michael hlebechuk nccbh

8/3/2019 Michael Hlebechuk NCCBH

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Moving from LearnedMoving from LearnedDependency toDependency to

SelfSelf--DeterminationDetermination

Moving from LearnedMoving from LearnedDependency toDependency to

SelfSelf--DeterminationDetermination

Michael HlebechukMichael HlebechukOregon Department of Human ServicesOregon Department of Human Services

Addictions and Mental Health DivisionAddictions and Mental Health Division


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SelfSelf--DeterminationDeterminationSelfSelf--DeterminationDetermination

The ability and freedom to make choicesThe ability and freedom to make choicesand determine the direction of ones ownand determine the direction of ones ownlife. To hope, dream, and work to realizelife. To hope, dream, and work to realize

goals. To become liberated from beinggoals. To become liberated from beingdefined by a disability and the servicesdefined by a disability and the servicesprovided for that disability.provided for that disability.

SelfSelf--Directed Care is not the ultimate goal.Directed Care is not the ultimate goal.Rather, it is a valuable tool that canRather, it is a valuable tool that canpromote selfpromote self--determination and recovery.determination and recovery.

The ability and freedom to make choicesThe ability and freedom to make choicesand determine the direction of ones ownand determine the direction of ones ownlife. To hope, dream, and work to realizelife. To hope, dream, and work to realize

goals. To become liberated from beinggoals. To become liberated from beingdefined by a disability and the servicesdefined by a disability and the servicesprovided for that disability.provided for that disability.

SelfSelf--Directed Care is not the ultimate goal.Directed Care is not the ultimate goal.Rather, it is a valuable tool that canRather, it is a valuable tool that canpromote selfpromote self--determination and recovery.determination and recovery.


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Principles of SelfPrinciples of Self--DeterminationDeterminationPrinciples of SelfPrinciples of Self--DeterminationDetermination

FreedomFreedom to choose a meaningful life in the communityto choose a meaningful life in the community

AuthorityAuthority over a targeted amount of dollarsover a targeted amount of dollars

SupportSupport to organize resources in ways that are lifeto organize resources in ways that are life

enhancing and meaningful to the individual with aenhancing and meaningful to the individual with adisabilitydisability

ResponsibilityResponsibility for the wise use of public dollars andfor the wise use of public dollars andrecognition of the contribution individuals withrecognition of the contribution individuals withdisabilities can make to their communitiesdisabilities can make to their communities

ConfirmationConfirmation of the important leadership role thatof the important leadership role thatindividuals with disabilities and their families must play inindividuals with disabilities and their families must play ina newly rea newly re--designed system and support for the selfdesigned system and support for the self--advocacy movementadvocacy movement

FreedomFreedom to choose a meaningful life in the communityto choose a meaningful life in the community

AuthorityAuthority over a targeted amount of dollarsover a targeted amount of dollars

SupportSupport to organize resources in ways that are lifeto organize resources in ways that are life

enhancing and meaningful to the individual with aenhancing and meaningful to the individual with adisabilitydisability

ResponsibilityResponsibility for the wise use of public dollars andfor the wise use of public dollars andrecognition of the contribution individuals withrecognition of the contribution individuals withdisabilities can make to their communitiesdisabilities can make to their communities

ConfirmationConfirmation of the important leadership role thatof the important leadership role thatindividuals with disabilities and their families must play inindividuals with disabilities and their families must play ina newly rea newly re--designed system and support for the selfdesigned system and support for the self--advocacy movementadvocacy movement


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Rethinking our SystemRethinking our SystemRethinking our SystemRethinking our System

Why are individuals with disabilities not afforded norWhy are individuals with disabilities not afforded norexpected to have purposes in life similar to thoseexpected to have purposes in life similar to thosewithout disabilities? Virtually everyone else arises towithout disabilities? Virtually everyone else arises to

carry out daily responsibilities, work, earn income, plancarry out daily responsibilities, work, earn income, planfor life goals, take care of family members, contribute tofor life goals, take care of family members, contribute tothe common good, and exercise citizenship. Until peoplethe common good, and exercise citizenship. Until peoplewith disabilities are accorded these same expectations,with disabilities are accorded these same expectations,our view of quality will remain severely constrained. Weour view of quality will remain severely constrained. We

will focus solely on the quality of services. will focus solely on the quality of services.

