fairfax-falls church community services board suzette … · 2017-12-16 · csb board meeting...

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FAIRFAX-FALLS CHURCH COMMUNITY SERVICES BOARD Suzette Kern, Chair

Merrifield Center 8221 Willow Oaks Corporate Drive

Level 1 - Room 308 A/B Fairfax, Virginia 22031

Wednesday, December 20, 2017 5:00 p.m.

(Please note change to room and date)

1. Meeting Called to Order Suzette Kern 5:00 p.m.

2. Recognition Suzette Kern

3. Presentation - Affordable Housing Thomas Fleetwood, Dir. FX Co Dept. of Housing and Community Development

4. Matters of the Public Suzette Kern

5. Amendments to the Meeting Agenda Suzette Kern

6. Approval of CSB November 15, 2017 Board Meeting Minutes

Suzette Kern

7. Matters of the Board

8. Committee Reports

A. Behavioral Health Oversight Committee

B. Fiscal Oversight Committee

C. Developmental Disabilities Committee

D. Other Reports

Gary Ambrose

Captain Basilio ‘Sonny’ Cachuela, Jr

Sheila Jonas/Jane Woods

9. Director’s Report Tisha Deeghan

10. Adjournment

CSB Board Meeting Minutes November 15, 2017 Page 1 of 8

Fairfax-Falls Church Community Services Board

November 15, 2017

The Board met in regular session at the Merrifield Center, 8221 Willow Oaks Corporate Drive,

Fairfax, VA.

The following CSB members were present: Suzette Kern, Chair; Jennifer Adeli, Gary Ambrose,

Thomas Burger, Basilio ‘Sonny’ Cachuela Jr., Ken Garnes, Sheila Coplan Jonas, Bettina

Lawton, Molly Long, Paull Luisada, Edward Rose, Diane Tuininga, and Adrienne Walters

The following CSB members were absent: Daria Akers and Jane Woods

The following CSB staff was present: Tisha Deeghan, Daryl Washington, G. Michael Lane,

Lucy Caldwell, Evan Jones, Victor Mealy, Linda Mount, David Simmons, Cindy Tianti, and Lyn

Tomlinson

1. Meeting Called to Order

Suzette Kern called the meeting to order at 5:00 p.m.

2. Opening remarks

Board members and attendees introduced themselves, including position and relationship to

the CSB.

3. Matters of the Public

None were presented.

4. Amendments to the Meeting Agenda

The agenda was provided for review and accepted as presented.

5. Approval of the Minutes

Bettina Lawton offered a motion for approval of the October 25, 2017 Board meeting

minutes of the Fairfax-Falls Church Community Services Board as presented, which was

seconded and passed.

6. Matters of the Board

• Edward Rose, Chair of the Ad Hoc Board Member Orientation and Continuing

Education Committee announced the first meeting of the committee is scheduled for

Thursday, November 30, 2017 at 12:00 p.m., at the Pennino Building, 12011

Government Center Parkway, Fairfax, Room 836A. It was announced that the topic of

the meeting would address delivering testimony before the General Assembly in

January on the identified topics of implementation of STEP-VA (System

Transformation, Excellence and Performance in Virginia), the Opioid Epidemic, and

Development Disability (DD) Waivers.

• Sheila Jonas offered an update to the November 9th CSB Board Tour of Dominion

Hospital reporting that the tour was powerful and moving, encouraging members to

attend when another opportunity is offered.

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• Molly Long, following up on Ms. Jonas’ remarks on the tour of Dominion Hospital,

reported the tour was well-attended. Distributing some literature and thanking Lucy

Caldwell for arranging the tour, Ms. Long reported that the tour was highly interactive,

and highlighted some current trends being seen in youth treatment including cyber-

bullying and trauma.

• Ms. Long distributed a CSB Board Delegate Assignment List, noting it had been

updated to reflect changes due to some delayed election results in two delegate races.

Sheila Jonas requested that Senator Saslaw’s tour of Merrifield be included in the

information on the assignment list, the addition of which, was confirmed by Ms. Long.

• Suzette Kern displayed a copy of the 2016 CSB Annual Report and inquired about the

status of the 2017 CSB Annual Report, remarking the report would be a welcome

addition, if published in time, to the packets provided for Board member visits with

members of the General Assembly.

• Gary Ambrose reported an invitation to speak on Diversion First at the Metropolitan

Washington Council of Government Regional Behavioral Health Forum on Friday,

November 17th. Mr. Ambrose will distribute copies of the 2016 Annul Diversion First

Report, along with an update for FY 2017 first quarter.

