FAIRFAX-FALLS CHURCH COMMUNITY SERVICES BOARD - Fairfax County

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FAIRFAX-FALLS CHURCH COMMUNITY SERVICES BOARD

Gary Ambrose, Chair Merrifield Center

8221 Willow Oaks Corporate Drive Level 3 - Room 409A

Fairfax, Virginia 22031

Wednesday, April 26, 2017 5:00 p.m.

1. Meeting Called to Order Gary Ambrose 5:00 p.m.

2. Matters of the Public Gary Ambrose

3. Amendments to the Meeting Agenda Gary Ambrose

4. Approval of CSB March 22, 2017 Board Meeting Minutes Gary Ambrose

5. Matters of the Board

6. Committee Reports

A. Behavioral Health Oversight Committee

B. Fiscal Oversight Committee

C. Legislative Committee

D. Intellectual and Developmental Disability Committee

E. Other Reports

Diane Tuininga

Ken Garnes

Kat Kehoe

Lori Stillman

7. Action Item

A. CSB Officer Nominating Committee

B. Establish CSB Ad Hoc Fee Committee

Gary Ambrose

Gary Ambrose

8. Directors Report Tisha Deeghan

9. Adjournment

March 22, 2017 CSB Board Minutes Page 1 of 8

Fairfax-Falls Church Community Services Board

March 22, 2017

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

Fairfax, VA.

The following CSB members were present: Gary Ambrose, Chair; Daria Akers; Ken Garnes,

Sheila Coplan Jonas, Kat Kehoe, Molly Long, Paul Luisada, Edward Rose, Lori Stillman, Diane

Tuininga, and Jane Woods

The following CSB members were absent: Basilio ‘Sonny’ Cachuela Jr., Suzette Kern, Bettina

Lawton, and Sarah Meiburg

The following CSB staff was present: Daryl Washington, G. Michael Lane, Mark Blackwell,

Belinda Buescher, Lucy Caldwell, Jean Hartman, Evan Jones, Victor Mealy, Jerome Newsome,

Jean Post, Lisa Potter, and Cynthia Tianti.

1. Meeting Called to Order

Gary Ambrose called the meeting to order at 5:03 p.m.

2. Matters of the Public

Dennis Brown with ServiceSource spoke on budget matters and offered thanks for the

recently posted Frequently Asked Questions (FAQ) document related to Developmental

Disability Services.

Tom and Helen Jaeger, parents of an individual receiving services at the Community

Readiness and Support Program (CRSP) regarding budget matters concerning the CSB.

Charles Martin with Wildflour Caterers introduced himself to the Board.

3. CSB Staff Introduction

Mark Blackwell, recently hired Director, Office of Consumer and Family Affairs was

introduced and welcomed.

4. Amendments to the Meeting Agenda

Following a request to add a presentation on Regional Projects including the Local Inpatient

Purchase of Service (LIPOS) program, the agenda was revised as requested and accepted.

5. Approval of the Minutes

Molly Long made a motion for approval of the February 22, 2017 Board meeting minutes of

the Fairfax-Falls Church Community Services Board as presented, which was seconded and

passed.

6. Matters of the Board.

Kat Kehoe described a sporting event for students with disabilities held at McLean High

School, noting the event was enthusiastically and well attended.

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Molly Long conveyed the results of a survey conducted by Supervisor John Cook’s Braddock

District office; informing the board that 2/3 of the 750 responses received were in favor of

Diversion First efforts.

Lori Stillman reported reading a news article on ‘recovery schools’ which design creative

resolutions to address youth opiate use, which has generated some public attention.

Sheila Coplan Jonas reported a tour of the Merrifield Center March 13th for Senator Dick

Saslaw, which was hosted by Tisha Deeghan and Daryl Washington.

Gary Ambrose reported attending a Public Safety Committee presentation before the Board

of Supervisors (BOS) on March 21st. Focused on diversion First, others attendance included

CSB staff Laura Yager and Daryl Washington as well as the Honorable Michael Cassidy,

Chief Judge, Fairfax County General District Court, the Honorable Thomas Sotelo, Chief

Judge, Fairfax County Juvenile and Domestic Relations Court and Lt. Ryan Morgan, Crisis

Intervention Team (CIT) Coordinator, Police Department.

7. Committee Reports

A. Behavioral Health Oversight Committee:

Diane Tuininga, noting Suzette Kern chaired the committee in her absence, read from

the draft minutes highlighting the following:

Tom Jaeger, parent of an individual receiving Community Readiness and

Support Program (CRSP) services expressed concern over the closing of the

program due to proposed budget reductions.

