MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JANUARY 10, 2002
TABLE OF CONTENTS
SEATS Director Lisa Dewey: SEATS Rider’s Guide for Johnson County
Report (Thompson): Attended Meeting with Human Resources Administrator Lora Shramek
National Alliance for Mentally Ill Co-President Carol Spaziani: Support of Impact Program
Mental Health Center Director Steven Trefz: Support of Impact Program
Executive Session: Collective Bargaining Strategy for the Sheriff’s Unit
Chairperson Lehman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 6:32 p.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, Sally Stutsman, and Carol Thompson.
SEATS DIRECTOR LISA DEWEY: SEATS RIDER’S GUIDE FOR JOHNSON COUNTY
Thompson: Call to order the Information meeting of the Johnson County Board of Supervisors on Thursday. January 10th, 2002. First is business from Lisa Dewey Director of SEATS regarding the SEATS Riders Guide for Johnson County.
SEATS Director Lisa Dewey: I have brought forth the modified Riders Guide. The initial Riders Guide was developed in March of 2000. There had been some areas where we wanted to expand to make sure it covered everything and was really clear for our riders. So with that assistance of the Para-Transit Advisory Committee, we put together a Riders Guide. However there is on page one, there is one paragraph that seems to have a little difficulty. So I’m bringing both of those paragraphs to the Board to ask them to make the final approval of which version they would like to have. There are some issues with these for some individuals on the Committee, so we just thought it would be better to bring it forth to the Board. On page one of the Riders Guide, you have the very first paragraph that welcomes everyone to the program. Then the next paragraph had a statement that was request to be modified. There were a couple of different ways to do that, but there are some concerns with requirements for funding under the ADA, you have requirements where you can not do trip purpose. It’s not just a public transport system, so you can not do trip purpose or special type groups or things like that. One page you’ll see where there it shows where SEATS is a high quality para-transportation service. A lifeline that links riders to family, friends, health care services and the work place, enabling the riders to live more independent and productive lives. There are a few members on the committee that would prefer that paragraph, however there are some concerns about it being to specific and trip oriented. The next paragraph on the other page has what a large group of individuals request. SEATS is a high quality transportation system, which is a shared rights service for people in Iowa City, Coralville and University Heights who are certified by their city of residence as being unable to use their fixed route bus service or for the general public of Johnson County who live outside of the City limits of Iowa City, Coralville and University Heights. So what that does, is let them know, under the 3 cities you are under the ADA and require eligibility. Every where else in the County is under the rural system, but it just makes it public transit. That is the only area of this current pamphlet that was of issue to the group at any point in time. So what were asking the Board to do, is to decide which of these two paragraphs they would like to see in this Riders Guide.
Neuzil: Lisa what’s the recommendation of the Committee and what’s your recommendation.
Dewey: The majority of the committee had gone with the one "it’s a high quality transportation system" and then combining it with that one sentence. My recommendation is to go with that paragraph. The reason being it does not lend to any type of discrepancy in regards to making a trip type purpose or a special group of individuals. ECICOG funds our vehicles under public transit only, not under ADA, so you can’t discriminate by doing just a specific group such as elderly or disabled. So under the rural, that’s why it’s anybody out in the rural area can receive this transportation. This one gets a little specific, so there’s some concerns with that with regards to funding through FDA and ECICOG. So, it would be my recommendation to go with the one sentence. It makes it clear it’s a para-transit system.
Neuzil: Thank you.
Stutsman: You didn’t read the second paragraph, which I think clearly spells out what SEATS is. I think it’s stated well in that second paragraph. Pat and I are on that SEATS Advisory Committee. Pat and I both supported what the majority of the Commission or the Advisory Board supported. Including that SEATS is a compassionate door to door service shared with other riders that seeks to be responsive to the individual needs of eligible riders of Iowa City, Coralville, and University Heights. I guess I support what the majority of the Advisory Board and you too, Lisa wants for the wording in the first paragraphs of the Riders Guide.
Dewey: I’d like to request that this go to the formal to be approved as…
Stutsman: I might add that Pat and I do serve on that Advisory Committee and this took a lot of work. What did we say 4 meetings?
Dewey: We had 5 meetings on this Riders Guide.
Stutsman: We assured the Committee that we would give this our wholehearted support so that it will not go back to the Committee. So it will be approved. It is a good document. We had lots of discussion. Lots of input. I’m really pleased with what…
Neuzil: It’s a great book. I really is, it’s a great book.
Dewey: It really does a lot for the riders.
Neuzil: Very well done.
Thompson: We’re on for next week with this?
Lehman: Yes.
Stutsman: I was just wondering… Mike’s taking my place on the Advisory Committee, so Mike had a vested interest.
Lehman: I met with Lisa and Pat. She gave the details of it. So concurrence to put it on.
Thompson: Thanks Lisa.
Dewey: Thank you very much.
MENTAL HEALTH/DEVELOPMENTAL DISABILITIES DIRECTOR ELAINE SWEET: CONTRACTING WITH UNIVERSITY OF IOWA HEALTH CARE TO PROVIDE IMPACT SERVICES UNDER JOHNSON COUNTY'S MENTAL HEALTH/DEVELOPMENTAL DISABILITIES SERVICES MANAGEMENT PLAN
Thompson: Next is business from Elaine Sweet, Director of Mental Health/Developmental Disabilities regarding contracting with University of Iowa Health Care to provide IMPACT services under Johnson County’s Mental Health/Developmental Disabilities Services Management Plan, discussion action.
Mental Health/Developmental Disabilities Director Elaine Sweet: Good evening.
Stutsman: Hi Elaine.
Neuzil: Hi Elaine.
Sweet: I’m coming to you this evening for a discussion for a request from University of Iowa Health Care to contract with them for IMPACT services. IMPACT is a comprehensive psychiatric and rehabilitation service to persons with serious and persistent mental illness. The question of whether to contract with the University for IMPACT services predates my time in Johnson County. It’s something that’s been proposed on a number of occasions and has been discussed on the Planning Council level. I know of 2 different recommendations from Planning Council that Johnson County contract with the University for this service. Each time the proposal comes forward there seems to be a lot of discussion. A lot of questions and we felt it appropriate to bring it to the full Board and have public discussion on some of the pros and cons of contracting for IMPACT services. I don’t feel I can adequately describe the service itself and the program, but there are representatives here from the University this evening if the Board would entertain some comments from them.
Neuzil: Sounds good.
IMPACT Administrative Support Person Rick Dobbins: I’m Rick Dobbins. I provide administrative support from UI Health Care for the IMPACT Program at the University of Iowa Hospitals and Clinics.
IMPACT Medical Director and Psychiatrist Nancy Williams: I’m Nancy Williams. I’m the Medical Director and Psychiatrist for the IMPACT Program.
IMPACT Advanced Nurse Practitioner Betsy Rodick: I’m Betsy Rodick. I’m an Advanced Nurse Practitioner. I am a coordinator of the program. We were here with some of you, as Elaine mentioned, a couple of time in the past. Dr. Clancy and I were here with the Planning Council in 1998, when Craig Mosher was the CPC. Then we were here in January of 2000 with the Planning Council. We gave kind of lengthy descriptions of IMPACT at those times. I know some of you weren’t here at some times. Our intent tonight was just to do a brief overview and we’ve brought some written material along too, which I will pass around, both the front and back. I think you probably want to sit at the mic and go through the information that we brought. We’d be happy to respond to questions too. We’re not quite sure how much detail you want or as Elaine had said, the Planning Council at both time made recommendations that a contract be drawn up between UI Health Care for IMPACT and Johnson County. We actually are not quite sure why that hasn’t happened and hope this will provide some venue to figure that out.