• Bettina Lawton, Chair of the Ad Hoc CSB Board Statutory Responsibilities Committee,

announced an initial meeting of the committee has been scheduled, remarking that the

committee was developed to refine the statutory information provided at the September

2017 CSB Board Retreat. This first meeting will be attended by several CSB staff and

two committee members with a purpose of refining the large amount of statutory data

to identify the primary areas to be addressed at future committee meetings.

7. Committee Reports

A. Behavioral Health Oversight Committee (BHOC):

Gary Ambrose, noting the ongoing theme of transparency in services, reported the focus

of this meeting was on Integrated Health Initiatives including the following:

• Daryl Washington provided an overview of National and Commonwealth statistics

of Integrated Healthcare, noting that the three goals or ‘Triple Aim’ of integrating

healthcare include 1) Better Care, 2) Improved Health, And 3) Lower Costs.

• Laura Yager provided highlights of collaborative Integrated Healthcare efforts,

highlighting the Be Well program. A reminder was offered that integration of

primary and behavioral health supports is a goal of the CSB Strategic Plan. It was

further reported that the Be Well program is just beginning the third year a four-

year grant awarded by SAMHSA (Substance Abuse and Mental Health Services

Administration). The report noted numerous positive outcomes that have been

realized in the first two years of the program.

• Robin Mullet with the Health Department and Program Director of the Community

Health Care Network (CHCN) presented an update to the collaborative efforts of

CHCN, the Health Department, and the CSB to promote access to behavioral and

primary health care.

• Tom Schuplin with PRS reported on the partnership with the CSB on the Turning

Point program.

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• Maria Ugincius, a Data Analyst with the CSB, distributed a report providing details

of the highly positive outcomes reported in the first two years of the Be Well

program and reviewed the information with the Board members.

• Maria Horsey, Health Coach with the Be Well Program, shared several encouraging

stories offered by individuals receiving Be Well services.

• Tammala Watkins, Associate Member representing Inova, reported that after

several months of integration efforts, there are Behavioral Health Specialists placed

at 15 of the 25 Inova primary health care locations.

The next meeting is Wednesday, December 6 at 5:00 p.m. at the Merrifield Center,

Level 1-Room 308 A/B.

B. Fiscal Oversight Committee:

Captain Basilio ‘Sonny’ Cachuela, Jr, noting the meeting had occurred immediately prior

to the Board meeting, provided some highlights including:

• The CSB is in a strong financial position with accumulated savings in

Compensation and Fringe Benefits resulting from staff vacancies.

• The Modified Fund Statement, which will provide extra financial status

information, will be added to the Financial Status materials beginning in January

2018.

• Funding levels for the FY 2019 Budget Submission have not yet been finalized. It is

anticipated that the numbers will be available by the next Fiscal Committee

Meeting, Friday, December 8th.

• An update to recruitment efforts for the Sr. Fiscal Officer position include posting

an ad at several websites to include the Neo-Gov website the National Council

JOBank, the Government Finance Officers Association, and with the VACSB

(Virginia Association of Community Services Boards).

• The HR update included a report of 137 vacant positions, noting abundant efforts to

fill critical vacant positions in Emergency Services, Youth & Family, Support

Coordination, and Jail Based/Jail Diversion.

• Daryl Washington provided a Diversion First update to include staffing

accomplishments and continuing needs in both Jail Based and Jail Diversion

positions, Organization charts that illustrated vacant positions and recent hires were

distributed and reviewed.

• Mr. Washington also provided an update to ongoing efforts with Inova to provide

medical clearances ‘downstairs’ in the Merrifield Center. This is considered an

improvement over clearances provided upstairs at CHCN, which requires

individuals, sometimes in crisis, to travel through the building up to the fourth floor.

• An update to Time to Treatment wait times included recognition of an increase in

the wait times at Merrifield due to staff turnover. Increases at some smaller sites

were also recognized, reporting that at the smaller sites, the loss of even one staff

member greatly affects the wait times at that location.

• Tisha Deeghan provided an update to the Health and Human Resource Plan,

information that will also be provided at the Board meeting.

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The next meeting is Friday, December 8 at 9:00 a.m. at the Pennino Building,

Room 836A.

C. Developmental Disabilities Committee:

Sheila Jonas, reporting she was unable to attend the meeting, supplied information of

committee activities from notes provided, to include:

• Dennis Brown with ServiceSource spoke of his concern over the increasing number

of individuals on the DD Waitlist, reporting that 2,000 of the 12,000 individuals

currently on the waitlist are from Fairfax County, further reporting an increase of

approximately 4,000 individuals throughout the Commonwealth in the last year.

• Reporting a proposal to revise the DD charter to allow for appointment of Associate

Members on the DD Committee, this matter will be presented as an Information

Item later in the meeting.