Daryl Washington provided several updates including:

• A budget review of priorities and challenges highlighted the following: 1)

Diversion First; 2) Opioid Epidemic; 3) Affordable Housing; 4)

Integration of Behavioral and Primary Health Care; 5) Public Funding for

Youth Services and; 6) Implementation of Developmental Disability

(DD) Waiver Redesign

• An update to Diversion First was provided. Highlights include an

announcement that the Annual Report is available online, notice that

many of the diversion First achievements are attributed to successful

partnering with court services. There was also a reminder that no new

funding was included in the FY 2018 proposed budget.

• Implementation of Intellectual and Developmental Disability Waiver

Redesign services since the CSB became the single point of entry in July

2016.

Jean Post provided an update to three Regional Programs including Local

Inpatient Purchase of Services (LIPOS), Discharge Assistance Plan (DAP), and

Crisis Stabilization Units (CSU), noting a budget crises facing each program.

Mark Blackwell was introduced and heartily welcomed

Tisha Deeghan provided information on a free mental health event at the Joe

and Fredona Gartlan Mental Health Center, April 27, 2017; attendance was

encouraged.

The Wellness and Recovery Group met just prior to the BHOC meeting,

continuing work on identifying an appropriate venue and confirmation of a

date for the October 2017 Wellness and Recovery Conference.

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The next BHOC meeting is Wednesday, April 12, 5:00 p.m. at the Merrifield Center,

Level 3-Room 409A.

B. Fiscal Oversight Committee:

Ken Garnes supplied the following overview of the March meeting to include:

Fiscal reports indicated no material change from last month. Staff reported

Vacant General Merit positions of 143, which is 43 over the Vacancy

Breakeven Point (VBP)

CSB and Department of Management and Budget (DMB) staff are working to

identify one-time requests for utilization of FY 2017 unspent funds. Staff will

report identified requests to the CSB Board before submitting a request to the

county.

The Human Resources Update indicated no material changes.

Referring to a handout provided in the meeting packet, Mr. Garnes reported on

a follow up Human Services Council (HSC) meeting held Saturday, March 18th

the title of which was “Unified Messaging Initiative”:

• The primary focus was to identify a unified message in preparation for

testifying before the Board of Supervisors (BOS) in April. Note: CSB

staff Belinda Buescher is crafting the language for the CSB testimony.

• HSC budget priorities (listed in order) were identified as 1) Diversion

First; 2) a $500,000 grant for a longitudinal study on an addictive

analysis of children; 3) a $250,000 one-time grant to study Health and

Human Services trends; 4) and the Contract Rate Adjustment (CRA) not

currently in the FY 2018 proposed budget.

• There was some discussion regarding ‘block scheduling’ future testimony

instead of several speakers addressing the BOS in small increments.

• Also in attendance were Board Chair Gary Ambrose and Board Member

Edward Rose.

The next meeting of the Fiscal Oversight Committee is Friday, April 21, 9:00 a.m. at

the Pennino Building, Room 836A.

C. Legislative Committee:

Kat Kehoe noted no business was conducted as there was no quorum at the March

meeting. However, Ms. Kehoe provided highlights of recent legislative activities to

include:

The General Assembly session does not conclude until the Governor reviews

and possibly vetoes bills that have passed the House and the Senate. The

General Assembly reconvenes on what is sometimes referred to as ‘Veto Day’,

which is scheduled for Wednesday, April 5, 2017.

An update was provided regarding legislation of interest to the CSB to include

both supported legislation and bills of concern:

Supported legislation:

• REVIVE trainers will be allowed to dispense Naloxone, signed into law.

• Guidelines for the safe prescribing and appropriate use of opioids by

health care providers will be developed, signed into law.

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• Approval for the use of alternative transportation providers (other than

law enforcement personnel) for inmates, a Diversion First effort, signed

into law.

• Legislation of concern:

• A bill that imposed restrictions on the siting of group homes and required

notification of Home Owner Associations (HOAs); retracted and died in

committee.

• A bill to establish a process for state level registration of Peer Recovery

Specialists and Qualified Mental Health Professionals was amended with

the efforts of the Virginia Association of Community Services Boards

(VACSB), which resolved CSB concerns; signed into law.

• A bill authorizing the possession of firearms in homeless shelters passed

the House and Senate; vetoed.

• Additionally, it was noted that House Bill 1549 which mandated same

day access but did not include funding has not been signed. It was

highlighted that this CSB already provides this service.