Williams: Thank you for having us here. I’d like to keep my comments very brief. You have in front of you a description of what IMPACT provides. If you look to the medical literature for the best, the ideal treatment for people with serious mental illness that PACT type care is supported. The Surgeon General’s Report endorses PACT care and PACT care is now available Statewide in 6 States in the United States and in the majority of States PACT is being implemented. The reason why PACT is so highly thought of is it can provide cost effective care. It can provide better quality of life for people with serious mental illness. It can have people live in the community, which is their choice that has serious mental illness. Our program has been up since 1996. We have over 5 years of proven excellent outcomes. How we differ from traditional treatment is that… Let me just describe it this way, if you’re a physician taking care of someone with a serious mental illness, on the one end of continuum of care, is that they come to you in the clinic and you see them there once every month or several months. If they come to you and it’s clear that they’re not doing very well then you try to add on services to see if you can help them to do better. So you might call the visiting nurse and ask them to come to the home to set up their medications and make sure they get their medications. You might ask a home skills councilor to come into the home and help them with shopping and clean up their apartment and things like that. You might ask Goodwill to help them provide vocational support. For a lot of people this does very well for them. In Johnson County we have plethora of good agencies that can provide these services. However there are people with very serious mental illness for which these services are not adequate. For Johnson County payers right now, if they’re failing those services as evidence by hospitalizations or jail time or having that kind of things. They tend to go to residential care. Well, they do go to residential care. Typically at Chatham Oaks or at the Abbe Center. Where IMPACT fall in is in between those 2 services, so how we differ from traditional care plus those in home services is that we provide a comprehensive multi disciplinary team. We meet every morning. The doctors, the nurses, the social worker, both rehab specialist and occupational therapist and talk about every person in the program. On average we see people in the home, 3.9 times per week. We’re integrated. We provide 24 hours a week, 7 days a week care for these folks. That’s not available at the lower level of care and what we’ve found over are 5 years of operation we can have folks who were in Chatham Oaks for 5-10 years who wanted to have a trial in the community living on their own. The medical team at Chatham Oaks thought that was a reasonable thing to do. They can go into IMPACT. We have followed our outcomes. They have a higher quality of life and their symptoms are less intense. They’re not being hospitalized again. This is cheaper for them to be in IMPACT, then for them the be in Chatham Oaks. So it’s cost effective and the patients are happier, the families are happier. This is just a point on the continuum of care for someone with serious mental illness. As I mentioned before there have been communities across the nation who have implemented PACT care and have realized significant cost savings for these folks. I see it as a win/win situation for the patients and for the County to save money that way. I hope that was not too lengthy. I’d be happy to entertain any questions.
Lehman: What number of individuals do you have?
Rodick: We currently serve 42 people in the program. The program is reimbursed by Medicaid, in fact Medicaid as the result of the financial saving for them as people here in Iowa City have started additional programs throughout the State. We’re reimbursed by Blue Cross/Blue Shield. They’re a for profit company and they were able to recognize such significant health care saving by reduction of paying for inpatient days that they now contract with us for inpatient care. Of the 42 people in the program, there is one person that we are currently serving without reimbursement who would be… That Johnson County would be their payer. That person’s been in the program for 3 1/2 years, so they came in when we were admitting people into the program regardless of pay, when we believed that there would in the foreseeable future be a contract with Johnson County. When there’s been no contract forth coming with Johnson County and because people amass large bills, we have not been admitting Johnson County pay people into the program. My best estimate would be that at any given time the County might have 3 or 4 people in this program, because many people who need this kind of service are Medicaid eligible. The people who are not Medicaid eligible, which does not cover an outpatient psychiatric care in the home, unless the person’s homebound, which means they never leave their home. So those people rely on their Counties in Iowa to pay for community based services.
Lehman: Have these people been here since the program started or are you able to see people… You get them to a level where they aren’t needing this program. Anybody in this program would be considered a success from getting where they probably were before.
Rodick: There are a lot of differing opinions about that. Different communities have adopted PACT differently. What is becoming clear is for at least the majority of people receiving PACT care… The people we provide care to have averaged 39 days in the hospital or greater than 6 months of residential care in the year before they came into the program. What has been found is, if we transition people after 3 or 4 years out of the program, they resort back to that pattern. In other words, these are ongoing illnesses. People can live a productive quality of life with adequate support, but if you try to withdraw the support, a lot of times there are problems that reoccur. That isn’t true all the time. We have discharge criteria that say, if the person wants out of the program and if they and their physician believe that they can have the health care needs met through other provision of care, that is something we would certainly work with them to achieve. But we actually don’t see a lot of discharge from the program. It is kind of an ongoing thing in most cases.
Lehman: I think people have to get to mindset where physical ailment or a broken bone or something heals. People with mental problems, they’re ongoing as you said. That’s the need for this program. Anyone in this program would probably a success from what type of treatment or help they were getting before.
Rodick: There are PACT program all over the country, but because this was the first PACT program in Iowa we did a lot of collection of data even though that had been done in other places. You know I mentioned the hospitalization data that people average 39 days in the hospital for residential care before coming into the program. The people that have been in the program now for 5 years are having no days in the hospital. The 42 on average are having 3 days in the hospital, so hospitalization is markedly reduced, so if you’re Blue Cross Blue Shield and you pay a thousand dollars a day for every day in the hospital, and you can reduce the days in the hospital from 39 to 3. It really reduces health care costs. Beyond the costs we measure a lot of clinical outcomes. People show about a 60% decrease in symptoms and increase in functional ability. Generally for persons with these kinds of disorders, you’ll see less then 15% employed. We have about 40% of people in the program employed. Not full-time, but employed. In fact, the Medicaid for Employed Persons with Disabilities was a new program that came about in the last couple of years. It has actually really reduced the number of people, who we previously thought we would be asking for contracts with Johnson County, because it changes the eligibility for Medicaid for people who are working. So it’s a real incentive for people with disabilities to work, even part time, because it allows them Medicaid eligibility.
Harney: Obviously I wasn’t one of those that was here when you gave the lengthy program on this process. If this is paid by Medicare, by Medicaid I mean, and by Blue Cross, and obviously if they don’t have Blue Cross they would have no coverage. What is the advantage of us endorsing this? Is there a cost to the County?
Rodick: Some people don’t have Medicaid or Blue Cross.
Harney: You said that there’s only one that first that category currently.
Rodick: That’s correct.
Stutsman: But what they’re saying…
Rodick: We haven’t been admitting people in that category.
Stutsman: Because nobody’s paying for them. I’m assuming this is pretty costly. I guess we haven’t talked about that.
Harney: That was going to be my next question. What is the cost per person per County? I know it varies with the individual, but approximately what would that run?
Dobbins: We feel the County is losing money.
Rodick: What we’re reimbursed by Medicaid is $1,106 per month and that is comprehensive, including physician fees. People who have Medicare, they’re Physician fees are billable to Medicare, so if in many cases Medicare might pay a couple hundred dollars of that per month. So we’re looking at a cost somewhere of about $900 per month on average. Although it may vary. We can bill some occupational therapy costs to Medicare too. Again the County being the payer of last resort, anything that could be billed to Medicare would be billed to Medicare.