• There was a staff presentation on Nursing and Integrated Primary Care.

• Staff updates included

o LaKeisha Flores Kennedy provided a status update on the implementation of

Commonwealth Coordinated Care Plus (CCC+);

o Victor Mealy reported participation in a Case Management survey issued by

the Department of Behavioral Health and Developmental Services (DBHDS)

to determine the impact of waiver redesign on Case Management service

delivery with a goal of developing guidance that addresses the need for

changes resulting from the identified impact.

o Evan Jones provided an update on Employment and Day Services, with a

focus on the review of the Psychosocial Rehab services. Note: Mr. Jones,

encouraging participation, provided a reminder of several opportunities to

provide public input, directing attention to a flier included in the Board

packet materials.

The next meeting is Wednesday, February 7 at 5:30 p.m. at the Merrifield Center,

Level 1-Room 308 A/B.

D. Other Reports

• Suzette Kern and Edward Rose met with Lyn Tomlinson to discuss continuing

education opportunities for Board member. Following up on a recommendation,

Ms. Kern encouraged staff to highlight events that may offer good learning

opportunities for Board members. Mr. Rose reminded attendees that the most

efficient method for contacting Board members, would be to go through Erin

Bloom, Clerk to the Board.

• Ms. Kern, offered thanks to the Chairs of the Ad Hoc Committees established in

response to decisions made at the September 2017 CSB Board Retreat; the

Workforce Review, Board Member Orientation and Continuing Education, and

Statutory Responsibilities. A reminder was offered that the first Workforce Review

Committee and the Board Member Orientation and Continuing Education

Committee meetings are Thursday, November 30.

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• Due to several member’s absence, it was decided to delay the CSB Board Member

group photo until all members were present.

• Ms. Kern, reporting that Tisha Deeghan had shared some information from a report

on premature mortality that was presented at a recent conference, requested that the

data be shared during the Directors Report, remarking the information is

particularly impactful and may be valuable to share at visits with General Assembly

legislators.

7. Information Items

A. Proposed Amendment to Developmental Disabilities Committee Charter

Sheila Jonas, DD Committee Co-Chair, proposed adding language to the Development

Disabilities Committee Charter allowing appointment of Associate Members to the DD

Committee, thereby improving the committee by the appointment of Associate Members

whose work and knowledge are important to the work of the Committee. The proposed

revision to the DD Charter will be presented to the full Board for approval at the

December CSB Board meeting.

CSB Board Approval to Post for Public Comment, CSB Board Bylaws

Suzette Kern requested approval to post for public comment a proposed amendment of

the CSB Bylaws, Section 4: Associate Standing Committee or Ad Hoc Committee

Members to clarify the procedure for appointment of Associate Members to a Standing

Committee. Additionally, the proposed revision clarifies the status of Associate

Members on a Standing Committee as non-voting and not included in a quorum of the

Committee. Following the public review period, the Draft Bylaws will be presented to

the Board for approval at the December 20th CSB Board meeting. Following CSB

Board approval of the proposed amendment to the Bylaws, the Bylaws will be presented

to the Board of Supervisors at the January 23, 2018 meeting as a Consideration Item, per

County Policy.

8. Action Items

A. Approval of CSB 2018 Board meeting Schedule

During review of the proposed 2018 meeting schedule, it was indicated that the new

room location needed to be revised to the correct room at the Merrifield Center. Bettina

Lawton made a motion to approve the 2018 CSB Meeting Schedule as amended, which

was seconded and passed.

9. Director’s Report

Tisha Deeghan offering a reminder that the Health and Human Services ((HHS) Resource

Plan was briefly discussed at the Budget 101 training provided to the CSB Board in October,

offered an update to development of the Resource Plan, including these highlights:

• Development of the Resource Plan was in response to a directive from the Board of

Supervisors (BOS) to the Human Services Council (HSC) directing the Council to

identify priority funding needs across the Human Services System. The Plan is to be

fiscally constrained, use priorities already established by the BOS and the Human

Services Council, and must be flexible enough to respond to changing community

priorities and shifts in federal funding.

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• Following BOS direction, the 2016 Human Needs Assessment was reviewed as a

source document identifying priority community needs across the Health and Human

Services system. Researched in 2015, the Assessment offers guidance in development

of a planning document that will assist the Council with making recommendations to

the BOS. A link to the Assessment will be forwarded to the Board.

• Preliminary information shared at a recent HSC meeting identified several categories

identified in the Needs Assessment, some of which are; affordable housing,

accessible housing, support services, financial assistance, affordable child care, early

education, affordable health insurance, behavioral health services for adults,

behavioral health services for children, domestic violence, accessible public

transportation, and access to human services information. Further information will be

shared as it becomes available.

