIP settings. All persons participating in the
program will be involved in support groups. These groups will focus on sharing
experiences around such themes as work skills, community integration and family
dynamics, interpersonal relationships. Groups will be facilitated by Community
Mental Health therapists specializing in groups, thereby establishing an ongoing
resource after training has been completed.
SIP - funding for slots will come directly from persons SSI and the individuals
will hold jobs preferably in the community. CMH will provide support staffing
for no more than one year. Additionally, all persons in SIPs will attend group
on a weekly basis.
page 4
Phase V
The final phase of this program involves evaluation The basic measure for
most participants is thought to be reduted recidivism rates, both from a hos-
pitalization or more restrictive setting perspective.
Additional variables to be examined will be:
1. Does social skills training alone help to maintain
placement. The measure is the group not designated
for SIP.
2. Does the consistency of the professional interactions
across settings impact on the dually-diagnosed persons
success.
3. Does the use of the Reiss Screen maximize a correct
diagnosis. "Are the people referred truly dually-
diagnosed".
To conclude, a full circle treatment appraoch is the premise for success in this
program. This system will attempt to strengthen the existing services for these
clients through linkages to reinforce a continuum of service. In addition, by
developing a comprehensive training program we empower the clients with the skills
they need to succeed in the community. The total time estimated to carry a person
thru the program and to the potential placement is two years.
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OAKLAND COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
DUALLY DIAGNOSED PROJECT
APPLICATION GRANT BUDGET
Personnel
Mental Health Clinician
Typist I
Fringe Benefits(41%)
Total Personnel
Year 1 Year 2 Total
$26,422 $ 27,479 $ 53,901
15,060 15,662 30,722
17.008 17,688 34.696
58,490 60,829 119,319
Operating
Clinical Services 13,261 41,641 54,902
Client Services 2,300 1,800 4,100
Publications 100 100 200
Rent 4,000 4,000 8,000
Personal Mileage 700 700 1,400
Stationary Stock 300 300 600
Equipment Rental 400 400 800
Total Operating 21,061 48,941 70,002
Furniture & Fixtures 2,900 0 2,900
Grand Total $82,451 $109,770 $192,221
Revenue
100% State $82,451 $109,770 $192,221
RESOLUTION # 89024 • February 9, 1989
Moved by Susan Kuhn supported by Johnson the resolution be adopted.
AYES: Olsen, Pappageorge, Pernick, Rewold, Skarritt, Wolf, Aaron, Bishop,
Caddell, Chester, Crake, Gosling, Hobart, Jensen, Johnson, R. Kuhn, S. Kuhn,
Luxon, McConnell, McCulloch, McPherson, Moffitt, Oaks. (23)
NAYS: None. (0)
A sufficient majority having voted therefor, the resolution was adopted.
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lynn D. Allen, Clerk of the County of Oakland and having a seal, do
hereby certify that I have compared the annexed copy of the attached resolution,
adopted by the Oakland County Board of Commissioners at their regular meeting
held on February 9 , 1989 with the original record thereof now remaining
on file in my office, and that it is a true and correct transcript therefrom,
and of the whole thereof.
In Testimony Whereof, I have hereunto set my hand and affixed the seal
of said County at Pontiac,Michigan this 9th day of February , 1989
LYNX D. ALLEN, County Clerk
Redister of Deeds