~ Thomas Nerney, Executive Director~ Thomas Nerney, Executive Director

Center for SelfCenter for Self--DeterminationDetermination

Why are individuals with disabilities not afforded norWhy are individuals with disabilities not afforded norexpected to have purposes in life similar to thoseexpected to have purposes in life similar to thosewithout disabilities? Virtually everyone else arises towithout disabilities? Virtually everyone else arises to

carry out daily responsibilities, work, earn income, plancarry out daily responsibilities, work, earn income, planfor life goals, take care of family members, contribute tofor life goals, take care of family members, contribute tothe common good, and exercise citizenship. Until peoplethe common good, and exercise citizenship. Until peoplewith disabilities are accorded these same expectations,with disabilities are accorded these same expectations,our view of quality will remain severely constrained. Weour view of quality will remain severely constrained. We

will focus solely on the quality of services. will focus solely on the quality of services.

~ Thomas Nerney, Executive Director~ Thomas Nerney, Executive Director

Center for SelfCenter for Self--DeterminationDetermination


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The Traditional Mental Health SystemThe Traditional Mental Health SystemThe Traditional Mental Health SystemThe Traditional Mental Health System

Assumes thatAssumes that clientsclients are not able to makeare not able to makechoices that are in their own best interest muchchoices that are in their own best interest muchof the time.of the time.

Believes it is often necessary to make decisionsBelieves it is often necessary to make decisionsfor clients.for clients.

StressesStresses clientclient safety far more thansafety far more than clientclientchoice.choice.

This results in theThis results in the clientclient growing dependent ongrowing dependent onthe system to make life decisions. (Decreasedthe system to make life decisions. (Decreasedclient choice means increased clientclient choice means increased clientdependence.)dependence.)

Assumes thatAssumes that clientsclients are not able to makeare not able to makechoices that are in their own best interest muchchoices that are in their own best interest muchof the time.of the time.

Believes it is often necessary to make decisionsBelieves it is often necessary to make decisionsfor clients.for clients.

StressesStresses clientclient safety far more thansafety far more than clientclientchoice.choice.

This results in theThis results in the clientclient growing dependent ongrowing dependent onthe system to make life decisions. (Decreasedthe system to make life decisions. (Decreasedclient choice means increased clientclient choice means increased clientdependence.)dependence.)


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A Transformed System that PromotesA Transformed System that PromotesRecovery Through SelfRecovery Through Self--DeterminationDeterminationA Transformed System that PromotesA Transformed System that PromotesRecovery Through SelfRecovery Through Self--DeterminationDetermination

Believes that people can and do recover from mentalBelieves that people can and do recover from mentalillness.illness.

Helps facilitate recovery by providing selfHelps facilitate recovery by providing self--directeddirected

services and supports.services and supports.Treatment in this system is centered around the goals ofTreatment in this system is centered around the goals of

the personthe person what is important to the person.what is important to the person.

Safety issues are addressed in a collaborativeSafety issues are addressed in a collaborative

relationship between the individual and the provider ofrelationship between the individual and the provider ofservices and supports.services and supports.

Individuals are allowed to make, and grow from, theirIndividuals are allowed to make, and grow from, theirown mistakes.own mistakes.

Believes that people can and do recover from mentalBelieves that people can and do recover from mentalillness.illness.

Helps facilitate recovery by providing selfHelps facilitate recovery by providing self--directeddirected

services and supports.services and supports.Treatment in this system is centered around the goals ofTreatment in this system is centered around the goals of

the personthe person what is important to the person.what is important to the person.

Safety issues are addressed in a collaborativeSafety issues are addressed in a collaborative

relationship between the individual and the provider ofrelationship between the individual and the provider ofservices and supports.services and supports.

Individuals are allowed to make, and grow from, theirIndividuals are allowed to make, and grow from, theirown mistakes.own mistakes.


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Products of the Transformed SystemProducts of the Transformed SystemProducts of the Transformed SystemProducts of the Transformed System

People move toward recovery and becomePeople move toward recovery and becomeincreasingly selfincreasingly self--reliant.reliant.