• Strategic plans and FY 2019 budget documents for all of the County Human Services

Agencies were reviewed to inform revision of the Needs Assessment. Reporting that

some of the CSB related items added included Support Coordination, Employment &

Day Services, Diversion First and the Opioid Epidemic, it was noted an updated

report was submitted to the HSC with the agency designations removed in order to

illustrate the needs of the community as a whole.

• Noting a desire to engage the community in development of the Resource Plan,

possible involvement of Boards, Authorities and Commissions (BAC) leadership was

proposed. Board members interested in participating were encouraged to reach out to

their district representatives. Further information will be shared as it becomes

available.

• Developed as a three-year plan, there are some gaps in funding recommendations as

the budget is not yet complete. The current proposal is to add approximately $39M

over three years to the estimated $450M in the General Fund. Updates to the Plan will

be shared with the committee and the full board as they become available.

Ms. Deeghan provided an overview of the Development Disability (DD) Services (Update

#4) provided to the Health and Human Services Council on October 31st. A key topic was the

development of a DD stakeholders group. The group will be designed and managed by

community members and stakeholders, offering a fresh perspective for increasing service

delivery to the DD population and creative planning for anticipated future needs. Of note was

the announcement that retired CSB Board member Lori Stillman has agreed to be the citizen

Chair.

A reminder was offered of the VACSB Legislative Committee is January 16 – 17, 2018 in

Richmond. Interested Board members will please notify Erin Bloom.

Lyn Tomlinson reported hosting a group of International Mental Health Leaders from varied

locations across the globe including from Australia, England, Canada, Scotland, Ireland, New

Zealand, and Sweden to discuss youth services. Partnering with the Healthy Minds program,

the Substance Abuse and Mental Health Services Administration (SAMHSA) and the

Commonwealth, interactive presentations included several topics including integrated health,

trauma, systems of care, and working with children and families, providing abundant

opportunities for dialog. Areas of follow up discussion included comparisons in the

opportunities and challenges of behavioral health care when working with youth and

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families. Of note is the ongoing networking between participants sharing positive procedures

and outcomes.

Linda Mount provided the First Quarter FY 18 Status Reports and Data Definitions covering

July – September 2017, it was noted there were no significant changes to the data, further

noting that the number of individuals served is an unduplicated number. It was emphasized

that the number of individuals receiving Behavioral Health services who have a Primary Care

Provider has increased to 72%, the highest number reported since this data point has been

tracked.

Tisha Deeghan reported speaking at the American Public Health Association National

Meeting in Atlanta, November 2017. Her presentation, titled Protecting a marginalized

population from preventable death and excess mortality in one of the richest and healthiest

counties in the US: Why is it so hard? provided comparative National and Fairfax County

statistics on mortality rates impacted by Serious Mental Illness (SMI), Substance Use

Disorders (SUD), disabilities, and poverty. Highlights of the overview included:

• As noted earlier in the meeting, STEP-VA is a priority of the General Assembly. Two

services mandated to be implemented for STEP-VA in FY 2019 are 1) Same-Day

Access, and 2) Screening and Follow up with Primary Care. Remarking that the

information provided in the presentation impacts both mandated services, some

supportive information was offered to include:

• Statistics offered for Fairfax County indicate a wealthy and safe county with

substantially healthy and well-educated citizens,

• Contrary to the statistics provided, there is an 18-year disparity in life expectancy in

Fairfax County for citizens with SMI, and/or SUD, and/or disabilities. This statistic is

increased when poverty is a factor.

• The most commonly identified health conditions among those with SMI are diabetes,

high blood pressure, and obesity (twice as prevalent), with nearly twice the normal

risk of dying from cardiovascular disease.

• Fairfax County mortality data revealed that the average age at death for CSB

consumers was 47.5 years (even lower for consumers with SUD), the average age at

death countywide was 74.5 years, a difference of 27 years. The leading causes were

natural deaths followed by suicide, overdose, accident, other, and homicide (ranked

highest to lowest occurrence). Contributing social determinants of health for

individuals with SMI are unemployment, social isolation, poverty, and loneliness.

This data demonstrates that the presence of a behavioral health condition is the major cost

driver in the treatment of chronic conditions supporting efforts to integrate behavioral and

primary healthcare, housing, employment, and social services. Referring to information

provided in the Behavioral Health Oversight Committee meeting update provided earlier,

CSB efforts to integrate healthcare include the Be Well program that is designed to integrate

behavioral and primary healthcare while also addressing the social needs of the individual;

highly positive outcomes have been reported. Noting that the program is in the third year of a

four-year SAMHSA grant, ongoing funding will be needed.