County Legislative efforts during the General Assembly were summarized

noting that once the veto session has concluded, closing the General Assembly

session, County Legislative staff will work with CSB staff to prepare a

comprehensive report of all the new legislation that impacts the CSB.

The Human Services Issue Paper is expected to be received in May. It was

noted that no significant changes are expected.

The next meeting of the Legislative Committee is Wednesday, May 17, 6:00 p.m. at

the Merrifield Center, Level 3-Room 409A

D. Intellectual and Developmental Disability Committee:

Lori Stillman happily notified the Board that members Jane Woods and Sheila Jonas

have agreed to co-chair the I/DD committee when she steps down in June. Other

information provided included the following:

Noting the distribution of the “Frequently Asked Questions for priority access

guidelines for CSB DD Services” (FAQs) document to the BOS, it was

recommended that Board members follow up with their appointing supervisors

to encourage them to review the document as it may help with responding to

inquiries regarding budget issues related to Medicaid Waivers.

At the March meeting, members of the public expressed concern regarding

funding for Special Ed. graduates. Additional concerns regarding eligibility of

non-citizens were expressed. Associates voiced regret at the lack of funding

for a contract rate adjustment (CRA), reporting they felt devalued as partners.

Some General Assembly matters discussed included:

• The prohibition on Medicaid payment of overtime for certain consumer

directed services.

• The requirement for a stakeholder workgroup to review data on the

Supports Intensity Scale (SIS) evaluation tool for individuals with

developmental disabilities.

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• A requirement for the Department of Medical Assisted Services (DMAS)

to develop a cost-sharing proposal for families of individuals receiving

Medicaid long-term care services.

Staff updates included:

• Ongoing DD case management training.

• The upcoming release of an RFP for Assisted and Community

Residential Services.

• Tisha Deeghan’s presentation on DD Waiver Redesign to the Health &

Human Services Committee of the Board of Supervisors, a copy of which

has also been provided to all Board members.

• Victor Mealy reported on the assignment of 75 waiver slots for

individuals residing in Fairfax County. Ms. Stillman will report back to

the board on the projected cost of the new waivers.

• Jean Post provided data on the regional I/DD Psychiatry Program, the

regional REACH (Regional Educational Assessment Crisis Response and

Habilitation) Youth and Adult Crisis Services and upcoming regional

autism trainings. Ms. Post also noted that a new adult and children’s

therapeutic home is being considered for our area due to high occupancy

rates and demand.

• Daryl Washington led a discussion on CSB Priority Access Guidelines,

including the definition of developmental disabilities.

Other reports included the following:

• vaACCSES members April Pinch Keeler and Karen Tefelsky stressed the

need for creation of a focus group from Northern Virginia to strategize

and determine appropriate messaging on future funding for a Northern

Virginia differential related to Medicaid payments. This will be further

discussed at the upcoming vaACCSES conference in April.

A brief report on the VACSB Board meeting earlier in the day, attended by

Ms. Stillman and Gary Ambrose was provided, to include:

• The General Assembly’s budget requirement for the Secretary of Health

and Human Resources to design an implementation plan that will

financially realign the behavioral health system. Intended to increase

accountability of the hospitals and responsibility of the CSB’s, as well as

build community capacity, this presents a possible opportunity for CSB

Board advocacy as this further develops. The plan is to be completed and

submitted to the General Assembly by December 1st.

In other business,

• Tisha Deeghan will continue as the Chair for the Services Development

Committee.

• Gary Ambrose was endorsed again as a Regional Representative for

Region 2.

• Angelo Wider, a CSB Board member from Loudoun County, has been

chosen to replace Ms. Stillman on the VACSB Board due to term-limits.

The next I/DD meeting is Wednesday, May 10, 5:30 p.m. at the Merrifield

Center, Level 3-Room 409A. Please note the change to the meeting schedule in

accommodation of the VACSB Conference May 3rd – 5th.

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8. Information Item

A. DBHDS Funded Diversion Program Grant Proposal

Daryl Washington notified the Board that annual funds in the amount of $28,195 were

requested from the Virginia Department of Behavioral Health and Developmental

Services (DBHDS) on February 27, 2017, the due date of the application. The funds,

if awarded, will be added to the baseline budget for state-funded Jail Diversion and

will provide for two additional Long Term Permanent Supportive Housing placements

(beds) supporting Diversion First efforts.