Thompson: Are other Counties doing this?
Rodick: There are programs in Polk County and in Linn County. Those Counties do both reimburse. They both contract for PACT care.
Thompson: What about the other counties for the 42 people in your program?
Rodick: Right now we don’t have that be the case. We did have a county who wanted to put a person in the program that was living in a residential care facility in their particular county. The person has never moved out of residential care. So we have no people from whom the County would be the payer from another county.
Thompson: If we had a contract would that allow other counties to pay as well as us. Would they sort of piggyback on ours?
Sweet: They could if they wanted to, but they would not be required to. Once legal settlement is determined in another county, then it falls under that other county’s Services Management Plan.
Harney: So we would not pick up another county’s patient unless they determined that they would be residents of Johnson County.
Sweet: We wouldn’t be doing it long term. Our Services Management Plan says that we fund services while legal settlement is being determined. During the time when we would be deciding which county would be legally responsible, it would be possible that Johnson County would have to pay. Generally counties are good about picking up the cost retroactively, but it’s not mandated.
Thompson: Is the fact that we don’t have a contract keeping other counties from using this or can they do it?
Sweet: I have not heard that that is the case.
Stutsman: Do you run the program in Polk County and Linn County or is that…
Rodick: No. The Polk County program is operated by an agency called Golden Circle and the program in Linn County is operated by the Abbe Center for Community Mental Health.
Stutsman: I remember when we were talking about doing this before, we talked about a contract for maybe 3 or 4 Johnson County residents. Elaine you weren’t here yet when we were doing that were you?
Sweet: Actually the last one I was. I pulled the minutes from Planning Council. That was January 11th of 2000. The recommendation was that we contract for 6 clients at $600 per month. But again that was two years ago.
Lehman: The type of impact it sounds like would be pretty minimal to your budget. You’re talking one individual now. It’s been up to 3 or 4. Is that right?
Sweet: Did we identify 7 at one point in time I believe?
Rodick: I think we identified 4 or 5 at one point in time. Those have all become eligible for Medicaid under the MEPD program.
Stutsman: So the County wouldn’t be paying for them.
Rodick: So you wouldn’t be paying for them. That new program makes many more people eligible for Medicaid if they’re employed. One of our goals, we use employment as part of treatment. That really being involved in a meaningful activity, certainly aids in recovery. We have a very high employment rate and to get many people eligible for Medicaid through that program that allow for greater assets and greater income and still meeting Medicaid eligibility guidelines. So right now there would be only one. We have… But again, Elaine’s right, we’re always turning people away. There’s a woman in our inpatient unit right now who was referred to us whose payer is Johnson County. We weren’t able to take her, so she’s going to Chatham Oaks. But the County is going to pay more to have her at Chatham Oaks then they would pay to have her in IMPACT.
Thompson: Won’t Title 19 pay that?
Sweet: If they’re Title 19 eligible, Title 19 pays. The contract with the County would be for those persons who aren’t eligible for Title 19. The County would be paying for IMPACT for them.
Stutsman: What kind of impact will this have on your budget Elaine?
Sweet: It depends on their rate and the number of clients that would be appropriate for that service. Then I was going to say too, right now I don’t have a way to identify what we’re paying for services for those clients in other services.
Thompson: So this would mean that we wouldn’t pay for any other services. The $1,106 would cover all the services. If they go to Goodwill, if they get guided employment or what ever that’s called. Are all of those services paid by the hospital?
Rodick: There are 2 services that are not part of PACT programming. One of them is representative payee. We do use the representative payee for a number of people in the program. Currently for people that are in IMPACT, Johnson County doesn’t pay for their representative payee; the individuals are paying for it themselves. The other service, we provide lots of vocational services. The one vocational service we can’t provide is sheltered employment. That is working at a Goodwill store. If the person needs a job coach, we would never expect the County to pay Goodwill to job coach a person. This has come up. Right now there’s gentleman at Chatham Oaks who would like to be discharged and followed by IMPACT. He would be paid for by Medicaid, so the County would save what they're currently paying for this gentleman to live in Chatham Oaks. His cost under IMPACT is going to be reimbursed by Medicaid. The hold up is that this gentleman’s job is at a Goodwill store in Coralville and if he comes to IMPACT, he would loose that job. I’ve been reluctant to advise him to do that, so he stays at Chatham Oaks so he can keep his job. Now I’ve also spent a lot of time talking with him and told him if he wants to give up that job, we will work with him to find a community based job, but we can’t keep him working at Goodwill.
Thompson: If people stay in the program long term, does it keep growing?
Rodick: It does keep growing. Probably last time we came to see you, our census was in the 30’s. We keep a staff to client ratio of 1 to 8. So every time we admit 8 clients we hire another staff person. The ideal PACT team size is about 8 to 10 staff and about 80 clients. Because we cover a lot of hours of the day with staff. Having a few more staff helps us. We work Saturdays and Sundays too. We see people in their homes on Saturdays and Sundays. When you’re small it’s kind of a stretch to cover those hours. As we get bigger it actually makes the program easier to operate.
Harney: I don’t understand why… You want to get them active in the community, why would they loose, if they keep the job in Coralville.
Rodick: Because the County funds the job in Coralville and if they left Chatham Oaks and were followed by us and Medicaid paid for us. The County wouldn’t pay for their job in Coralville at the Goodwill store.
Lehman: The catch 22.
Thompson: This is supposed to be a comprehensive service.
Sweet: Might I offer some observations? I think this is a perfect example of how complicated Senate File 69 has made some things that we do. I think PACT programs are very good choices for clients and I think PACT provides an excellent service for clients. The problems come in reimbursement and administration and more or less the bureaucracy of what we do. The PACT program is intended to be an all-inclusive program. A one package deal. As was mentioned, there are some things that kind of fall outside that, that creates problems. The representative payee and the sheltered employment being a couple of them. Supposedly for the $1,106 a month, the PACT program provides everything that the client needs. In reality that doesn’t happen. If the client doesn’t have money to pay their rent, their utilities, their groceries, then Johnson County is asked to pay for that. If the client doesn’t have money to pay for their prescription medications then Johnson County is asked to pay for that. In most cases the clients that are currently in the IMPACT program are Medicaid eligible, so Medicaid pays this $1,106 a month. Then Johnson County is asked to pick up the difference. Our Services Management Plan and Senate File 69 were designed so that the County actually acts as a managed care company. We’re responsible for the monies that are paid out of the Mental Health/Developmental Disability fund. In order to do that, the whole system revolves around the issue of service coordination and case management. Our entire plan is written as are the plan in the other counties saying there’s a process that’s followed, so that the needs are identified. The case is managed by County staff; the County staff requests the funding. What happens with the IMPACT program though also, is that Merit will not reimburse the County for case management. They consider that part of this comprehensive umbrella and they reimburse the PACT program for case management. So the ability for us to control those dollars for prescription medication, for rent, for the utilities, all of these other things we’re asked to pay for is removed from us. We’re asked to do it, but we’re not allowed to receive the revenue for doing it. So that’s probably one of the bigger problems that we deal with, is that piece of it.
Thompson: Elaine, what service would this be on our service matrix? What’s this called?