Edward Rose reported attending the Opioid Panel Discussion and Roundtable, Saturday, October

21, 2017, noting the drug and opioid statistics for Fairfax County were startling and encouraged

CSB and Board efforts to get local media involved in further publicizing the local opioid and

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substance use crisis. It was noted the BOS has directed, as part of the Resource Plan discussed

earlier, development of a taskforce, in part, to address further publicizing the local impact of the

opioid crisis.

Ms. Kern offered a reminder of the memo written by retired County Executive Ed Long and

distributed to the Board in September, noting it contains helpful information related to the opioid

crisis and may be provide useful information for General Assembly legislator visits.

Ms. Deeghan, encouraged members to review the articles included in the Board materials

including new literature designed to simplify First Responder efforts to connect citizens in crisis

with treatment, asking Lucy Caldwell to provide additional information.

Ms. Caldwell directing attention to small business-sized cards included in the Board materials

explained that the cards were developed with input from Lyn Tomlinson in response to a request

from First Responders. Reporting that citizens in crisis are discovered at various locations

throughout the county in varied public areas, First Responders requested a simple and easy

means of providing contact information for accessing treatment, suggesting a small card that

could be easily accessed and distributed. The cards will be circulated throughout the county

including to police, fire fighters, EMT’s, Jail staff, hospitals and others as identified or requested.

Ms. Tomlinson added that Fairfax County Public Schools (FCPS) are developing a similar tool,

noting they have asked to partner with the CSB, police, and the Chris Atwood foundation among

others. Cards were provided to the Board members noting they would be a good addition to the

materials provided to the General Assembly legislators.

There being no further business to come before the Board, a motion to adjourn was offered,

seconded and carried. The meeting was adjourned at 6:20 p.m.

Date Staff to Board

Actions Taken--

Approval of the October 25, 2017 minutes

Approval of CSB Board Bylaws for public posting

Approval of the CSB Schedule of Meetings for 2018

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Behavioral Health Oversight Committee Meeting Notes

Behavioral Health Oversight Committee Page 1 of 5 November 8, 2017

Date: November 8, 2017 Location: Merrifield Center, First Floor, Room 1-308A/B West Board and Associate Members: Chair, Gary Ambrose; CSB Board Member Captain Basilio ‘Sonny’ Cachuela Jr.; CSB Board Chair Suzette Kern; CSB Board Member Diane Tuininga; Terry Atkinson, Gartlan Advisory Board; Peter Clark, Northern Virginia Mental Health Foundation; Gordon Dean; Concerned Fairfax; Lauren Goldschmidt, ServiceSource, Inc. Wendy Gradison and Tom Schuplin, PRS, Inc.; Deanne Mullins, Community Residences, Inc.; Joe Pettit, Concerned Fairfax; Bill Taylor, Concerned Fairfax; Tammala Watkins, Inova. Staff: Daryl Washington, CSB Deputy Director, Clinical Operations; Mark Blackwell, Director Office of Consumer and Family Affairs; Lucy Caldwell, CSB Communications Director; Maria Horsey, Health Coach; Evan Jones, Director, Employment and Day Services Lyn Tomlinson, Assistant Deputy Dir., Acute & Therapeutic Treatment Services; Maria Ugincius, Wellness, Health and Promotion Prevention; Laura Yager, Director Systems Transformation. Also present were other private sector staff as well as members of the public Guests: Robin Mullet, Asst. Program Director, CHCN (Community Health Care Network)

Topic Action Responsible Party

Due Date

Meeting Call to Order

Meeting was called to order at 6:04 p.m. Gary Ambrose

Opening Remarks Announcements

All attendees introduced themselves, including agency affiliation and relation to the Committee.

Minutes

The October 11, 2017 Behavioral Health Oversight Committee draft minutes were provided for review. Following review, Suzette Kern made a motion to approve the minutes as presented, which was seconded and passed unanimously.

Committee Members

Associate Member Presentations and Concerns

Several Associate Members provided updates to recent agency activities.

• Terry Atkinson, Gartlan Advisory Board; reported the November meeting of the Gartlan Advisory

Board is Tuesday, November 14 at 9:00 a.m.

• Tammala Watkins, Inova; updates included collaboration with Alexandria Hospital and the

Alexandria CSB to ensure that individuals with a medical admission can receive Behavioral Health

assessment and services, an Inova initiative to combat the opioid epidemic, creation of a specialty

team to assist with admitting patients to the Inova detox unit effectively and efficiently, following

several months of efforts, 15 of the 25 Inova primary care locations have a behavioral health

therapist embedded providing behavioral health services throughout Northern Virginia.