B. Application submission for DBHDS Criminal Justice Diversion Programs

Daryl Washington notified the Board of an application for one-time funds totaling

$100,452, must be submitted to DBHDS no later than March 24, 2017, the due date of

the submission. The funds, if awarded, will be added to the budget to fund six part-

time Peer Support Specialists to respond to all five intercept points in support of

Diversion First efforts. As these are one-time funds, a plan will be developed to

integrate these services into the base.

C. Priority Population Guidelines – Update

Daryl Washington provided an overview of the prevailing themes captured following

consultation with Human Services Agencies, public dialogues, the CSB Board and

Committees to include:

A shortage of behavioral healthcare professionals in the Fairfax Community

that are willing to accept insurance causing issues with timely access to

counseling and prescriber services for those who do not meet CSB criteria.

Multiple individuals expressed a desire for a service that would have up to date

information on providers in the community that would be willing to accept

their insurance.

CSB Human Service Partners would like for us to improve our intake,

assessment, and communication process after a referral occurs. Multiple

agencies indicated they would like more timely written

recommendations/findings.

There is a feeling that too many individuals are getting turned away from

behavioral healthcare services at the CSB. People feel this is happening at the

call center and at the point of screening/assessment. (Especially with

individuals that have insurance.)

Concern was expressed over individuals with moderate to mild substance

abuse issues not getting access to CSB services.

Concern was expressed over the proposed changes to DD Day and employment

services. Parents and providers expressed concerns over the future lack of

access to this service area for DD individuals and graduates.

Concern was expressed over the need to define what other services individuals

with DD would access, and when they would be able to access these services:

• Counseling/Therapy

• Behavior Support Specialists

• Medication Services

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• Residential

• Care Coordination/Case Management

Board members and staff engaged in lively discussion.

9. Regional Projects Update

Jean Post provided several handouts in support of a presentation on the critical budget

challenges confronting Regional Programs funded through grants awarded by DBHDS

including LIPOS (Local Purchase of Service), DAP (Discharge Assistance Program) and

CSU (Crisis Stabilization Units). A lengthy discussion ensued.

10. Directors Report

In the absence of Tisha Deeghan, Daryl Washington provided the following information:

A copy of the final issue of the CSB Beacon was provided to Board members.

Moving forward, electronic means of communication will be utilized including

Facebook and the new CSB blog.

A reminder of the Community Conversation on Youth Suicide at the Joe and Fredona

Gartlan Mental Health Center on April 27, 2017 from 1:30 p.m. – 4:30 p.m. A multi-

agency panel of experts including Tisha Deeghan and Lyn Tomlinson will cover

topics including what can be done, risk factors, and prevention. Additional

information will be furnished as it becomes available.

Mr. Washington provided highlights of the Public Safety Committee presentation

before the BOS that was noted earlier by Board Chair Gary Ambrose. Highlights

included:

• First year Diversion First accomplishments.

• A revised Diversion First budget request for FY 2018 of $1.9 million and 18

positions including staff in court services, law enforcement (for 24/7 coverage

at the Merrifield Crisis Response Center (MCRC)), and case managers for

inmates on supervised release and community case management to be provided

at intercept points one, two, and three.

The Frequently Asked Questions (FAQ) document mentioned earlier is being revised

following feedback. The revised version is anticipated to be finalized and distributed

electronically as well as posted on the CSB website within two days.

Noting this report will be provided on an ongoing basis to the Board, Mr. Washington

provided an update on Time to Treatment, to include:

• Highlighting the high number of same-day arrivals requesting walk-in

assessments that cannot be anticipated and may impact the time to treatment.

• Current wait for adult services in English or a native language is two weeks or

less at all sites except Reston, where the wait is 10 weeks and is attributed to

staff turnover. Three staff are being recruited which is expected to reduce the

wait time to match the other sites at an average of two weeks or less.

• Current wait for youth services in English is two weeks at all sites except for

South County. At South county, the wait is three weeks for both English and

Spanish speaking therapists. The wait for a Spanish speaking therapist is

averaging one month at Chantilly. It was noted that efforts to reduce the wait

time include offering a translator in place of a native language speaking

therapist which, if declined, may result in the longer wait time for services.

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Lisa Potter provided copies of the CSB Status Report – FY 2017 Second Quarter (Dashboard

Report) and the accompanying CSB Report Data Definitions. A summary of the changes to

the report was provided. It was noted the Status Report provided is the pilot of a new format,

to which the Data Definitions provide context and background. Feedback was requested from

the Board members. Following some minor corrections, an electronic copy will be furnished

to the board.

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

seconded and carried. The meeting was adjourned at 7:02 p.m.

Date Staff to Board

•

Actions Taken--

⬥ The February 15, 2017 meeting minutes were approved.