Sweet: It would probably come under psyche rehab. Let me look really quick.
Thompson: But it is a service that we’ve identified in our plan?
Sweet: Yes, yes it is.
Rodick: I asked that question and that was the answer. That it would come under psyche rehab.
Sweet: I remember looking it up for you, but I don’t remember what it was.
Stutsman: So if we don’t get reimbursed for case management, then we wouldn’t have any case management responsibilities right?
Sweet: Merit considers the case management component included in the PACT program. I don’t think that’s something that we could work around if the University were willing to work with us on that. But right now it does create a problem. It removes the administration of County funds for those things that I mentioned from the County.
Stutsman: You work closely with your case managers working with clients. You know, when we talk about reimbursement for prescription drugs and rent and utilities and things.
Sweet: Our plan says that we don’t reimburse those unless it fits into the process of workings with the interdisciplinary team, developing the individualized Services Management Plan. Going through the County’s process of funding and approvals within Senate File 69. Our ability to work with that the way it is right now is just not there. That service coordination piece is completely removed from us. Yet County monies are supposed to be funding these things. The individual that was just mentioned, that’s in the sheltered workshop, that would loose that. It would be because he went to the IMPACT program; he would no longer fall under our Services Management Plan. Therefore the County would not fund the sheltered workshop.
Rodick: Elaine, does everyone who falls into the County Services Management Plan, for every one of those people do you get reimbursed by Merit for targeted case management.
Sweet: No.
Rodick: I thought some people could have some limited service coordination by the County and the County was not reimbursed for case management for those people.
Sweet: Some people are not reimbursed and they fall under the social work rather then the targeted case management component. But in effect by IMPACT doing the case management for Merit persons, we would be loosing a net of about $140 a month in revenues.
Thompson: How do you handle it with the Mental Health Center when their clients need medication or something, do you assign a case manager to them?
Sweet: Yes. We do not fund persons under the Mental Health/Developmental Disabilities Fund unless their services are some how coordinated through our department. For Johnson County funds to be spent, a Johnson County worker works with them. In the case of the Mental Health Center, they are a designated access point within our plan, but they don’t… It’s very minimal the services that are funded through them. They’re not the persistent and severe mentally ill, it’s the persons with MI diagnosis only.
Thompson: Well, Elaine, what do you want from us tonight? Do you have a contract ready to put on for our agenda next week? Do you want direction from us on whether to proceed with this or not?
Sweet: I’m looking for direction as to whether or not to proceed with the contract. The University has taken our standard contract and requested a number of changes. Those changes have been with the County Attorney reviewing for recommendation to the Board of Supervisors.
Harney: Elaine, where are these clients currently getting services or are they not getting the services that are going through this program?
Sweet: They would be getting services probably targeted case management or services coordination through Mental Health/Developmental Disabilities Services Department. We would be purchasing other services that they need from other providers in the community. The IMPACT program is the only program in the community that provides that umbrella service. If a consumer were in the IMPACT program, IMPACT would be providing everything that they needed within that program. Someone that was not in the IMPACT program would have a case manager in my department. The case manager would be working with that person to purchase supported community living from one of the providers in the community that offers that service. Supported employment from possibly another provider in the community that offers that service. Possibly respite from still another provider. I believe there are some providers that are in attendance this evening also, that worked in a small group a couple of years ago looking at the IMPACT proposal. I’m not sure if they would like to offer comments.
Harney: So in essence they’re moving from one program to another program that we may possibly support, so really the costs aren’t that great for us then. Is that correct?
Sweet: There are costs involved, but I think the costs are secondary to our being able to comply with Senate File 69 and with our Services Management Plan and in the way Johnson County actually reimburses programs within the context of Senate File 69. To me the targeted case management component is probably one of the larger questions that are out there, as well as the funding for services that are not coordinated through our department.
Stutsman: I guess that’s kind of unsettling to me too. If we have no say in coordination of services and yet we’re going to be expected to pay the bill.
Rodick: The way the contract was proposed you would have all say. Before a person was enrolled in the IMPACT program… Right now, if a person wants to enroll in the IMPACT program and their payer is Medicaid, I contact Medicaid, I review clinical information. Medicaid determines medical necessity in terms of whether they’re going to authorize this service for this person. I do the same thing for Blue Cross. The way the contract is written I would do that with Elaine or her designee. You had spoken about that being Bruce when we talked about that in Planning Council. So, I would contact Johnson County, CPC or designee and say this is the clinical situation, this is what we could offer. We certainly would work with Elaine’s office and they would certainly be able to say no, we don’t believe we want IMPACT in this case. We want to stay with Hillcrest, Goodwill, VNA, this therapist and our own case manager. Or they might say you know we’ve been doing all of this for a couple of years and the client is really struggling, let’s do IMPACT. The way the contract was written, I would review the client’s progress and continued stay with Elaine’s office every 3 months. So, I don’t see that you folks would loose control. If you want to authorize continued stay in IMPACT every month, I would do that.
Thompson: I guess we were thinking about the control over the ancillary services. The plan is written so Elaine as the CPC approves all these services, but she does it with the advice of social workers that we employ. In your case, she’d be having to rely on your word that the people have the same need for the service that she trains her staff to identify. I can see a little problem with consistency there.
Sweet: I think consistency, even conflict of interest and the competitive advantage, I think those are all things that we need to look at. But again I think there’s a way to work through them. I’m not sure that we couldn’t possibly talk about subcontracting the targeted case management function or something along that line. As I said I’m here for the direction of the Board of Supervisors. Whether or not to pursue some of these options.
Stutsman: But when we talk about it before, I was supportive of entering into some kind of contract on a limited basis. To monitor it and see how it’s going and if it’s working as we anticipated, if it’s providing the kinds of services and having the kinds of results that we would hope. I’m not comfortable with just writing a contract saying anybody that is referred gets the service, at least at the onset, just to see where we at with it and things. So I guess I don’t have a problem with proceeding to the next step and just seeing…
Thompson: Will the same amount of money that would have supported 6 clients 2 years ago, will not support a little more then 3. Would we want to reduce the number to 3?
Stutsman: I’m OK with 3.
Sweet: I would like to move forward, to start and to monitor the program. I’m convinced that the PACT program is good for a segment of the population that we serve. I would like to try to find a way to work through these difficulties.
Stutsman: I guess I’m a firm believer in an array of services. One program doesn’t fit all. If this meets the needs of a particular client then we should have a contract and have that available for them.
Sweet: I’m equally concerned thought with not having control of the County dollars.
Stutsman: It’s complicated. It’s just a lot of issues, but it’s a starting point to start working through those issues.
Thompson: You’re saying you can see ways that this can be worked out?
Sweet: I see some options that we can talk about.
Lehman: Would this be an ongoing contract or would it terminate and have to renew it every fiscal year?
Sweet: Our contracts are for supposedly a year at a time, but what we’ve done lately is just kind of extend them past that year. We’re participating in the County rate information system, so that will be an annual process and this will fall under that process in the future.
Lehman: Like any program, you’d hate to get a client into a program and then have to discontinue it for financial reasons or some logistics or administrative.
Stutsman: Are there providers that would like to speak to the issue.