As people recover they use fewer services.As people recover they use fewer services.It is a winIt is a win--win proposition. Service dollarswin proposition. Service dollars

are saved. Far more importantly, peopleare saved. Far more importantly, peoplemove on with their lives.move on with their lives.

Individuals gain far higher levels of dignityIndividuals gain far higher levels of dignityand selfand self--respectrespect greater selfgreater self--esteem.esteem.

People move toward recovery and becomePeople move toward recovery and becomeincreasingly selfincreasingly self--reliant.reliant.

As people recover they use fewer services.As people recover they use fewer services.It is a winIt is a win--win proposition. Service dollarswin proposition. Service dollars

are saved. Far more importantly, peopleare saved. Far more importantly, peoplemove on with their lives.move on with their lives.

Individuals gain far higher levels of dignityIndividuals gain far higher levels of dignityand selfand self--respectrespect greater selfgreater self--esteem.esteem.


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Oregon FY 2001 Real ChoiceOregon FY 2001 Real ChoiceSelfSelf--Direction ProjectsDirection Projects

Oregon FY 2001 Real ChoiceOregon FY 2001 Real ChoiceSelfSelf--Direction ProjectsDirection Projects

Person Centered Planning demonstrationsPerson Centered Planning demonstrationsin 4 Oregon countiesin 4 Oregon counties

Employment for LifeEmployment for Life projectproject

Empowerment Initiatives BrokerageEmpowerment Initiatives Brokerage

Person Centered Planning demonstrationsPerson Centered Planning demonstrationsin 4 Oregon countiesin 4 Oregon counties

Employment for LifeEmployment for Life projectproject

Empowerment Initiatives BrokerageEmpowerment Initiatives Brokerage


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AnalysisAnalysis

Employment for Life and Empowerment InitiativesEmployment for Life and Empowerment Initiativesoperate from the selfoperate from the self--determination and recoverydetermination and recoveryperspective. The 4 PCP pilots used traditional caseperspective. The 4 PCP pilots used traditional case

management services that do not operate from themanagement services that do not operate from theselfself--determination and recovery perspective.determination and recovery perspective.

A culture change that embraces selfA culture change that embraces self--direction anddirection andrecovery in mental health treatment is needed. Therecovery in mental health treatment is needed. The

use ofPerson Centered Planning, inuse ofPerson Centered Planning, in--ofof--itself, is notitself, is notenough to bring this change about.enough to bring this change about.

Employment for Life and Empowerment InitiativesEmployment for Life and Empowerment Initiativesoperate from the selfoperate from the self--determination and recoverydetermination and recoveryperspective. The 4 PCP pilots used traditional caseperspective. The 4 PCP pilots used traditional case

management services that do not operate from themanagement services that do not operate from theselfself--determination and recovery perspective.determination and recovery perspective.

A culture change that embraces selfA culture change that embraces self--direction anddirection andrecovery in mental health treatment is needed. Therecovery in mental health treatment is needed. The

use ofPerson Centered Planning, inuse ofPerson Centered Planning, in--ofof--itself, is notitself, is notenough to bring this change about.enough to bring this change about.


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Goal Attainment PlansGoal Attainment PlansGoal Attainment PlansGoal Attainment Plans

Written by customer and broker through aWritten by customer and broker through aperson centered planning process.person centered planning process.

Brokered services and supports are obtainedBrokered services and supports are obtainedthrough the implementation of this plan usingthrough the implementation of this plan usingthe individual customer account.the individual customer account.

Two examples (next 2 slides):Two examples (next 2 slides):

1) Goal: obtaining employment1) Goal: obtaining employment2) Goal: being discharged from state hospital2) Goal: being discharged from state hospital

with suitable services and supports.with suitable services and supports.

Written by customer and broker through aWritten by customer and broker through aperson centered planning process.person centered planning process.

Brokered services and supports are obtainedBrokered services and supports are obtainedthrough the implementation of this plan usingthrough the implementation of this plan usingthe individual customer account.the individual customer account.

