Illinois Department of Human Services Illinois Mental Health Planning and Advising Council met Feb. 9.
Here are the minutes provided by the council:
Call to Order/Introductions
Sue Schroeder noted that a quorum may not yet be available but suggested that the meeting be called to order so we could start with attendance and introductions. Lee Ann asked to cover some WebEx housekeeping issues for new attendees before calling the roll. Camera function is allowed, but chat is only allowed to the host for technical issues, not for discussing council business, due to the Open Meetings Act, as people calling in cannot see the chat. Courtney reminded everyone calling in to mute themselves to avoid background noise, because if she needs to mute them as the host, they will not be able to unmute themselves to join in the discussion. Lee Ann offered to facilitate the roll call and noted that enough people have joined now that a quorum has likely been reached. Sue agreed.
Attendees:
Via WebEx: Lee Ann Reinert, Lisa Betz, Nanette Larson, Amy Starin, Brock Dunlap, Christopher Stohr, David Albert, Donell Barnett, Ricardo Anderson, Sarah Scruggs, Erin Grima, Heather Butler, Irwin Kerzner, Isaac Palmer, Joan Lodge, John Fallon, LaToya Marz, Marianne Bithos, Michelle Churchy-Mims, Patty Johnstone, Ray Connor, Ron Melka, Ryan Rollinson, Sarah Wiemeyer, Shane Hassler, Shirley Davis, Sidney Weissman, Stephanie Frank, Sue Schroeder, Thane Dykstra, Tracy Meinert, Greg Roudin, Rashad Saafir, Courtney Aidich (Host), Christina Ancira (notetaker)
Via Phone: Dennis Hopkins, Michael Davis, John Fallon;
Lee Ann advised that Ryan Rollinson is now joining the call to discuss Consent Decree matters, as Beth is no longer with DMH.
Approval of the Minutes
Sue Schroeder asked for a motion to approve minutes from November 4, 2021. Joan Lodge had a name spelling correction for Ron Melka. Tracy moved to approve the minutes with the correction, and Dr. Scruggs gave a second; so approved.
Committee Reports
Sue noted that the agenda has been moved around so that committees that used to be at the end are now at the beginning, so they are not rushed.
Child & Adolescent Committee Report
Amy Starin noted she was not at the last meeting, but they wanted to put forth for consideration a problem of the children's mental health workforce shortage crisis, and the role of DMH in it. The programs have grant money, but child MH experts don't exist out there to be hired. The work is hard and pay is low, so it's created a crisis for children, not just in IL but across the country. The community mental health system's ability to support and train new workforce has eroded, and they're wondering what the DMH can do to reinstate some capacity in the community MH system. Michelle agreed with Amy's summary of the previous meeting and the state of crisis. She stated they also want more family involvement on their committee. Ray Connor stated it would be helpful if IMHPAC could make some recommendations on how to address this problem. There is the issue of rates, but also of policy & procedures. John Allen was wondering if the DD GuideStar system could be useful? Also, we need to recognize that we lost a DCFS worker in the community yesterday, and that we need more home supports as part of the Olmstead decree. Are there opportunities to see if services provided by school districts could be Medicaid reimbursable? Director Albert ask for contributions from his team for ideas, and also deferred to HFS on any rate studies or related questions. He agreed that we are facing crisis in the behavioral health workforce and would be happy to join with existing efforts to help. It should be an 'all hands on deck' effort, not just DMH. He welcomed any ideas that anyone wants to share. We need to do all we can that providers don't shut down and services remain available. We've faced similar challenges in the past, but the current issues are unique, as well. We're looking at other resources for CMHCs, including COVID mitigation support funds. Many of these are short-term solutions, though, and we need to look more into long-term sustainability to attract, train and retain behavioral health workforce, such as student loan forgiveness programs. We are currently partnering with higher education institutions to create a Behavioral Health Workforce Center which will help with long-term concerns and facilitate pathways to employment. We are also working on our CRSS Success program, to which we have committed $8 million to develop CRSS training programs at higher education institutions, as well. There are funds built into this to help overcome barriers such as transportation and childcare. We are doing a lot of things, but I'm sure there are other great ideas that we haven't heard, so we would love to hear more ideas.