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Behavioral Health Oversight Committee Meeting Minutes

Behavioral Health Oversight Committee Page 1 of 4 March 8, 2017

Date: March 8, 2017 Location: Merrifield Center, Third Floor, Room 3-409A East Attendees: CSB Board Member Suzette Kern; CSB Board Member Daria Akers; CSB Board Member Gary Ambrose; CSB Board Member Basilio ‘Sonny’ Cachuela, Jr; Terry Atkinson, Gartlan Advisory Board; Peter Clark, No. Virginia Mental Health Foundation; Lauren Goldschmidt, ServiceSource, Inc. Joe Getch, PRS, Inc.; Deanne Mullins, Community Residences, Inc. ; Heather Peck, LMECC; Joe Pettit, Concerned Fairfax; Tisha Deeghan, Executive Director; Daryl Washington, CSB Deputy Director; Jean Post, Director Northern Virginia Regional Projects; Lyn Tomlinson, Assistant Deputy Dir., Acute & Therapeutic Treatment Services; Lucy Caldwell, CSB Communications Director; Marissa Farina-Morse, Director Diversion and Jail-Based Services; Mark Blackwell, Director Office of Consumer and Family Affairs. Also present were other private sector staff as well as members of the public

Topic Action Responsible Party

Due Date

Meeting Call to Order

Meeting was called to order at 5:00 p.m. Suzette Kern

Opening Remarks Announcements

All attendees introduced themselves including staff, committee and associate members, and members of the public.

Minutes

Following review of the February 2017 Behavioral Health Oversight Committee draft minutes Gary Ambrose made a motion to approve the minutes as presented, which Basilio ‘Sonny’ Cachuela, Jr. seconded. The motion carried unanimously.

Committee Members

Associate Member Presentations and Concerns

Terry Atkinson announced the March meeting of the Gartlan Center Advisory Board will be Tuesday,

March 14 indicating a report will be presented at the April BHOC meeting.

Heather Peck, Executive Director Laurie Mitchell Empowerment Career Center (LMECC) and Carlton

Van Lowe, LMECC, shared their stories of recovery, also giving examples of the positive effects of

employment on recovery for others they have worked with.

Joe Getch, reported that the Substance Abuse and Mental Health Services Administration

(SAMSHA), the National Institute of Mental Health (NIMH), and the Office of the Assistant Secretary

for Planning and Evaluation at the Department of Health and Human Services (HHS) have selected

the Turning Point program, a specialty care program operated in partnership with PRS, as one of 32

programs to participate in the Mental Health Block Grant 10% Set Aside Study (MHBG 10% Study).

Programs who participate in this three-year study will be reimbursed $5000 for participation in

years 2 and 3 of the study, a total of $10,000 each.

Additionally, Mr. Getch reported that PRS is hosting a Hope and Recovery Benefit on Saturday, April

6th, titled “PRS Raising the Stakes” flyers were distributed and attendance was encouraged.

Associate Members

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Due Date

Joe Pettit with Concerned Fairfax reported that Jeanne Comeau, President and CEO, National

Alliance on Mental Illness (NAMI) NO VA and Co-Chair of Concerned Fairfax will be speaking at the

Human Services Council on Thursday, March 9th.

Matters of the Public

Thomas Jaeger, parent of a client in the Community Readiness Support Program (CRSP), provided testimony regarding budget matters concerning the Fairfax-Falls Church Community Services Board

FY 2018 Budget

Referring to documents included with the agenda materials, Daryl Washington provided an overview of FY

2018 budget priorities and challenges for the CSB including: 1) Diversion First; 2) Opioid Epidemic; 3)

Affordable Housing; 4) Integration of Behavioral and Primary Health Care; 5) Public Funding for Youth

Services and; 6) Implementation of Developmental Disability (DD) Waiver Redesign including the impact to

non-mandated day and employment services. Questions and discussion followed each topic.

Also addressed was the infusion of resources in FY 2018 for the addition of 22 Support Coordinators, needed

to provide mandated services related to Developmental Disability (DD) Waiver Redesign.

Mr. Washington provided an overview of the proposed program eliminations in the FY 2018 budget

affecting the Youth Day Treatment Program and the Community Readiness and Support Program (CRSP). It

was noted there are options in the community for individuals affected by proposed program closures and

planned staff redeployment.

Included in the materials were copies of a presentation on the FY 2018 Advertised Budget Plan provided in

February 2017 by Deputy County Executive Pat Harrison. The presentation provided a high-level overview of

the county budget as well as the proposed human services reductions. Mr. Washington emphasized that the

FY 2018 budget reflects a slow, steady growth reflective of a change to the county tax base driven primarily

by decreased real estate tax revenue.

