BOARD MEETING PACKET - Hanover County, VA

STATEMENT OF MISSION

We partner with individuals to provide supports and services in the areas of • Mental Health• Developmental Disabilities• Substance Use Disorders

in their efforts to lead satisfying and productive lives in their communities.

BOARD MEETING PACKET PREPARED FOR

HANOVER COUNTY COMMUNITY SERVICES BOARD

MEETING DATE June 17, 2019 MEETING TIME 5:30 p.m. LOCATION Hanover Community Services Board Conference Room

12300 Washington Highway Ashland, VA 23005

Hanover CSB - June 2019 Board Packet Page 1

AGENDA HANOVER COUNTY COMMUNITY SERVICES BOARD

June 17, 2019 – 5:30 p.m. Hanover Community Services Board Conference Room

12300 Washington Highway, Ashland, VA 23005

5:30 p.m. – Call to Order and Welcome

Work Session: Intensive Community Treatment Team

6:30 p.m. – General Business

1. Reconvene

2. Donations

3. Public Comments

4. Approval of Minutes – May 20, 2019 Board Meeting

5. Executive Director’s Reporta. Directors’ Updatesb. Other Items

6. Chairperson’s Reporta. Executive Committee Reportb. August Meetingc. Work Session Planningd. Other Items

7. Board Member Updates & Activities (to include Board Liaison Reports)a. Public Awareness Committeeb. Other Items

8. Action Item – Appointment of Ad Hoc Committee – Jean C. Harris Award

9. Closed Session: Section 2.2-3711(A)(1) of the Code of Virginia – AnnualPerformance Evaluation of the Executive Director

10. Adjourn

Next Regularly Scheduled Meeting: July 15, 2019, 5:30 p.m. Hanover Community Services Board Conference Room

12300 Washington Highway, Ashland, VA 23005

The Hanover County Community Services Board, an administrative policy body, is comprised of county residents appointed to set policies for the provision of mental health, developmental and

substance use disorder services.

Among other duties, the HCCSB reviews and evaluates services and facilities, ensures compliance with the annual performance contract, approves a schedule of fees and advocates on behalf of

county residents.


Hanover: People, Tradition and Spirit

BOARD OF SUPERVISORS

0BW. CANOVA PETERSON, CHAIRMAN MECHANICSVILLE DISTRICT

HANOVER COURTHOUSE

COMMUNITY SERVICES BOARD

5BSCOTT A. WYATT, VICE-CHAIRMAN COLD HARBOR DISTRICT

SEAN DAVIS HENRY DISTRICT

IVY T. SAGER, MSW

EXECUTIVE DIRECTOR

2BWAYNE T. HAZZARD SOUTH ANNA DISTRICT

12300 WASHINGTON HIGHWAY ASHLAND, VIRGINIA 23005

1BANGELA KELLY-WIECEK CHICKAHOMINY DISTRICT

PHONE: 804-365-4222

3BFAYE O. PRICHARD ASHLAND DISTRICT

FAX: 804-365-4252

HANOVER COUNTY ESTABLISHED IN 1720

4BAUBREY M. STANLEY BEAVERDAM DISTRICT

WWW.HANOVERCOUNTY.GOV

CECIL R. HARRIS, JR. COUNTY ADMINISTRATOR

UDRAFT OF MINUTES May 20, 2019

Members Present Members Absent Others

Scott Bateman William Brenzovich Anne Cross Jeanie Edwards Amy Gregory Lynn Hargrove Hamilton Holloway Jim Hunt Melissa Young

Sean Davis Margaret Perkinson Lori Spain

Lorrie Ann Booker Gabriella Caldwell-Miller Katie Donhauser Joelle Inge-Messerschmidt Bernie Jordan Courtney Lakin Lars Messerschmidt Stephanie Rohde Ivy Sager Jim Taylor Scott Ward

Call to Order The meeting was called to order by Scott Bateman, Chairperson, at 5:35 p.m. at the Hanover Community Services Board conference room, 12300 Washington Highway, Ashland VA 23005. The following members were present: Scott Bateman, William Brenzovich, Anne Cross, Jeanie Edwards, Amy Gregory, Lynn Hargrove, Hamilton Holloway, Jim Hunt and Melissa Young. Work Session Scott Ward, Lars Messerschmidt and Stephanie Rohde provided an overview of Crisis & Urgent Care Services. Donations None. Public Comments None. Approval of Minutes The minutes of the April 15, 2019 Board meeting were approved as submitted.