Associate Members

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Due Date

• Eleanor Vincent, Pathway Homes, Inc.; Provided an update to housing efforts

• Wendy Gradison, Psychiatric Rehabilitation Services (PRS); offered a reminder of the annual PRS

fundraiser “Springtopia, A Season of Hope”, Saturday, May 12, 2018 at the Hyatt Regency Tysons

corner, McLean, VA

• Bill Taylor, Concerned Fairfax; offered a reminder of the next meeting, Monday, November 13, 2017

at 7:00 p.m. at the Merrifield Center.

• Peter Clark, Northern Virginia Mental Health Foundation (NVMHF); reported on the Wellness and

Recovery Conference that was held October 20th noting it was a great success. Attended by 225

people, there were 20 exhibitors and keynote speaker Jennifer Marshall was enthusiastically

received further noting the Government Center was an excellent venue for this annual event.

• Lauren Goldschmidt, ServiceSource; announced a new employment program in partnership with

Skillsource and the VA Department of Social Services supporting individuals who are considered low

income and/or have a disability with achieving employment with career growth opportunities,

noting that the program also serves Prince William County, further noting that referrals are

welcome. Funds for training and paid internships are available. Further information will be

forwarded as it becomes available.

Matters of the Public

None were presented

Integrated Health Initiatives – State Lead Initiatives- State, County, and CSB including Commonwealth Coordinated Care (CCC+)

Daryl Washington provided an overview of the critical need across the nation and in the Commonwealth for integrated health care, described as the coordination of mental health, substance abuse, and primary care services. The three goals of integrated health care include: 1) better care, 2) improved health, and 3) lower costs. A presentation including health care cost statistics for the Nation and the Commonwealth was provided. Highlights included:

• Nationwide statistics:

o Individuals with mental illness and substance abuse issues die significantly earlier than the

general population.

o Mental health and substance use disorders are the leading cause of death (disease burden) in

the US.

o The US has the most expensive healthcare in the world and the gap is increasing.

o Mental Health treatment (2015) is an estimated $89B annually.

Daryl Washington

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Due Date

o The total cost of US National Healthcare (2015) is approximately $3.2T, which is approaching

20% of the Gross Domestic Product.

o The Gross Domestic Product in 2015 was an estimated $18T.

o Medicaid is the single largest payer for behavioral health care services in the US, comprising

almost 75% of State Mental Health Agency revenues for community mental health services.

• Highlights of the statistics for the Commonwealth of Virginia include:

o Mirroring the national data, Virginia Medicaid is the primary payer for Behavioral Health

Services in the Commonwealth.

o It was reported that older adults and individuals with disabilities comprise 23% of the

Medicaid population, but are 66% of the funding expenditures, prompting many of the

changes in Virginia Medicaid.

o Several models of medical and behavioral health integration were illustrated, noting that

the integrated model is best suited to address the needs of the population served by the

CSB.

o A reminder was offered that CCC+ (Commonwealth Coordinated Care Plus) is the mandated

integration of primary and behavioral health care in a Medicaid managed care program. It

was noted that some services are ‘carved out’ at this time, but are anticipated to be phased

in to the program over time.

• The slide presentation will be distributed electronically to all attendees.

Integrated Health Initiatives – Primary and Behavioral Healthcare Integration Efforts

Laura Yager provided highlights of the history of integrated health care efforts including:

• It was noted that integrating primary and behavioral health is a priority in the CSB Strategic Plan.

• The Be Well program is in the third year of a four-year grant awarded from SAMHSA (Substance

Abuse and Mental Health Services Administration). Be Well is designed for individuals with serious

mental illness and provides integrated services to improve outcomes. These services include

providing primary care in a behavioral health care setting, providing behavioral health care on the

home and providing wellness activities with an assigned health coach to assist the individual in

meeting their assigned goals.

• There are three partner agencies collaborating on this effort including Psychiatric Rehabilitative

Services (PRS), Neighborhood Health, and CHCN.

• Noting that there were several speakers attending to provide further information on behavioral

health integration efforts, the following speakers were introduced:

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Due Date

o Robin Mullet with the Health Department and Asst. Program Director for CHCN (Community

Health Care Network) provided a timeline of the collaboration between the Health

Department/CHCN and the CSB to promote access to primary and behavioral health care as

needed.

o Tom Schuplin with Psychiatric Rehabilitation Services, Inc. (PRS), noted collaboration with

the CSB in the Turning Point and the Be Well Programs. Mr. Schuplin distributed Be Well

literature and provided further information on the role of the essential position of Health

Coaches who are provided by PRS and work directly with the individuals in the program

assisting with data collection and helping to create a personalized wellness plan.

o Maria Ugincius, Data Analyst Be Well program, distributed a data report as the Be Well

program enters the third year. Ms. Ugincius reviewed the data, offering clarification and

additional information on the data provided.

o Maria Horsey, Health Coach, Be Well Program offered some personal stories provided by

individuals who have been involved in the Be Well program.