Daryl Washington

Diversion First Update

Announcing the Diversion First Annual Report is available online, a link will be sent to all attendants.

Marissa Farina-Morse provided an update to recent Diversion First activities highlighting the following:

o Diversion First teams are partnering with the Court Services Unit to address identifying individuals entering the jail or already incarcerated who may need diversion services.

Daryl Washington Marissa Farina- Morse

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Due Date

o Jail Diversion Staff is embedded at the Merrifield Center in Emergency Services and with the Merrifield Crisis Resource Center (MCRC) offering an early opportunity to identify individuals in need of diversion services.

o Jail Diversion staff is also deployed with the Mental Health Court Services Unit to assist with early intervention and assessment for need of diversion services.

Acknowledging that the FY 2018 Advertised Budget does not include new Diversion First funding, it was noted a primary factor the success of the first year was partially attributed to collaboration with community partners and use of targeted resources.

A proposal for some additional funding is being drafted by CSB staff and law enforcement partners in preparation for the March Public Safety Committee meeting. Note: The Public Safety Commission Meeting is Tuesday, March 21st at 7:00 p.m. in the Government Center, 12000 Government Center Parkway, Conference Room #11, Fairfax

o The proposal includes a request to increase the number of Behavioral Health Commissions to address diversion at early intercept points and due to the rise in diverted individuals coming to Emergency Services (ES) and the MCRC, a request for funding to increase to 24/7 the hours of law enforcement coverage.

Implementation of IDD Services

Mr. Washington provided an update to the implementation of Intellectual and Developmental Disability Services, acknowledging many changes since the CSB became the single point of entry for services in July 2016. Those updates included:

Vendor agencies contracted to provide DD Case Management services have begun billing Medicaid under the CSB license. Training of the vendor agencies included documentation and procedures in compliance with Medicaid regulations, noting that any non-compliance pay back will be the responsibility of the CSB as the licensed entity.

It was clarified that CSB Support Coordinators provide ID Case Management services as well as DD Case Management services to individuals with DD Waivers. It was noted the CSB received 70 DD Waivers that will be assigned to individuals on a waitlist following assessment and prioritization by the Independent Review Committee (IRC) for community members with the highest level of need.

Tisha Deeghan provided further insight noting that there are more than 11,000 individuals on the statewide waitlist of which approximately 2,000 are waitlisted in Fairfax County.

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Due Date

Regional Office Information and Implications

Jean Post with Northern Virginia Regional Projects provided a brief overview of three behavioral health regional programs. Ms. Post distributed handouts that illustrated the significant changes in the last year which contributed to insufficient funding for each program, noting the following:

Local Inpatient Purchase of Services (LIPOS); a Department of Behavioral Health and Developmental Services (DBHDS) grant program that addresses diversion/step-down from state facilities to community resources. It was noted the funding has not increased in a number of years and due to an increased demand for hospital-based services there is insufficient funding to continue LIPOS authorizations through April 2017. Additional funds have been requested to cover the shortfall through FY 2017. Without further funding, LIPOS authorizations will cease in April 2017 and resume July 1, 2017 when the FY 2018 acute care allocation becomes available.

Discharge Assistance Plan (DAP), a DBHDS grant program designed to assist individuals who require non-traditional services appropriate to meet their complex and specialized needs discharging from state hospitals. A lack of funding has resulted in a waitlist. It was noted that unspent DAP funds from other regions may be redistributed to this region to address the waitlist.

Crisis Stabilization Units (CSU), funded through a combination of a DBHDS grant award and local funding is primarily for step-down from hospital care or diversion from hospital admission, providing crisis stabilization services in a group home setting as an alternative to hospitalization.

The committee recommended that the full board receive an overview briefing of the funding issues impacting the regional behavioral health programs.

Staff Reports

Mark Blackwell, recently hired Director for the Office of Consumer and Family Affairs was introduced and welcomed.

Tisha Deeghan encouraged attendance at a free Mental Health event to be held at the Joe and Fredona Gartlan Mental Health Center on April 27, 2017, additional information will be furnished as it becomes available.