UThird Quarter Financial Report Bernie Jordan reviewed the revenue and expenditure report found in the Board packet. He spoke to Medicaid Expansion and Medicaid revenues. He mentioned that at 3P

rdP quarter, the year-end projection is

that revenues will be over expenses by $548,000. Ivy Sager spoke to the Medicaid Expansion monitoring process and mentioned the expected $382,000 reduction in state funding next year. Discussion ensued. Anne Cross inquired as to the number of clients signed up through the expansion. Mr. Jordan spoke to an analysis of the signups, as there are many things to consider. Discussion ensued and Ms. Sager reminded the Board that a work session related to Medicaid Expansion, to include the data queried, is being planned for later in the year. Executive Director's Report Ms. Sager reminded everyone that it is time for the Performance Contract process and spoke to the 30-day public comment period, which staff are working to have begin on June 14. She added that if there were no delays, it will be on the July Board agenda and presented to the Board of Supervisors also in July. Ms. Sager spoke to the success of the Prevention Team’s community Mental Health First Aid class. She went on to say that the Mental Health First Aid class, as well as the Hostage Negotiation Team and Critical Incident Response highlighted in the work session, are a few examples of our continual commitment to community partnerships. Hamilton Holloway asked for details on the new Credible Enhanced Engagement module. Ms. Sager responded that the proposed features are significantly better and more robust than the previous product and it will be able to assist with the implementation of “Just In Time” scheduling. Scott Bateman brought attention to the Employee Appreciation event and encouraged participation by the Board. Chairperson’s Report Scott Bateman announced that Melissa Young will report on the VACSB Conference. William Brenzovich interjected that this was the best VACSB Training and Development Conference he had ever attended. He went on to say that over 30 Board Members attended and the Board sessions were fantastic. Mr. Brenzovich announced that he had been re-elected to his position with the VACSB. Ms. Young then provided a power point presentation on her experience during the second day of the conference. Mr. Bateman yielded to Jim Taylor who addressed the Performance Evaluation process for the Executive Director. Mr. Taylor gave a quick overview of the process and shared that members would receive a survey shortly for each to share their input. He added that feedback is a gift and that Ms. Sager appreciates it. Mr. Bateman reviewed Work Session planning and asked for clarification on Transition Services; Ms.



Sager provided further information. Ms. Sager spoke to the August Board meeting and indicated that a decision would be made in June, based on completion of the Performance Contract, as to whether or not the Board will meet in August. She also reviewed the work sessions for the remainder of the year. Board Member Updates and Activities Mr. Brenzovich mentioned that he wished more Board members could have attended the VACSB conference. Mr. Holloway announced two scholarships available to Hanover residents for equipment and recreation. Amy Gregory announced that HCSS awarded two scholarships, one to a Lee Davis graduate and the other to a Patrick Henry graduate, to be used toward Fall tuition. Ms. Gregory announced that Miss Hanover Abilities sang at the Spirit of Volunteerism Awards and shared that the next HCSS meeting will feature a presentation from a fund raising expert. Ms. Gregory announced that the Public Awareness Committee is taking small steps and plans on presenting at the July Board meeting. Action Item(s) None. The next regularly scheduled Board Meeting will be held on June 17, 2019 at 5:30 p.m. at the Hanover Community Services Board conference room, 12300 Washington Highway, Ashland, VA 23005. There being no other business, Mr. Bateman asked for a motion to adjourn. Mr. Brenzovich made the motion to adjourn with Ms. Cross seconding; the motion passed unanimously. The meeting was adjourned at 7:46pm.