Life Skills Director Gillian Fox: My name is Gillian Fox and I’m the director of Life Skills. I participated in the committee that Elaine had talked about a couple of years ago. One of the issues that was problematic for consumers transitioning into IMPACT was the way in which the program announces that a consumer has to make a choice between the community services or IMPACT. A couple of years ago when it was implemented that the County couldn’t fund both IMPACT and another supported community living program we had several problems with consumers being forced to choose between IMPACT and another supported community living provider. At the time we worked with our CPC to get a hold of the managed care company who assured our consumers and assured us as providers and the County as well that an interdisciplinary team would be formed to determine what level of service was appropriate for the consumer and to advocate for that person so that appropriate services could be provided. That has not happened. We’ve not participated in any interdisciplinary teamwork since that period 2 years ago. Additionally just as recently as a month ago we had a consumer who was informed by an IMPACT staff person they needed to choose. Once again this is someone receiving payee services through our supported community living program as well as IMPACT services. I believe it was a contract with staff transition at the department came to light. The consumer was informed by IMPACT they needed to choose and that individual experienced great emotional difficulty. Their mental health symptoms deteriorated. It was a big problem. Again I’m restating what I stated initially when we met with our CPC and I believe that Bruce was there as well. This team work approach to make sure the consumer needs are met, I have not seen evidence of. That would be my input as a provider. Everyone works very hard, the providers and the MH/DD staff to be cooperative in the delivery of services to make sure needs are met. Again I voice that concern that I don’t see that kind of community cooperation that our provider network is known for in this county.
Stutsman: Let me get it straight. What your observations are is that once they enter into the IMPACT then there's no cooperation with the community.
Fox: Or if there has to be decisions made regarding the service that’s most appropriate for that consumer IMPACT is there first and the consumer is told you have to decide now. That escalates the mental health symptoms and puts the consumer at risk for further deterioration or hospitalization. It’s the approach. This is feedback from my staff and the consumers themselves calling me in a state of panic telling me I met with IMPACT today. They told me I had to choose. Our only recourse is to get a hold of MH/DD and work with the service coordinator there to try to deescalate the symptoms to figure out what’s best. When in reality what we were told by the managed health care company was an interdisciplinary team was to meet that would include MH/DD, it would include any or all providers that that person had prior to entering IMPACT, and IMPACT staff as well. Again I’ve not participated in a single meeting of that nature since that’s the information we received. Elaine I could be wrong and misperceiving that you were in the room when we were informed via telephone conversation with the managed care company that that was the specific process that had to take place before services would be discontinued or changed for a consumer.
Thompson: So you’re talking about consumers who enter the IMPACT program from community services.
Fox: right or consumers who’ve had both services. As the staff change at MH/DD happened more of the files are looked through and brought up to date and its realized that there’s more than one SCL provider. Or more than one county funded provider.
Stutsman: Well how would that be worked through.
Thompson: The clients are told they have to choose.
Stutsman: No but if this is a problem, the interdisciplinary team.
Sweet: In effect, clients do have to choose. They have to choose between the IMPACT umbrella program and an array of community based services that are available and that relates to some of my earlier comments about how it impacts other providers in the community and consistency and the competitive edge. Bruce is here this evening. I don’t know if he’s like to comment on the case management component of it.
Clinical Supervisor Bruce Juetten: Just to reflect a number of case workers have approached me over the 2 years that I have been at MH/DD and have expressed a number of concerns about persons on their case load. In fact one just very recently expressing concerns about the level of vocational support persons received. The common response among caseworkers is if you need significant vocational support you cannot depend on the IMPACT program to provide it. If you need very limited, someone to come in and check on you that’s not a problem. But if there’s specific training that’s needed IMPACT can’t do it. That’s the common response from caseworkers. Certain cases have cropped up where individuals in departments need specific skill training. The reports we get from those consumers are that the IMPACT worker will come in, tell them what is needed and then leave. The consumers will further report, I caught the first half of the sentence and the rest of it escaped me. I can’t simply be told I need to be supported in these tasks. That all along has been the type of comment that I’ve received. I too am supportive of IMPACT and I think it is a good idea. I’m familiar with PACT program over the course of quite a number of years from Wisconsin, know people personally who work in the program. I’ve worked with a number of the doctors that have been involved in that program. I think its great. I wonder though is not IMPACT in Iowa somewhat more significantly different than some of these other successful programs that you’ve noted around the country?
Thompson: It sounds like if we want to make it work we have to reinvent it to match Senate File 69.
Juetten: I hope that we could find a way to work with IMPACT. As Jerry Clancy said it is a great program for a narrow segment of the population. It works great for some people. It’s not an answer for all persons that we serve by any means.
Williams: I certainly would. I think that IMPACT is definitely for a very narrow segment of the population. I think for most people that have schizophrenia they can do well with the services that are provided. What we’re looking at is a very small percent of people who have schizophrenia who need more intensive services. I actually did my training in Madison Wisconsin with (inaudible) and have been up there several times to work with them. We’ve had Debbie Alnas, who started IMPACT up there has come to our program and I’ve done training with her as well. I’m very confident that our program meets national standards. Just in terms of the vocational piece I see patients every month and I ask them if there’s anything IMPACT can do or can’t do better and I feel like I have a pretty good sense of that. In addition we have a satisfaction survey that we do. I guess your comments aren’t reflected in the majority of people who have filled out the satisfaction survey. Although I’m sure that there are a couple of people in the program that wish we would do things different than we do.
Juetten: I’m sure there are.
Williams: I think that that’s probably fair. I would also like to say that I want folks to get care where they have the best quality of life and where they do best. I tell the patients all of the time that if they want out of the program it’s a voluntary program. People are not committed to IMPACT and so all they have to do is tell me that they don’t want IMPACT. We will contact whoever it is who needs to be contacted based on the payer and follow their care until they have transitioned services. I guess my response would be for those people that are coming to the DHS caseworkers...
Juetten: MH/DD case workers.
Williams: I’m sorry. I don’t get all of that straight. What I would like to see happen is that they contact me and we sit down with the case workers, me and the person in the program. I have not received one call from a caseworker with any of these concerns. Not a single one. If I would receive a call I don’t want my patients to be unhappy or not do well. I’d really like to sit down and talk with them. That would be my solution back.
Thompson: It does seem like if we write a contract it should spell out that anybody having to make choices should be supported by the team from the hospital and also their former provider so that they could make that decision without a lot of trauma.
Sweet: I think everything we do needs to be a collaborative effort. In some cases we’ve not seen that and at times there’s an element of fear on the part of the consumer as well. A lot of our clients are not comfortable in making changes and there are fears associated with every choice that they make because many times they don’t know what those choices will be.
Thompson: I see some people here who probably want to make comments. We have a comment period at the end of our formal meeting, which shouldn’t be too much longer. We can’t ask you to comment now because earlier we told others that they had to wait until the end. Is there further discussion about this from the Board?
Stutsman: Elaine your recommendation is to go ahead and try to work out some of these issues. I guess is there support from the Board to invest the time to work out some of these issues. Because it sound like its going to take time from the County Attorney’s Office as well as Elaine and staff.
Assistant County Attorney Andy Chappell: From the County Attorney’s office standpoint, based on the contract I’ve seen and I don’t think we have, the appendices from the contract which lay out some of the things that have been specifically discussed but other than not having seen that which is not uncommon in these things, those are usually matters of policy which are far less legalese then what we are normally asked to deal with. But with what we have been asked to deal with I don’t see anything in there which would be problematic or couldn’t’ be worked out in rather short order at this point. Just as far as the provider contract based on the format that MH/DD uses versus the questions concerns and recommendations from the Hospitals Council. I wouldn’t see that from our office, there’s nothing we’re uncomfortable with at this point that we couldn’t work out.