Two examples (next 2 slides):Two examples (next 2 slides):

1) Goal: obtaining employment1) Goal: obtaining employment2) Goal: being discharged from state hospital2) Goal: being discharged from state hospital

with suitable services and supports.with suitable services and supports.


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Name: Wanda B. Wurking Customer Number: 1234

Todays date: 02/25/05 Phone #: 503.123.4567 Plan Begins: 06/01/05 Plan Ends: 06/30/06

What is my goal? What personal outcome do I expect as a result of this request? (Describe the specific symptoms orexperiences related to your illness that this service will improve or relieve) I will have a job where I am able to support myselfin an independent lifestyle, and feel positive about my role in society. My self-esteem will improve dramatically throughbecoming self-sufficient. I have experience as an administrative assistant.

Specific description of request

Resource analysisList provider here if needed

(All the ways to get what I need, includefamily, friends, community supports )

How will this purchase helpme achieve my goals

What itmightcost

Monthly &Annually

Whenwill we

startand

end

1) A full set of clothes that I will wearto job interviews.

2) A professional resume consultantto assist me in updating my resumeto effectively demonstrate mycapabilities.

3) A bus pass to help me get to job

interviews.

PLAN TOTAL:$2143

1) I will purchase clothes at ClothesR Us. Pants, shirt, shoes, jacket,belt.

2) Resource broker will arrange forresume assistance with volunteercareer developer working out of DoDrop-In center.

3) I will purchase monthly bus passfrom mass transit service.

1) Dressing professionally willhelp me be more confident andlook more employable duringinterviews.

2) A solid resume will help meappear professional coverthe gaps in my work history.

3) It will allow me to get to jobinterviews.Page total

$250

$ -0-

$56 / mo

4 months

$474

06/05onetime

06/05

06/05-10/05

SIGNATURESIndividual:

Date:Legal Representative:

Date:Resource Broker:

Date:Other:

Date:


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Name: Red E. Toolieve Customer Number: 9874

Todays date: 05/25/05 Phone # (503) 987-6543 Plan Begins: 07/01/05 Plan Ends: 07/31/05

What is my goal? What personal outcome do I expect as a result of this request? (Describe the specific symptoms orexperiences related to your illness that this service will improve or relieve) To be discharged from Oregon State Hospital and livein my former residence with extra services and supports in place to help me cope with living in the community.

Specific description of request

Resource analysisList provider here if needed

(All the ways to get what I need, includefamily, friends, community supports )

How will this purchase helpme achieve my goals

What itmightcost

Monthly &

Annually

Whenwill we

startand

end

1) A health club membership.

2) a) Light therapy panel.b) Full-spectrum lighting.

3) Eye Movement DesensitizationReprocessing therapy series.

4) Naturopathic Doctor and NutritionalSupplements.

PLAN TOTAL: $1558

1) Broker has made arrangement withYMCA for sliding scale fee based on myincome.

2) a) Light panel through OHSU lighttherapy program.

b) Full spectrum lights from localhardware store.

3) Broker will assist me in obtaining areferral from Veterans Association.

4) I will receive sliding-scale servicesthrough the National College ofNaturopathic Medicine. My medicalprovider will coordinate with mynaturopathic provider.

1) Strenuous exercise helps mesleep and night and feel morerelaxed during the day.

2) Light therapy and full-spectrumlights (no UV) will help memaintain a positive mood.

3) I believe this treatment will helpme resolve the trauma that leadto my diagnosis of Post TraumaticStress Disorder.

4) Fish oil, flaxseed oil, and anti-oxidants such as CQ-10 arewidely believed to help keepmoods level.

Page total

$9 / mo$108 / yr

a) $200b) $150

$100 /session8 weeklysessions

$50 / mo12 months

$1558

7/05 6/06

07/05one time

08/0510/05

07/0506/06


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Some Findings FromEIBSome Findings FromEIBSome Findings FromEIBSome Findings FromEIB

EIB customers are moving toward employmentEIB customers are moving toward employmentin response to brokered selfin response to brokered self--directed servicesdirected servicesand supports.and supports.