Committee members, attendees, and speakers engaged in lively and informative discussion, including plans for the ongoing and expanding implementation of wellness programs.

Integrated Health Initiatives – CSB Role in the future of the Health Safety Net and a look at the new direction

Robin Mullet, noting a large component of the Health Safety Net is the integration of primary and behavioral healthcare, reported that Deputy County Executive Pat Harrison is very involved in this initiative. An overview of the efforts to strengthen Fairfax County’s Safety Net was provided, including the following:

• A long-term partnership with the Health Department includes CHCN staff deployed to work at

Woodburn with medical staff to prioritize individuals with mental illness and receiving services.

• Due to some challenges with the CHCN billing system, the Health Department has contracted with

Neighborhood Health to cover some of the costs for primary care services at Gartlan and at

Merrifield for people not currently able to access CHCN services. Additionally, the Health

Department awarded a new CHCN contract that included priority enrollment for all people served

by the CSB in need of health care regardless of payer source.

• The Health Department is also exploring a contract with HealthWorks Herndon to establish a similar

primary care model in the north part of the county. This is an important partnership and has

allowed people served by the CSB to improve access to care.

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Due Date

A reminder was offered that the county's overall safety net model is evolving and the CSB will be an ongoing partner in the future planning.

Staff Reports

Daryl Washington provided several updates to recent activities some of which include:

• Referring to a flier provided in the meeting packet, a reminder of the opportunities to provide comment and feedback on the Psychosocial Rehabilitation program was offered. Evan Jones offered a brief description of the program noting it is provided by the CSB at the Community Readiness and Support Program and through partner PRS/Recovery Academy. The opportunities are:

o Tuesday, December 5th at the Fairfax County Government Center from 7:00 p.m. to 9:00 PM o Thursday, December 7th at the South County Government Center from 7:00 p.m. to 9:00 PM o Online opportunity at www.fairfaxcounty.gov/csb/innovation-challenge.htm

Adjournment There being no further business to come before the Committee, the meeting was adjourned at 7:20 p.m. Gary Ambrose, Chair

December 6, 2017 Date Approved Prepared by Erin Bloom

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http://www.fairfaxcounty.gov/csb/innovation-challenge.htm

CSB Fiscal Committee Meeting Notes

Fiscal Oversight Committee Meeting Notes Page 1 of 3 November 15, 2017

Date: November 15, 2017

Attending: Captain Basilio ‘Sonny’ Cachuela Jr, Chair; Jennifer Adeli, Gary Ambrose, Ken Garnes; Suzette Kern, Bettina Lawton, Molly Long, and Edward Rose

Staff: Tisha Deeghan, Daryl Washington, Michael Lane, and Marta Cruz

Summary of Information Shared/Decisions:

Review of meeting notes The committee reviewed and accepted the notes of the October 18, 2017 committee meeting with no changes recommended.

Financial Status Michael Lane provided highlights of the fiscal documents included in the meeting materials to include:

• Position Status: o As of Pay Period 24 there were 137 vacant general merit positions with an

average biweekly vacancy rate of 14.5%, no material change from the previous reporting period.

• Pay Metrics: o Accumulated Compensation and Fringe Benefits savings through PP 22 was

approximately $1.8M, with a projected accumulated savings of approximately $5.3M, at the end of FY 2018.

• FY 2019 Budget Submission Update: o It was reported that the funding amounts for Diversion First, Support Coordination,

and Opioid treatment are not yet available as the Department of Management and Budget (DMB) is finalizing the budget amounts. A reminder was offered that accumulated Compensation and Fringe Benefits totals are anticipated to be available in January 2018. It is anticipated that some further information will be available for presentation at the December 8th Fiscal Oversight Committee.

• A reminder was offered that the Modified Fund Statement (MFS) and Explanation of Variance will be included in the Financial Status documents beginning in January. It was reported that the CSB is working with DMB to refine the data procedure related to methodology and projections, including possible modification to the Vacancy Breakeven Point (VBP), and possibly adding obligations to the MFS in response to a prior committee request.

Senior Fiscal Officer Hiring Update

Displaying a brochure developed to assist in recruitment of this position, Michael Lane reported that a recruitment ad had been placed on November 4th, with a closure date of November 24th. Ads were placed on the Neo-Gov website and with the National Council JOBank, the Government Finance Officers Association, and with the VACSB (Virginia Association of Community Services Boards). Two volunteer CSB Board members may be asked to participate in an interview panel when candidates have been identified. Michael Lane provided a brief overview of the hiring and interview process for this position including an anticipated time line.