Thompson: Straw poll.
Neuzil: I would like to see more study done on this.
Lehman: I would like to see Elaine continue on working on this.
Harney: I hate at this time the way the budgeting is to start new programs and add more costs. But I’m one that really supports the use of these services for the mentally ill and the needs that’s out there because I know there's a lot of time spent by public officials in the community that really spend hours dealing with individuals like this that need some monitoring and need some help. I guess I would support doing some more work on this and try it out at least.
Thompson: You’ve already said that you would be interested.
Stutsman: Yes.
Thompson: So would I. It looks like you have instruction to go ahead.
Sweet: Thank you.
Thompson: The next item on our agenda is business from the County Attorney.
Chappell: We don’t have any business for the informal.
Thompson: Under business from the Board of Supervisors we note that we’ve received Minutes from the Johnson County Board of Social Welfare/Cluster Board for December 10, 2001, the SEATS Para-transit Advisory Committee for December 11, 2001, and the Johnson County Nutrition Board for December 17, 2001. Reports and inquiries from the Board. Sally would you like to start?
Stutsman: It’s been a very busy week to say the least. Last Thursday I attended an Empowerment Board meeting and unfortunately I’m not as well prepared to give a report on that. So I think I’ll give it next week. Pat is an inspiration as to how well prepared he is on reporting on these meetings. I thought there are questions that come up from time to time about Empowerment so I think its more important that I give you a more complete report rather than just saying I attended the Empowerment Board meeting. So be prepared next week for a full report on the Empowerment Board and what we’ve been doing there. Terrence and I attended a Communications Meeting on Friday. We did some discussion about some changes in the external newsletter and maybe some format changes in the internal newsletter that we’re going to review for our next meeting. We talked about the display cases downstairs in the entryway. It was suggested by the Communications Committee to look into doing some wood display cases down there to dress it up. Harry from the Conservation Department offered some native oak from his department. He and Mark are working out some display cases and will come back with some costs to see if this is something that we can pursue. We also talked about a reception for members of county boards and commissions. We’re going to tie this in with National County Government Week, which is in April. We’ve not done anything to say a thank you to all our volunteers that serve on the 46 Boards and Commissions that we appoint. This will be an opportunity to have some kind of public reception where they can come and we can hopefully have some food and tell them thank you. We’re going to continue working on that. We also spent some time talking about an annual report and what we want to accomplish with that and what we want to include, some of the costs involved with that. The idea would be to have a County annual report available for July when we have the County fair booth at the Johnson County Fair. That was about everything included in that. I don’t know if you have anything more to add. That’s it for tonight.
Thompson: Terrence.
Neuzil: Another extremely busy week and I think this has got to be a record as far as controversial issues go for our Board. I think that through my experience this past year this week has really been pretty amazing. I’m not going to get into all of the meetings that we’ve been to but a few of the meetings I’ve been to. I joined Carol Thompson along with our Budget Coordinator Jeff Horne and one of our Planning and Zoning guys Dan Swartzendruber. We’re putting together right now a study of our economic development plan or policy that the County hopefully at some point is going to have. We’re in the preliminary stages of that and we’ll be giving a more detailed update in our Strategic Planning update, which actually is next week. Also attended a Jaycees banquet. I want to congratulate Bubba Piper. He’s the new president of the Iowa City/Coralville Jaycees. I was elected as the Jaycees Chamber of Commerce Representative. I look forward to working with them as well. Again a very busy week with all kinds of issues, all of our different meetings with the seniors, meeting with department heads, meeting with elected officials. It’s been an incredible week. I think we continue to make progress in regards to our budget which is going to be a very tough one for our County this year as we start to see the kind of revenues and the kind of situation there. Hawkeye Friday Listening Post, I held one last Friday. It was held here at the Johnson County Board of Supervisors. We had people come in asking questions about the County farm, we had questions about the senior issues, we had questions about TIF, we had questions about roads. It was a good discussion. All of us are going to be trying to hit a wonderful lunch that takes place tomorrow over at the Senior Center to say a farewell to our Senior Dining Department. That’s our week. Thank you.
Lehman: To start off Monday night Pat and I attended a Lone Tree City Council meeting along with Lisa Dewey and we discussed the Nutrition Contract. I think it was learning for both of us. We had a lot of questions as it pertained to Lone Tree. Lone Tree had a lot of questions for us. Hopefully the discussion we had here tonight they’ll be able to do something on a volunteer basis there. On Monday afternoon Pat and I attended a program put on by AARP at the Senior Center, a speaker from Elderly Services talked about dependant elderly abuse versus child abuse. It was a call of awareness to actually reported cases to the contrast of maybe you don’t really realize an adult that’s under some type of dependent care the reports that they get. They gave a county break down. There were a lot of questions as to why some of these rural counties have higher report instance. They talked about enforcement and reports and all of that. It was a very good topic. Pat and I also had a chance to discuss TIFs. There were a few people interested in talking about that. We had a few minutes of discussion. Tuesday night I was able to attend a Grant Wood School Iowa City Planning Department. They have been discussing a road project and a rezoning in the southern part of Iowa City. Also it’s an annexation of some property and rezoning. It was interesting, 5 or 6 years ago the Planning Department at Iowa City had sponsored neighborhood meetings where they got together and met at about 3 different meetings and they pooled and tried to come up with an idea of where the neighborhoods would like to see an additional school, retail centers, as well as residential. They brought that back several times. It was an interesting planning device and this meeting came about as the fact that a company wanted to rezone some property and there was going to be a public hearing coming up with that. Iowa City Planning Department wanted to go out and here what those neighborhoods had to say about this. This is something that started 5 or 6 years ago and its kind of interesting to follow through what we tried to do with our 5 Year Road Plan. Somebody can always refine it but I think we’re on the right track. But it was interesting to see another entity, how they operate. Part of their reasoning of why they’ve got to this point. What criteria they’re going to base some of their final decisions on. Last night had a chance to attend the Democratic Central Committee. We got to hear from our legislators Ro Foege, Mary Mascher, and Joe Bolkcom about some of the legislative tasks they’re going to be facing. They had a good explanation and question and answer.
Neuzil: Did Harkin show up?
Lehman: Yes.
Neuzil: He finally did?
Lehman: A little after 9:00. He spoke for almost half an hour. He highlighted several pieces of legislation and gave an insight of how compromise, you have to go along party lines or issues. It was just a nice little discussion of the things he has to work with to get legislation through. He discussed a little bit of the ag bill as he’s the chair of the Senate Ag Committee. I got to ask him a few questions about commodity loan rates with just 25 words or less, it’s the loan rate that farmers when they put corn or soybeans under loan at harvest time rather than having to liquidate that crop at a low price. The price that you get for that loan setting has been so low and with technology that crop production has been so high that it was intended to be a floor for your commodity but its actually become the ceiling. You actually sell your crop for less than what your loan is and you can either forfeit the loan or the USDA actually makes up the difference. It’s costing taxpayers because the USDA’s budget is providing that. He indicated that the bill that he has provided and proposed would actually raise that. It would help income the farmers, it would actually lower the budget for the USDA would have to make up the difference for what commodities sell for and what they’re paying out as a loan. He acted like there would actually be some bright prospect there of getting something done. He said no one else has proposed anything else so when they talk about compromise when the other party or side doesn’t offer anything its pretty hard to compromise. He got to speak for a half hour then he had to leave but it was real interesting discussion and he answered some very pertinent questions. I believe that’s all I have. I participated in a lot of the other things and on going budget and other things throughout the week.