Lee Ann expressed an interest in Amy's mention of policy & procedure issues and asked if there are things we can do, other than funding, to help address the problem. Getting funding quickly is very difficult, so if there are other things we can do as a regulatory body, those could be a helpful part of the solution. Amy agreed that it will take multiple approaches. Too much control has gone over to HFS over the MH system. Is there a possibility of using block grant funds to agencies to offer paid internships for BA/MA students, or to pay for supervision? Could child-specific competencies to the CRSS workforce program? She would like to see DMH lead these conversations. Ray Connor noted the complicated procedures needed to begin services; they can be burdensome. Maybe DMH & HFS could reduce the intake procedures and the complexity of the paperwork. Lisa Betz noted that HFS does have a workgroup to look at schools billing Medicaid. Also, there was a change in legislation that requires providers to offer up to 6 sessions for engagement before the IM-CANS is completed. This is especially important during COVID. Ron Melka asked if the relicensing leniency issue from a previous meeting has had any feedback. He stated that the way we reimburse for services, there is a focus on units rather than actual needs, so the people who need the most outreach end up falling through the cracks. We need to remember that there are important services that aren't necessarily as billable. Director Albert deferred the relicensing leniency issue to another staff member, but acknowledged that we need to address reducing the administrative burden. We are currently soliciting feedback from stakeholders. He also acknowledged the need to look into the way services are billed. Rates were raised some this year, as well. We're doing our best to make sure these things are being addressed. Donell Barnett said it will take a couple of months to see outcomes from the relicensing leniency changes. On the child workforce piece, we are working with all of our partners and agencies to get information out as we can. On administrative burden, we will be looking to work with the providers to get a better understanding of the issue, so we can target the specific burdens for each site. John Fallon asked about the IL Children's MH Partnership. Is there a central spokesperson who can help us understand it? It might be better to have ISBE lead instead of DMH, because federal legislation directs schools to provide certain services. We should hold ISBE accountable for the services since the courts are stronger in reinforcing services through education than through Medicaid. Director Albert replied that the child's space is one of the most challenging for making reforms; there are a lot of silos, but the reforms are definitely needed. There is a plan coming out in February and Deputy Director Lisa Betz represents us in that. Lisa offered to have an offline conversation with anyone who has concerns and asked Ray to talk about the plan. Ray noted that there is a one-page summary of the plan that was distributed yesterday, but it was not on the agenda, so it was going to be covered in public comment, but he will talk about it now instead. He went on to go over the attached one-page summary. Lisa confirmed they are looking for public comment, as well. Amy and Chris both said they have not gotten any Communication Alerts; Lee Ann clarified that they added the council members to the list about six weeks ago. If you're not receiving those, you may have a firewall setting that is blocking them - you can email Lee Ann directly to resolve the issue.
Development Committee Report
Ron Melka stated they did not have a committee meeting, but the council has 3 vacancies in leadership that need to be filled: Consumer Co-Chair, Secretary, and Development Committee Member. If anyone is interested, please contact us. Descriptions of the positions are in the Bylaws. We have trainings for new members and annual required trainings, as well, including the Open Meeting Act training, Sexual Harassment training, and Ethics training. Irwin will send out info on these. We have a PowerPoint presentation on the Bylaws that is helpful to review, as well. Irwin noted that there is an issue with the website for the Open Meeting Act training, so that requirement is being postponed until it is back up.
Adult Inpatient Report
Dennis advised that he knows the information needed on inpatient beds is available somewhere, but they don't know where it is. The 988 system needs knowledge on availability of all services, not just beds, and we hope that info is available soon. Insurance regulations are limiting the number of days available for treatment, and we need to look at services available after release. Partial hospitalization is a potential solution that might be more productive. One major issue is that if you want to be hospitalized, you have to say you're suicidal, and that can be problematic in many areas, including the stigma that goes along with it. He noted that the committee had talked about the possibility of increasing compensation for hospitalization via taxation, but keeping the least restrictive environment in mind. Director Albert replied that we are in a similar situation now, during the pandemic, as we have been previously. It's difficult to operate our hospitals with limited staff when people are out due to COVID or COVID exposure. Sometimes we have to pause admissions, and we do have some community hospitals who help to pick up the slack, and that is difficult on them, as well. There was a bed registry that was raised as part of the 988 planning; he deferred to Dr. Barnett for any update on that. Dr. Barnett advised they were given access to a system that will allow them to build it, but that is as far as they have made it. Director Albert acknowledged it was a lot of work to get that far. Also, there are Transitional Community Care & Support pilot programs that have been going on for a couple of years now, trying to reconnect people with services upon discharge from hospitals. They are reviewing the results of these programs currently. We need to commit to making these efforts ongoing.
Justice Committee Report: Committee not currently active.
Division of Mental Health Report
Lee Ann stated that block grant money for First.IL is being expanded with supplemental money. The internal DMH team has been planning for ways to use these funds, including adding contracts for team development that starts tomorrow. We're also enhancing the model for all existing and new teams to include specialized cognitive behavioral training for co-occurring substance use conditions. As far as 988, we are talking about expanding call center capacity and a NOFO was published a couple months back for a statewide call center. We have huge gaps in capacity to cover the entire state in time for 988 to go live, so we are working hard on that to ensure we will be able to provide the needed services. On a related note, SAMHSA was awarded funds for states to use for Lifeline call centers who contract with Vibrant. We're very excited about that opportunity, as well. I'll hopefully have more info at the next meeting. We also brought our consultants on board to assist us with phases of the work for 988, including the final draft of the implementation plan which is due next month. The Coalition meeting is next week and is open to anyone who wants to participate. In relation to the bed registry, Vibrant procured a vendor for a unified platform and will be working on the technical requirements over the next few months. It will include more than just bed registries, as well, since part of the point of 988 is to help reduce the number of inpatient hospitalizations. The registry will most likely not be ready until 2023. And a final heads up, the legislative session has started; hearings start as soon as next week.