Adjournment There being no further business to come before the Committee, the meeting was adjourned at 6:47 p.m. Suzette Kern

April 12, 2017

Date Approved Prepared by Erin Bloom

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CSB Fiscal Committee Meeting Notes

Fiscal Oversight Committee Page 1 of 4 March 17, 2017

Date: March 17, 2017 Attending: Ken Garnes, Chair; Gary Ambrose, Suzette Kern, Bettina Lawton, Edward Rose

and Lori Stillman Staff: Tisha Deeghan, Daryl Washington, Michael Lane, Marta Cruz, and Lisa Witt

Summary of Information Shared/Decisions:

Review of meeting notes

The committee reviewed and approved the notes of the February 17, 2017 committee meeting as presented.

Financial Status

Lisa Witt, noting no material change from the last reporting period, provided the financial status update to include the following:

Position Status

o As of March 13, 2017, the CSB had a total of 143 Fund 400 vacant general merit positions, 43 over the Vacant Breakeven Point (VBP) of 100.

o Position changes from Pay Period (PP)03 to PP04 included 15 vacancies offset by 17 appointments with a net of 2.

o Also noted, the Average Weekly Vacancy Rate for FY 2017 (PP15-PP6) was 14.3%.

FY 2017 PP Metrics

o PP4 reflects accumulated Compensation and Fringe Benefits savings of approximately $5,600,000.00.

Modified Fund Statement

o Compensation fringe benefit projections were updated to reflect a decrease in the number of projected new hires from ten to six to correspond with annual average.

o Noting the projected year-end balance, staff is identifying needs for one-time funding as well as FY 2018 needs not included in the FY 2018 budget.

Human Resources (HR) Updates

Marta Cruz provided the Human Resources update to include:

The Regular Merit Vacancies as of March 6, 2017 totaled 142 with 74 vacant positions funded and approved to fill.

February 2017 appointments totaled 34 with seven terminations. Note: Appointments include new hires, promotions, transfers, non-merit hires, and other appointment types.

Recruitment and retention activities include

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o Emergency Services: Hiring of one merit Crisis Intervention Specialist (CIS) and one Mental Health Counselor is being finalized. Resumes are under review for three remaining CIS positions.

o Youth & Family Services: Three Sr. Clinicians and one Manager have been hired in 2017. An ad for an additional seven positions closes March 17, 2107.

o Support Coordination: Seven Support Coordinators have been hired in 2017 to date. Six strong candidates are in consideration with another recruitment ad to be posted soon to fill the 7th available position. It was further noted that recruitment and retention for Support Coordination positions is a consistent challenge, noting recruitment is anticipated to be ongoing.

o Diversion First: All Diversion First positions have been filled.

Diversion First

Daryl Washington offered highlights of recent Diversion First activities including the following:

Peer Support staff contracted through Recovery Program Solutions of Virginia (RPSV) is being transitioned to part-time CSB staff in response to a request from RPSV. This transition is anticipated to be completed by the end of FY 2017.

Diversion First staff has assumed a new role with Court Services, working Mon. – Fri. beginning at 6:00 a.m. in booking, identifying individuals prior to the preliminary hearing who may need Diversion First services.

CSB staff and Court Services are also partnering to identify individuals, released on supervised probation, who may need mental health/case management services.

Noting no new Diversion First funding was included in the proposed FY 2018 budget, CSB staff in partnership with law enforcement and court staff are collaborating to draft an amended budget request.

Diversion First staff are now embedded in Emergency Services to assist with identification of individuals who need services but do not meet criteria for hospitalization or crisis care.

Time to Treatment

Daryl Washington provided an overview of the length of time from assessment to initial appointment (time to treatment) for both youth and adult programs.

Youth

o Time to treatment is an average of two weeks, noting an impact by the following factors:

Need or request for a translator or native language speaking therapist or case manager.

Location of services at request of individual.

Availability of clinician to meet the identified needs of the individual.

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o It was noted that recruitment of child psychiatrists has eased somewhat in response to the salary adjustment increase for psychiatrists.

o Additionally, Nurse Practitioners are being utilized to expand the ability to see clients.

o Delay to treatment information was provided for each location to include:

Chantilly services provided in English is 1 week, provision in Spanish can be up to 27 days, noting the usual delay averages two weeks.

At the Merrifield Center services are provided almost immediately following assessment.

Reston, including provision by a Spanish speaking therapist is also almost immediate.

Springfield is averaging two weeks including services in Spanish.

South County is 20 days, increasing to 22 days for a Spanish speaking therapist. It was noted that ongoing staff hiring is anticipated to decrease this wait time.

Please note the delay to treatment ranges provided above reflect an average time to treatment.

Adult

o Time to treatment varies widely, from two weeks to several months (wait list) and is impacted by the following:

Clinician availability, also impacted if a native language speaking therapist/case manager is needed or requested.