Harney: Like the rest of you I had a typical week this week. Many things going on. Last Thursday and Friday the Board conducted some first interviews for the position of the Ambulance Director. That was very interesting. We’ve got second ones coming up. On Friday Sally and I met with Mike Sullivan, the Executive Assistant. Went over his duties and how the progress is going. He’s doing very well; I’d like to say he’s really taking on the task and fulfilling that well. Friday I went with Planning and Zoning and did the site reviews, which we approved tonight. The farmstead split and the subdivisions. As Mike said we attended the meeting at the Lone Tree Council with Lisa Dewey of SEATS and talked about the meals and the SEATS program down there. Monday the Board met with City Staff, Iowa City and the Senior Center staff and discussed the 28E Agreement and the County’s supporting services to the program at the Senior Center. As Mike said Monday we went to the AARP program and there were many questions in addition to the TIF. They had a lot of interest in the 28E Agreement and our support for the Senior Center. It was good to be able to be there and answer a lot of their questions. I think they got most of their questions answered. Tuesday Sally and I attended the Chamber Ag meeting. They’re going to be resuming their winter 3 month ag breakfast series that will be beginning at 7 a.m. on Friday January 25. That one Dr. John Lawrence of Iowa State University Economist will be talking and he’ll be going over preparing people for the challenges of 2002 and the following years thereafter. On Friday January 22, Dr. Jerry Bolton, Dean of the Agricultural Department at Kirkwood will be speaking about the ag community and the things that they have to offer at Kirkwood. On March 22, Zacharakis-Jutz family of Solon will be talking about the Community Supported Agriculture, the diversity of their farm up there. The upcoming annual business Expo at Carver Hawkeye Arena is going to be Friday January 18 and from noon until 7 p.m. and Saturday January 19 from 10 to 4 p.m. It will be a good program, worthwhile going over and seeing all of the displays. Tuesday Mike and I met with Lisa Dewey, SEATS Director and reviewed policies and procedures that you saw, some of which you talked about tonight. Tuesday the Board had a Department Head meeting and received updates from all of the department heads and elected officials. Things are going real well and they’re managing their departments well. Tuesday the Board met with Secondary Roads on the 5 Year Road Plan. There was much valued public input from those programs. Many people attended and the 5 Year Program was laid out and we’ll be making some adjustments in that as well. Wednesday the Board had their work session on the clustered subdivisions and sensitive areas ordinances. There was much information at it and a lot of work needs to be done on that as well. Also on Wednesday the Board attended a joint meeting with the Iowa City School District, and Coralville and North Liberty a discussion on the TIF and update on the schools and their needs and plans for the future. They have a lot of plans and a lot of needs as well. There’ll be more coming out on that from them. Wednesday Mike and I met with Secondary Roads personnel, went out on North Dubuque Street and discussed some issues with the property owners out there and some problems with the Roads that will be corrected shortly. Thursday we had a budget work session with the Board and here we are.
Thompson: Thanks Pat.
REPORT (THOMPSON): ATTENDED MEETING WITH HUMAN RESOURCES ADMINISTRATOR LORA SHRAMEK
Thompson: On Tuesday, Sally and I met with Lora Shramek for her regular mentoring meeting. Upcoming in addition to the Senior Dining tomorrow, next Tuesday at 4:30 is the MH/DD Planning Council here in the Board office and on Wednesday at 10:00 a.m. the Youth Development Policy Council will be meeting here in this office. Is there any other business from the Board? We have an executive session coming up but I’m going to skip over that and move on to inquiries and reports from the public.
NATIONAL ALLIANCE FOR MENTALLY ILL CO-PRESIDENT CAROL SPAZIANI: SUPPORT OF IMPACT PROGRAM
Johnson County National Alliance for the Mentally Ill Co-President Carol Spaziani: My name is Carol Spaziani and this year I’m the current co-president of the National Alliance for the Mentally Ill of Johnson County otherwise known as NAMIJC. We have between 90 and 100 paid members and over 400 people on our mailing list who are not all members but come often into our support group meetings. We’re mostly families and friends of people with a long term mental illness. Many of us are retired and have been through this for along time so we’re experienced. I would just like to say our interest in the PACT model predates the existence of the program at University Hospitals. About 15 years ago when Madison Wisconsin was just starting this model for the country Don, Fran, Fred and I drove up to waterloo to hear Deb Alnas make a presentation. Deb is the person who was mentioned earlier who started this experimental idea, this revolutionary idea that people who are leaving hospitals in droves because of the deinstitutionalization needed a little more web of support than they were finding in the community and that perhaps a differentiated team approach would be the approach that would be best. We all sort of listened to her speech and looked at each other and said that’s what we need. Unfortunately that’s not the model in existence in the whole state of Iowa. We have a rather traditional model, which is not bad, its good, we have a lot of good agencies doing a lot of good things with our family members. But as a result of that and also the success that was demonstrated in Madison the entire state of Wisconsin adopted his model of delivery of mental health services then it spread to Michigan and then Texas. You probably know better than I what the other states are. Its been so demonstrated to be so cost effective as they were saying for cutting down the institutionalization costs that are sky high and also better for the clients. Its sort of become the model of choice. As a result the National Alliance for the Mentally Ill in Washington which represents 3 or 4,000 people across the country supports this model and has a brochure which describes their support which I could provide to you if you would like it. I believe they worked very closely with the Surgeon General in promoting this idea that it be the model of choice for treatment in the community. So its not like it’s a new idea. Its just that in Iowa our system isn’t’ set up that way. I think Claudine is here who has served on many state level committees with the Department of Mental Health Services. She was the one who worked very hard to get Merit, the managed care Title 19 entity in Iowa to be able to reimburse for this kind of community rehabilitative service. So in this very timid way that Iowa often has they established 3 model programs. One was at the university hospital, largely because of Dr. Clancy and Betsy Rodick who were the pioneers in drafting that proposal and getting it approved for funding from merit. Then they also started the one in Polk County and I can’t remember Linn County now through the Abbe Center has one. But they’re these 3 tentative models, sort of isolated models and the entire system has not been converted to this model. So that’s what we’re running into in Johnson County. Our traditional system isn’t quite set up on the same model. But since we have this model program in Johnson County it would be a shame in my opinion and I think in most members of the National Alliance not to be able to subcontract with a model that has been proven successful all over the country just because of the hang-ups of bureaucracy. It just doesn’t seem right. We ought to be able to look at this as a subcontract from the department of mental health services so that they are subcontracting things like case management. Rather than losing control that is a subcontract and the contract would outline the condition of control which is what Betsy explained and I believe the County Attorney suggested there would be no problem. So I would just hate to see this not be done because of bureaucratic hang-up when it is the model of choice across the country that family members are working to get into effect. So I just wanted to thank you for encouraging Elaine to work on the contract and thank Elaine for being willing to work on the contract and thank the County Attorney for being willing to work on the contract so that we can hopefully at some point convert our system in Iowa to this really positive model.
Thompson: Thank you.