Executive Director’s Monthly Report June 2019

A. Executive Director

UGeneral Updates • Credible Client Portal and Enhanced Client Engagement • Additional Same Day Access Funding • CSB Employee Appreciation Event

Subsequent to additional training on the functionality of Credible’s Client Portal and Client Enhanced Client Engagement module, a cross-system, multi-program Implementation Team, with assistance from county IT, has been established to develop a project plan for both. Staff are excited about these important enhancements to our EHR. DBHDS has offered additional one-time funding for Same Day Access related expenses. Hanover CSB will receive $12,000. A portion of the funds will be used for costs related to the Credible enhancements noted above. Staff are exploring other appropriate use of the remaining funds. As a reminder, the annual appreciation event for CSB staff is June 18, 2019, from 3:00pm - 6:00pm. It will be held in Andrews Hall at Randolph-Macon College. The following is included in this month’s packet:

• April 2019 Dashboard

UAccess Redesign Project In May 2019, 77 individuals presented at the agency seeking services through SDA (72 non-duplicated individuals). Fifty-six individuals proceeded through to the master assessment and were scheduled for an initial appointment with a primary clinician. The remaining 21 did not proceed through the process due to a variety of reasons, including being referred to another service provider (8), being referred to the crisis team for immediate intervention (9), and self-selecting to come back on another day due to time restraints (4). The chart below provides a visual of the primary service type for those who proceeded through master assessment and were scheduled for their first appointment over the last six months.


USTEP-VA The STEP-VA Advisory Committee (STAC) continues to meet monthly to finalize definitions and outcome measures for the remaining services. Staff continue to plan for implementation of Primary Care Screening while preparing to meet the expectations related to Outpatient Services. The agency did receive notification from DBHDS that Hanover CSB will receive $195,000 in July for the Outpatient Services component. Plans are being developed for the use of these funds. UHuman Resources In May, there was one new hire, a part-time “on call” non-benefited Training Specialist. There was one resignation, a Clinician. Also of note, the Psychiatrist position has been posted. Staff hope to have the new psychiatrist in place in the Fall but recruitment is slow, as expected. Supervisory staff continue to work on performance evaluations, which are due June 11, 2019. Eighteen employees were recommended and approved for a Performance Incentive, meaning they will receive 1 or 2% additional pay increase over the base 3% merit. UDonations There were no donations in May.

UCommunity Relations/Community Education Teens Care Too recently completed a short video that highlights their efforts over the past year to promote substance free youth. The video will be shared during the June meeting. The agency’s ICT Supervisor attended a Mental Health Sunday event at Cool Springs Baptist Church on May 19. He networked with local leaders and members of NAMI, provided literature about CSB services, and discussed mental health concerns and challenges with church members.


B. Business Operations • State Reporting Updates • Facility Repairs and Maintenance

36TUState Reporting UpdatesU – Staff continue to work on updating Credible’s (Electronic Health Record) client activity forms to meet the FY 2020 new State reporting requirements. This process will be completed by July 1, 2019. 16T36T

36TUFacility Repairs and MaintenanceU – Staff are working with Facilities and Parks & Recreation on several projects related to the exterior maintenance and grounds for Day Health. The repairs include the roof repair/replacement scheduled for FY 2020, power washing, drainage around foundation, current conditions of grounds, and brickwork maintenance.

C. Behavioral Health & Wellness • RAFT House Updates • Just Say Something Parenting Norms Campaign • Restoration of Competency • Recognizing and Responding to Suicide Risk Ethos Energy Group, a local power company serving a small number of county residents, through their parent company, Doswell Limited Partnership LLC, visited RAFT House recently. As a company, this group is interested in becoming more involved in their local communities. As a result of their visit, the company is purchasing a new commercial refrigerator for the RAFT House kitchen and providing a new sofa for the member services room. Neither donation has been received to date, though the sofa is expected to be delivered later this month. Both items will be presented to the board as a donation after they are received. This organization has also expressed their interest in becoming involved in volunteering to help with yard and outdoor projects later in the year. On May 20-21, the RAFT House peer specialist and five RAFT members attended the VOCAL Conference in Harrisonburg VA. While there, each member took an active part in the conference workshops and in the networking opportunities. VOCAL is a peer-led organization where “peers are empowered to understand and find their own recovery…” The Just Say Something Parenting Norms Campaign is a partnership with Hanover Cares that promotes messaging designed to encourage parents to engage actively with their youth around substance use prevention messages. Messages are shared in a variety of ways including a calendar distributed through the PTAs and county schools; banners at 3 little league complexes, 3 county parks, and 1 church; and 2,000 post cards that were mailed to parents of juniors and seniors with the message shown below:


In May, supervisors from several MHSUD programs attended a training hosted by DBHDS on Restoration of Competency. Competency restoration is a service that is required by VA Code to be provided by CSB’s to individuals that have been found by a Court to be incompetent to stand trial. Usually lasting around six weeks, restoration services attempt to restore the individual’s ability to stand trial through education and other supports. The Crisis and Urgent Care Coordinator led two sessions of Recognizing and Responding to Suicide Risk (RRSR). This two-day training is required for all MHSUD staff that have clinical contact with individuals. This set of trainings had 25 participants and, different from in the past, it included several staff from the Developmental Disabilities Division and three counselors from Hanover Schools. The school personnel attendance resulted from the ongoing relationship between the Crisis Team and the School’s Director of School Counseling.

D. Community Support Services • American Family Fitness Crew Transitions to Individual Employment • Promotional video for Camping World • DHR holds Art Exhibit • LEAP Program at DHR • Cross Division Support for Individual with Dual Diagnosis

The American Family Fitness (AFF) Crew recently transitioned from an enclave/community employment crew (working with a Job Coach who provided frequent, as needed supports) to individual employment status. These individuals have progressed so well it has allowed them more independence to perform job duties with a job coach providing support only twice a month instead of every day, unless there is a need for more visits. The staff at both AFF and the CSB are very proud of these individuals and congratulate them on their journey as they strive to become more independent. This is a huge accomplishment. Another individual receiving Supported Employment services who works at Camping World in Ashland was recently asked to participate in a promotional video for Camping World. This individual did a fantastic job and showed off some features of a new RV unit that will be used for marketing purposes and on Facebook.


DHR held an art exhibition called Different Strokes. This well-attended event gave families, caregivers and others an opportunity to see the creative ways DHR participants are expressing themselves through art. The LEAP Program wrapped up a two month long training for participants about prevention of abuse by establishing healthy relationships. They trained program participants in small groups about healthy, unhealthy, and confusing relationships, identifying feelings and physical signs associated with being uncomfortable, and how to get help.

The Supports Coordination team collaborated with MH Services to open an individual who has a co-occurring mental health diagnosis to ICT services. Supports Coordination continues to work with this individual to link him to housing and was able to obtain Emergency Funding for him to stay in a hotel until he is able to secure permanent housing.

Case Management Data

Case Management Numbers18-Dec 19-Jan 19-Feb 19-Mar 19-Apr 19-May

Active - SPO only 8 8 7 6 7 8

Active - WaiverCommunity Living Waiver 150 147 152 150 150 150Family & Individual Waiver 22 24 28 28 27 28Building Independence Waiver 16 16 16 16 16 15

Active Waiver Total 188 187 196 194 193 193Non Active (Follow Along & Tracking )

TOTAL 126 129 127 127 130 132Consumer Monitoring

TOTAL 193 197 201 205 209 211Contracted DD CM Services

Community Living Waiver 0 0 0 0 0 0Family & Individual Waiver 18 17 17 17 17 17Building Independence Waiver 0 0 0 0 0 0

TOTAL 18 17 17 17 17 17January - 130031 moved to Chesterfield

Total Unduplicated Individuals Served Through Support Coordination/Case Management 533 538 548 549 556 561

Walkins 6 4 5 4 6 7Transfers 2 0 1 0 0 0TOTAL Request for Intakes CM Svcs (Active/Non-Activ 8 4 6 4 6 7

Request for Screening DD Waiver Waitlist 6 6 2 5 4 6Dec Jan Feb Mar Apr May

*Those who meet eligibility and may also receive svcs through Active-SPO OR Non Active OR Consumer MonitoringDD Waiver Wait List Numbers

Priority 1 128 130 133 132 133 135Priority 2 119 122 125 127 129 136Priority 3 13 12 11 12 12 12

TOTAL 260 264 269 271 274 283


4.574081127 402

Hanover CSB ‐ April 2019

FY19 YTD Avg/MonthFY18 Avg/Month

RAFT: 97%57 of 59 attended one or more 6ays

At‐a‐Glance Hospitalizations: 43 Number Served: 1187 Prevention: 281 SDA Avg 1st Appt: 4.212627