At enrollment, 9 out of 25 customers were eitherAt enrollment, 9 out of 25 customers were either

competitively employed or in an educationcompetitively employed or in an educationsetting leading to employment. At the end ofsetting leading to employment. At the end ofone year of brokerage service, 23 of the 25one year of brokerage service, 23 of the 25customers were either competitively employedcustomers were either competitively employed

or in an education setting leading toor in an education setting leading toemployment.employment.

Surveys indicate that EIB customers are moreSurveys indicate that EIB customers are moreengaged in their recovery.engaged in their recovery.

EIB customers are moving toward employmentEIB customers are moving toward employmentin response to brokered selfin response to brokered self--directed servicesdirected servicesand supports.and supports.

At enrollment, 9 out of 25 customers were eitherAt enrollment, 9 out of 25 customers were either

competitively employed or in an educationcompetitively employed or in an educationsetting leading to employment. At the end ofsetting leading to employment. At the end ofone year of brokerage service, 23 of the 25one year of brokerage service, 23 of the 25customers were either competitively employedcustomers were either competitively employed

or in an education setting leading toor in an education setting leading toemployment.employment.

Surveys indicate that EIB customers are moreSurveys indicate that EIB customers are moreengaged in their recovery.engaged in their recovery.


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What Empowerment InitiativesWhat Empowerment Initiatives

Customers are SayingCustomers are Saying

What Empowerment InitiativesWhat Empowerment Initiatives

Customers are SayingCustomers are Saying

I think the brokerage is a great program. They haveI think the brokerage is a great program. They havehelped me get back to school (They) encourage me tohelped me get back to school (They) encourage me tofind my place in the world. They also made me feel likefind my place in the world. They also made me feel likeI can have a real life.I can have a real life.

IndependenceIndependence -- I was able to purchase my ownI was able to purchase my ownmanufactured home in a very low space rent park in themanufactured home in a very low space rent park in thecountry and I am so very happy out here.country and I am so very happy out here.

Today I feel like have options to help me get back onToday I feel like have options to help me get back onmy feet again.my feet again.

I am beginning to do things I have always dreamed of.I am beginning to do things I have always dreamed of.I have new perspective because of it.I have new perspective because of it.

Yes I was able to attend community college. I wasYes I was able to attend community college. I wasable to end last semester with a 3.5 GPA.able to end last semester with a 3.5 GPA.

I think the brokerage is a great program. They haveI think the brokerage is a great program. They havehelped me get back to school (They) encourage me tohelped me get back to school (They) encourage me tofind my place in the world. They also made me feel likefind my place in the world. They also made me feel likeI can have a real life.I can have a real life.

IndependenceIndependence -- I was able to purchase my ownI was able to purchase my ownmanufactured home in a very low space rent park in themanufactured home in a very low space rent park in thecountry and I am so very happy out here.country and I am so very happy out here.

Today I feel like have options to help me get back onToday I feel like have options to help me get back onmy feet again.my feet again.

I am beginning to do things I have always dreamed of.I am beginning to do things I have always dreamed of.I have new perspective because of it.I have new perspective because of it.

Yes I was able to attend community college. I wasYes I was able to attend community college. I wasable to end last semester with a 3.5 GPA.able to end last semester with a 3.5 GPA.


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Some Applications of MH BrokerageSome Applications of MH BrokerageModel Within the Existing SystemModel Within the Existing System

Some Applications of MH BrokerageSome Applications of MH BrokerageModel Within the Existing SystemModel Within the Existing System

Wrap around services;Wrap around services;

Discharge planning;Discharge planning;

Transitioning from longTransitioning from long--term structuredterm structuredresidential programs to more integratedresidential programs to more integratedcommunity living; andcommunity living; and

Providing recovery opportunities forProviding recovery opportunities forindividuals while collecting an evidenceindividuals while collecting an evidence

base.base.

Wrap around services;Wrap around services;

Discharge planning;Discharge planning;

Transitioning from longTransitioning from long--term structuredterm structuredresidential programs to more integratedresidential programs to more integratedcommunity living; andcommunity living; and

Providing recovery opportunities forProviding recovery opportunities forindividuals while collecting an evidenceindividuals while collecting an evidence

base.base.