JIM MCCUE: SUPPORT OF IMPACT PROGRAM
Jim McCue: My name is Jim McCue and I’ve lived in Johnson County for 36 years now. I feel torn in 2 directions. On the one hand I see some people around who’ve been dealing with severe mental illness for 30 or 35 years. I’ve only had to deal with it for 6. I think it has been obvious for years that unfortunately in Human Services, where everyone is a good guy there's always a lot of competition too. I speak as a parent of an adult woman with paranoid schizophrenia who had 2 children before being overwhelmed by schizophrenia. We have interacted with many service providers within Johnson County and I must confess for the particular needs of my daughter there simply is no comparison. A year and half ago the court committed her first to Psyche Hospital and then when she was finished with that, if IMPACT hadn’t been prepared to take responsibility she would’ve been institutionalized and I’m not sure she ever would’ve come out. Her previous days at Chatham Oaks, generally she ended up more depressed than when she went in. I’m a Booster of Chatham Oaks. One of my kids worked there for a number of years. I think it’s a fine place but it wasn’t a fine place for her. I don’t think she’d ever have rebounded. IMPACT has been able and willing to monitor her compliance with medication. Her general condition closely enough that she is now able to spend time with her children. She was not for a time. There were fears about their safety. She is able to live what any of us would consider a normal life but what compared to the alternatives is great. I can’t talk about cost effectiveness. My impression is that something can be cost effective but perhaps not cost effective for the County Board of Supervisors. The savings might come out of place. I realize there are real dilemmas here. I would second everything Carol said about the importance of working through this. But I would hope that the Board of Supervisors would recognize that other services in the County are very good for what they do but I think there are some people with severe mental illness who need the kind of intense integrated care that IMPACT provides and that case management with 6 or 8 different agencies which we went through for a time… For the record there was some IMPACT at all of those. There has been a lot of interaction there. For some people I think IMPACT is the only game in town. I must confess I was startled to discover here this evening that there are people being denied service because the Board of Supervisors has not yet found a way to provide funding for that. I don’t pretend to know what the solutions are but from I’ve been hearing it sounds as though with good will and all sides solutions can be funded. I would hope that the Board of Supervisors would push gently but firmly to decide that that gets done.
Thompson: Thank you.
Lowell Luhman: I’m Doctor Lowell Luhman. I think all of you on the Board know me well because I’ve served on the Planning Council for the last 3 and a half years and have been an advocate for the mentally ill so it compels me to talk about this a bit. Both times we went through the Planning Council and approved this from the standpoint of a good program that we thought it was going to be enacted and in progress. I know on at least 2 different occasions we allowed an amount of money in the budget for this. I’m not sure about this past year but it still would come under psychiatric rehabilitation. I think its such a tremendous program and I won’t repeat all of the things. I think we’ve proven it is a good program. I’m sorry its not more widespread in Iowa. I’ve been, as you know concerned about patients recurrently being admitted to the hospital and recycling. I think its been proven pretty well medically in the psychiatric world that these patients go on a spiral down hill and never do improve as much. After each time they’re admitted they may not come back to the same level that they were before. This concerns me that when we have a method that we can keep this from happening as often that we don’t make use of it. I think they’ve shown in the patients that they’re taking care of that they’re able to do this. I think that from the patients’ standpoint that’s got to be the end solution here. How are we best going to take care of these people and I think this is a program for a certain number of people that just has no other method of getting added. I think the tremendously most important part of the program is making sure they take their medications. It is notorious that people with mental illness will soon be off of their medications and the symptoms are recurring and that’s why they’re recycling back to the hospital. So I would really too encourage you all to work hard on a way to work this out. Whether it would be partial social work through the department and maybe the University could fund some of the social work through their contract and pay for part of it. I don’t know what the solution is and hope that we’ll work on it soon and be able to accomplish this. I think we’re well overdue and programs been around here now. I think these last few people who would benefit by it sure ought to be offered the program. Thank you.
CLAUDINE HARRIS: SUPPORT OF IMPACT PROGRAM
Claudine Harris: I’m Claudine Harris. I think a lot has already been said. I’m not going to make a long statement. What I keep thinking is why haven’t we done this earlier. Where is there opposition? I think there's a continuum in the degree of illness in people who have a mental illness and so there is room for all kinds of services. We need housing, as you know we need all sorts of things. We need vocational services. We need IMPACT for those who have the most serious forms of the illness. This should be no threat to any provider for other types of services. There are plenty of mentally ill people for everyone to take care of. I don’t have the percentages in mind, but the percentage of people with a mental illness in the county calculated against our population comes out so that there are probably several thousand and I don’t think all of them are going to go into IMPACT. We’re talking about having 40 now, there may be a few more and only a few of these are going to be funded by the County. When they are, the County saves because you are not having to pay for the more expensive care. What I really just wanted to say is there is room for everyone and there is a great need for IMPACT. I certainly hope you can work out whatever the problems are that stand in the way year after year.
Thompson: Thanks Claudine.
MENTAL HEALTH CENTER DIRECTOR STEVEN TREFZ: SUPPORT OF IMPACT PROGRAM
Mental Health Center Director Steven Trefz: I’m Steven Trefz, Director of the Mental Health Center, one of those other providers that’s been mentioned tonight. I just encourage you in all of the hard work that your about to do to make Senate File 69 work at a local level, to cooperate with Merit and to get all of these competing funding sources. I think we have a variety of parents, a variety of clients, a variety of service providers that are trying to work in the constraints of really competing systems at a different level that it is really beyond our ability to affect. Good luck folks and I think like other folks who’ve said I think the providers in the community all provide different services at a different level of care and I think we can all work together and solve this and support Elaine in the efforts that she’s got to do. Thank you for your efforts.
Thompson: Thank you.
Neuzil: Thanks.
Thompson: Anyone else wish to speak from the public? Thank you all for coming this evening and sharing your thoughts with us.
Harney: I would like to make mention that these services for the mentally ill are a tremendous service. It provides a quality of life for these individuals that they can’t have that in the modern… Over the years in law enforcement I noticed that we spent an awful lot of time trying to get individuals hospitals through the court systems into the jails. If we can alleviate that this is basically what you would call one of the jail alternatives as far as I’m concerned. If we can get this functional and get it to working I think it would benefit the entire county.
Spaziani: Right on.
Thompson: Thank you. The next item on our agenda is collective bargaining strategy for the Sheriff’s Unit and for that we need to go into executive session. Let’s take a short break first.
Recessed at 8:07 p.m.; reconvened at 8:15 p.m.
EXECUTIVE SESSION: COLLECTIVE BARGAINING STRATEGY FOR THE SHERIFF’S UNIT
Motion by Stutsman, second by Neuzil, to enter Executive Session at 8:15 p.m. to discuss collective bargaining strategy for the Sheriff’s Department under section 20.17(3), Code of Iowa: "negotiating sessions, strategy meetings of public employees… shall be exempt from the provisions of chapter 21 (Official Meetings Open to the Public)." Roll call: aye: Neuzil, Stutsman, Thompson, Lehman, Harney.
Motion by Stutsman, second by Neuzil, to leave Executive Session at 8:33 p.m. Roll call: aye: Neuzil, Stutsman, Thompson, Lehman, Harney.
Adjourned at 8:33 p.m.
Attest: Tom Slockett, Auditor
By Casie Parkins, Recording Secretary