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Human Resources (HR) Updates

Marta Cruz provided further details of the HR Update handout included in the committee meeting materials:

• As of November 13, there were 137 regular merit vacancies with 107 positions funded and approved to fill; this change included 43 appointments and 6 terminations.

• Highlights of critical position recruitment and status of pending interviews/hiring was provided for the areas of Emergency Services, Youth & Family, Support Coordination, and ADC/Jail Diversion.

• Jennifer Adeli offered a reminder that the initial Ad Hoc Workforce Committee has been scheduled for Thursday, November 30 at 1:00 p.m. at the Pennino Building, room 836A. The purpose of this initial meeting is to develop a baseline of employment information going back three years and focusing on employee turn-over, particularly with difficult to fill positions. It was also mentioned that employment data collection may include consultation with other CSB’s in Northern Virginia to identify similar and/or dissimilar employment challenges.

Diversion First

Daryl Washington distributed organizational charts that provided an update to the staffing needs for the Jail Based and the Jail Diversion staff. It was clarified that Jail Based staff works with inmates at the Adult Detention Center (ADC) while Jail Diversion staff works at the Merrifield Center and in the community with discharged inmates. Update information highlights included:

• Some recent appointments will be reflected on the next update, further remarking that recruitment to underfill some of the vacant positions is the next step as not all vacancies were filled. Following up on an inquiry into the underfill procedure, the following clarification was offered:

o Underfilling a position is hiring an individual who partially meets the requirements for a position and is provided the opportunity to gain what is needed by a specified date in order to meet the position requirements.

o A reminder was offered that several class specifications were recently re-classed. In so doing, it was discovered that the classification specs of Behavioral Health Specialist II (BHSII) had been written with higher requirements than required by the state. As the BHSII position is the most frequently requested job classification, the CSB is asking that the county classification requirements be rewritten to match the requirements of the state.

• Referring to earlier comments about the Diversion First budget, Mr. Washington recommended interested members attend the Public Safety Committee meeting scheduled for 1:00 p.m. on Tuesday, November 28th at the Fairfax County Government Center, Fairfax, Room #11. Mr. Washington will be in attendance along with Laura Yager and members of Law Enforcement who will present a FY 2019 multi-agency request that will extend five years, through FY 2024.

• Mr. Washington reported a meeting with Michelle Mullany of Inova and the continuing efforts to arrange for provision of medical clearances on the lower level of the Merrifield Center, remarking on the challenges of escorting individuals, who may be in crisis, to this service upstairs on the fourth floor at CHCN.

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Time to Treatment

Distributing Adult and Youth Time to Treatment charts, it was reported that some recommended modifications had been applied in an effort to simplify the data. Highlights of the data were provided to include:

• Reporting a concerning increase in wait times for both Youth and Adult Outpatient care, it was noted this is attributed to staff turnover. It was noted that at a smaller site, the loss of even one staff member can result in a large increase in wait times.

• Further customization of the reports was requested by the committee to include listing the locations in the same order on both the adult and the youth report, with Gartlan and South County listed last as these are the locations at which only adult or youth outpatient services are offered.

DD Presentation Report Out

This presentation was tabled, noting that the DD Presentation materials are already included in the Board packet for a presentation to the full board following this meeting.

HHS Resource Plan Report Out

Tisha Deeghan, offered an update to the Health and Human Services Resource Plan. Noting that the Human Services Council (HSC) initiated this effort. Highlights included the following:

• Development of a long-range, three-year planning document for the Health and Human Services system began with a review the 2016 Fairfax County Human Needs Assessment. It was noted that research for the Assessment was conducted in 2015, with data from 2014, resulting in some recent concerns not being included in the Assessment including the opioid epidemic and gang prevention.

• Strategic plans and FY 2019 budget documents for all the County Human Services Agencies were gathered and reviewed to inform revision of the Assessment. It was reported that some of the CSB related items added included Support Coordination, Employment & Day Services, Diversion First and the Opioid Epidemic. It was further reported that an updated report was submitted to the HSC with all agency designations removed in order to illustrate the needs of the community as a whole, not by agency.

• Budget recommendations included adding an approximate $39M over three years to the estimated $450M in the General Fund. When completed, the plan will be shared with the committee and the full board.

Action Items/Responsible Party Required Prior to Next Meeting:

Issues to Communicate to CSB Board:

Agenda Items for Next Meeting:

Fiscal Oversight Committee meeting Friday, December 8, 2017 at 9:00 a.m. Pennino Building, 12011 Government Center Parkway, Suite 836A, Fairfax, VA Please note the meeting date has changed to accommodate December holidays

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