1172

02000400060008000

100001200014000

Mental Health(732, 752, 943, 942)*

DevelopmentalDisabilities (186, 456,

523, 591)*

Substance UseDisorders (363, 425,

513, 446)*

Hou

rs

Case Management Units

FY16 FY17 FY18 FY19 YTD 3‐yr Avg‐Expected* # of consumers

29332450

28732166 2293

0

1000

2000

3000

4000

Emergency Services Units

HOURS

Emergency Services Units

FY16 FY17 FY18 FY19 YTD 3‐yr Avg‐Expected

Yes89%

No11%

CUMULATIVE RATE ‐1ST APPOINTMENT KEPT

Yes No

FY18 FY19 FY19 YTD % ofMental Health Services Actual Projected YTD Expected ExpectedAcute Psychiatric or Inpatient Services 19 18 21 15 140%Outpatient Services 316 350 305 309 99%Medical Services 497 500 523 447 117%Case Management Services 943 950 942 881 107%Intensive Community Treatment 69 70 68 68 100%Rehabilitation 76 80 74 76 97%Supported Employment 10 15 6 12 48%Developmental Disability ServicesMedical Services 59 60 54 53 101%Case Management Services 226 225 228 221 103%Rehabilitation 36 35 30 34 88%Supported Employment 86 85 84 82 102%Supportive Residential Services 37 35 33 33 99%Substance Abuse ServicesOutpatient Services 256 250 172 218 79%Medical Services 92 90 80 78 102%Case Management Services 518 525 446 462 97%Intensive Residential Services 24 25 28 21 134%Emergency ServicesEmergency Services 789 780 642 653 98%Consumer Monitoring ‐ Individuals 297 300 363 260 140%Assessment and Evaluation Services 1171 1100 906 924 98%

75‐150% 50‐75%; 151%‐175%<50%, >176%

91

37

9979 82 8372

31

7460 65 67

0

50

100

150

Nov Dec Jan Feb March April

Same Day Access

Walk‐ins (unduplicated)

Assessment Completed/Treatment Initiated

TOTAL: $11,774,253 $8,533,888

$2,535,000 $2,325,301

$779,703 $492,677

$3,591,177 $2,788,854

$4,868,373 $2,927,056

TOTAL: $11,774,253 $8,533,888Revenue

$23,042 $0

$1,593,972 $796,787

$10,157,239 $7,737,101

BUDGET

AMOUNT YTDExpenses YTD % BUDGET BUDGET

76.17%

49.99%

0.00%

Salaries

Oper. Exp

Capital Outlay

60.12%

77.66%

63.19%

91.73%

Local

State + Federal

Other

Medicaid

1) Support local and regional opioid response efforts: Community Response Committee meeting to develop several initiatives, including overdose response kits and a family education series. 2) Fully staff and build the agency's quality leadership team: Completed. 3) Implement just in time scheduling for psychiatric appointments: Pending; process to parallel recruitment of new psychiatrist. 4) Implement DLA‐20 and levels of care: Completed


CSB Board

Three-Month Planning Calendar

July August September -Annual Review of Policies -Jean C. Harris Award nomination period -Review Standards of Professional Conduct & Confidentiality -State Performance Contract Due -Board Planning: 7/8/19 -Board Meeting: 7/15/19 Work Session: Transition Services

NO MEETING? -Board Planning: 8/12/19 -Board Meeting: 8/19/19 Work Session: TBD

-Year End Financial Report -National Suicide Prevention Week -Substance Abuse Recovery Month -Board Planning: 9/9/19 -Board Meeting: 9/16/19 Work Session: Medicaid Expansion Update

Upcoming Events & Activities: June 18, 3:00pm - 6:00pm: Hanover CSB Employee Appreciation June 19: 11:00 am - 12:30pm: Day Health Summer Kick off Luau. The DHR Team will kick off summer with music, food and friends outside on the patio! Wear your best Hawaiian shirt! RSVP to 239-5949 if you plan on attending. Future Work Session Topics:

• State of the County & Budget Overview (October) • SPQM Overview & Data Review (November)


BOARD MEETING PACKET - Hanover County, VA

Documents