It was further noted that Sr. Clinicians may be used to provide services and remain in compliance with Medicaid billing requirements.

o Delay to treatment information for adults at each location was provided to include:

Individuals on a wait list are assigned to a team to provide a contact and in case of crisis; monitoring is provided, but no active work is conducted.

Chantilly averages two weeks.

Reston averages 10 weeks attributed primarily to staff turnover. It was noted that the hiring of three clinicians is being finalized and is expected to reduce wait time to approximately two weeks.

Merrifield, Springfield, and Gartlan are all averaging up to 3.5 weeks, which is being addressed through ongoing hiring.

It was further noted that if the individual is determined to need Emergency Services, the service provision location will change to Merrifield.

The wait list status may change if Emergency Services is recommended.

o Following a request for monthly updates, a Time to Treatment status update will be added to the agenda as a regular item beginning with the April 2017 committee meeting.

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FY 2018 Advertised Budget

Tisha Deeghan reported completion of a Frequently Asked Questions (FAQ) document which has been provided to the Board of Supervisors (BOS), the CSB Board, and CSB staff. The FAQ is intended to provide information and answers to questions from constituents, providers, families, and others wondering about the changes in access to non-mandated services for people with Developmental Disabilities.

Action Items/Responsible Party Required Prior to Next Meeting:

Daryl Washington will provide information on procedures related to client care and staff/team efforts to reach out/contact an individual while on the wait list.

Time to Treatment will be added to the committee meeting agenda as a regular item beginning with the April 2017 committee meeting.

Issues to Communicate to CSB Board:

Daryl Washington will provide a Time to Treatment overview to the full board; March 22, 2017.

Agenda Items for Next Meeting on April 21, 2017:

Fiscal Oversight Committee meeting Friday, April 21, 2017 at 9:00 a.m. Pennino Building, 12011 Government Center Parkway, Room 836A

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COMMUNITY SERVICES BOARD Item: 7A Type: Action Date: 4/26/2017

CSB Officer Nominating Committee Issue: The CSB Executive Committee is proposing the appointment of Ken Garnes, Sarah Meiburg, and Lori Stillman to serve on the Nominating Committee for the FY 2018 CSB officer elections Recommended Motion: I move that the Fairfax-Falls Church Community Services Board approve the Nomination Committee being recommended by the Executive Committee for coordinating the FY 2018 Board officer elections process. Background: As outlined in the CSB Bylaws, in April of each year a nominating committee comprised of three Board members is tasked with identifying potential candidates to serve as Board officers in the upcoming fiscal year. The officer positions include the Chair, Vice Chair and Secretary. Following the deliberation process, at the June meeting, nominees for each office are presented along with requests for any floor nominations and the elections held. Timing: Appointment of the Nominating Committee at the April 26 CSB Board meeting, with elections to take place at the June 28 Board meeting CSB Board member: Gary Ambrose, Chair

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Attachment

COMMUNITY SERVICES BOARD Item: 7B Type: Action Date: 4/26/17

Appointment of Ad Hoc Fee Policy Committee Issue The CSB Executive Committee is proposing the establishment of an Ad Hoc Fee Policy Committee and the selection of its members for the 2017/2018 fee related review work. Recommended Motion I move that the CSB Board establish an Ad Hoc Fee Policy Committee comprised of three members as recommended. Background As outlined in the CSB Bylaws, Ad Hoc Committees may be established by the full Board as needed. Those Committees may be established to address any issue for which the full Board determines that the subject matter or issue cannot be adequately addressed by the Standing Committees. The members of each Ad Hoc Committee shall elect one of their members as Chair for a one-year term. CSB Board Policy 2120, Reimbursement for Services, requires the annual review of fees and the provision of guidance on the system that provides subsidies and various payment methods based on the ability to pay and addresses delinquent accounts based on County policy. In addition to conducting a review of the Board Policy 2120, the Ad Hoc Fee Policy Committee reviews staff proposals on the Ability to Pay Scale, the Fee and Subsidy Related Regulation 2120.1, and the Fee Schedule, and makes recommendations. The Ad Hoc Fee Policy Committee then brings forward to the full Board a recommendation to post changes for public comment. Timing Request approval at the April 26th CSB Board meeting to prepare deliverables and meet the review deadlines. Board Member/Staff Gary Ambrose, Chair Lakeisha Kennedy-Flores, Service Director, Business Operations G. Michael Lane, Deputy Director, Administrative Operations

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FAIRFAX-FALLS CHURCH COMMUNITY SERVICES BOARD - Fairfax County

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