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Transformation V TransitionTransformation V TransitionTransformation V TransitionTransformation V Transition

Incremental systemic transition tends toIncremental systemic transition tends to notnotbring about system transformation. Incrementalbring about system transformation. Incrementalchange generally takes years and usually resultschange generally takes years and usually results

in a modified version of what currently exists.in a modified version of what currently exists.Successful systemSuccessful system--wide transformation requireswide transformation requires

extensive planning, technical knowextensive planning, technical know--how,how,dedication, and sustained commitment.dedication, and sustained commitment.

Responsible transformation requires that theResponsible transformation requires that thevarious elements that compose the desiredvarious elements that compose the desiredtransformed system have been demonstrated totransformed system have been demonstrated tobe beneficial for the persons receiving MHbe beneficial for the persons receiving MHservices.services.

Incremental systemic transition tends toIncremental systemic transition tends to notnotbring about system transformation. Incrementalbring about system transformation. Incrementalchange generally takes years and usually resultschange generally takes years and usually results

in a modified version of what currently exists.in a modified version of what currently exists.Successful systemSuccessful system--wide transformation requireswide transformation requires

extensive planning, technical knowextensive planning, technical know--how,how,dedication, and sustained commitment.dedication, and sustained commitment.

Responsible transformation requires that theResponsible transformation requires that thevarious elements that compose the desiredvarious elements that compose the desiredtransformed system have been demonstrated totransformed system have been demonstrated tobe beneficial for the persons receiving MHbe beneficial for the persons receiving MHservices.services.


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Demonstrations and PilotsDemonstrations and PilotsThings to ConsiderThings to Consider

Demonstrations and PilotsDemonstrations and PilotsThings to ConsiderThings to Consider

Until a a systemic transformation to a selfUntil a a systemic transformation to a self--directed caredirected careservice delivery system is embarked upon, workingservice delivery system is embarked upon, workingcollaboratively with existing providers of casecollaboratively with existing providers of casemanagement services will help avoid anmanagement services will help avoid an us against themus against themclimate. For example, EIBs customers were referred byclimate. For example, EIBs customers were referred byprovider agencies and continued to receive services fromprovider agencies and continued to receive services fromreferring agencies.referring agencies.

Collect qualitative and quantitative evidence thatCollect qualitative and quantitative evidence that

captures changes in customer selfcaptures changes in customer self--esteem, employmentesteem, employmentand education status, living situation, A&D recovery, andand education status, living situation, A&D recovery, andservice utilization.service utilization.

Until a a systemic transformation to a selfUntil a a systemic transformation to a self--directed caredirected careservice delivery system is embarked upon, workingservice delivery system is embarked upon, workingcollaboratively with existing providers of casecollaboratively with existing providers of casemanagement services will help avoid anmanagement services will help avoid an us against themus against themclimate. For example, EIBs customers were referred byclimate. For example, EIBs customers were referred byprovider agencies and continued to receive services fromprovider agencies and continued to receive services fromreferring agencies.referring agencies.

Collect qualitative and quantitative evidence thatCollect qualitative and quantitative evidence that

captures changes in customer selfcaptures changes in customer self--esteem, employmentesteem, employmentand education status, living situation, A&D recovery, andand education status, living situation, A&D recovery, andservice utilization.service utilization.


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SpeakerContact InformationSpeakerContact InformationSpeakerContact InformationSpeakerContact Information

Michael HlebechukMichael Hlebechuk

Department of Human ServicesDepartment of Human Services

Addictions and Mental Health DivisionAddictions and Mental Health Division500 Summer St NE, E500 Summer St NE, E--8686

Salem, Oregon 97301Salem, Oregon 97301

Ph. 503.947.5536Ph. 503.947.5536

Email. [email protected]. [email protected]

Michael HlebechukMichael Hlebechuk

Department of Human ServicesDepartment of Human Services

Addictions and Mental Health DivisionAddictions and Mental Health Division500 Summer St NE, E500 Summer St NE, E--8686

Salem, Oregon 97301Salem, Oregon 97301

Ph. 503.947.5536Ph. 503.947.5536

Email. [email protected]. [email protected]

michael hlebechuk nccbh

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