Nanette Larson stated we are very excited about the CRSS Success program. It's set to go live this month; we have extended offers to 12 colleges/universities. The curriculum is set up to work for either CRSS or the CPRS credential. They are very similar, and these college programs will include the skill sets for both, and the individuals will be able to choose which exam they want to take. The CRSS is the one mentioned in the MH Medicaid rules. We're looking into updating the rules to include both. SUPR rules include both CRSS & CPRS already. At the end of the 3-year grant cycle, there is the potential to have 500-600 new graduates of this program. Joan Lodge asked: What is the best way for them to refer people to the program? Nanette advised they will be holding off on announcing the sites until the grant agreements are signed, but once they are, those will immediately go out on a Communication Alert, hopefully as soon as next week. Joan asked about tuition reimbursement programs at the institutions, and Nanette noted that this program already includes tuition and fees coverage, as well as individually identified wraparound supports such as childcare and transportation. A request was made for the chart that shows the difference between the two credentials, and Nanette will send that out. Director Albert applauded the efforts of Deputy Director Larson and her team in the CRSS program as a great example of out-of-the-box thinking that helps us make progress on all the kinds of issues that we discuss in this meeting. John Fallon asked if there are ways we can support this program as part of this council. Nanette stated we will know more as the program rolls out, and efforts are already underway to improve the program for the next fiscal year. She will be looking for any lessons learned as we go along. Joan noted that this is another great way of supporting living room programs and mobile crisis response teams, as well. Patty Johnstone asked if 988 will have access to info on the living room programs. Lee Ann advised that we will be developing resource lists for the call centers over the next few months, but yes, living room programs will definitely be a part of what is included in those lists, but the process for creating those lists is complicated due to legislation. John Fallon stated that social workers and psychologists are not being trained to work in the field, so he is hoping that in the CRSS training, the curriculum can make sure it is not limited to the sites like drop-in centers, but includes training in field work and home-based services, as well.
Ryan Rollinson introduced himself and gave an update on the Williams and Colbert Consent Decrees including statistics on number of members transitioned as compared to goals. He noted a launch of a new housing program for individuals with low or no income, open at 8 providers. Early results look promising. John Fallon asked about gaps analysis for those unable to be served with housing. Ryan noted that the prices have been a mess during COVID and the bridge subsidy has been able to offer waivers far above their normal amounts, but it can be difficult to get landlords to work with subsidy programs. Staffing has also been an issue due to COVID and the overall behavioral health workforce issues that have already been discussed. We're working with the waiver services to try to make the enrollment process streamlined.
Brock had no additional reports about budgets; reminded about the rate increase that went into effect on January 1st but welcomed questions.
Dr. Barnett had nothing additional to share that had not already been discussed in previous items.
Lisa Betz advised of a Communication Alert that will be going out the last week in January regarding a piece of legislation that will go into effect in July concerning diagnostic tools for mental health of children under the age of 5. Training will all be done virtually over 3 days for 5 hours per day, starting in February. They will be run as often as possible.
Lee Ann noted the trainings for Council members that Ron and Irwin mentioned earlier are all computer-based, and with the exception of the one that is currently postponed, council members will be given a state ID to log in with. She offered for anyone who has questions to contact her directly.
John Fallon asked if Ryan could send some of the dashboard info and any annual survey info for the next meeting. Ryan said he would be happy to share that and the final report will be made public when it is complete, as well.
IDHFS Report
Sue asked if Lee Ann got anything from Kristine from HFS, and Lee Ann advised she did not receive anything from her due to technical difficulties.
New Business
There was no new business.
Public Comment
Greg Roudin asked if, in light of the events of yesterday (mentioned previously), is there a mechanism for people that work in the field to set up a chat room or something they can go to, to discuss some of the things they face? Is that something that DMH could set up to support the behavioral health workforce?
Lee Ann advised that there is a grant to support front-line workers and part of that includes a Tuesday Topics groups that might be helpful, and it is open to any who want to participate, and the info on those will come out in Communication Alerts.
Greg clarified that he was asking specifically for the individual workers, not as a group. He's concerned about the stresses and strains that people in this workforce face, as he and several of his family members all work in related fields and would like to see a forum where they could go to talk about the stresses, and that might help to keep them in the workforce. John Fallon noted that he also has experience in this field and he's not sure that this is the right body to address this, and we want to make sure we don't over-respond. It's important that mental health staff talk to each other in small groups where they work, but there are also resources are available when this kind of support is needed. He also noted that the way this kind of news is covered in the media is an issue. Greg agreed that the way the news is covered is an issue.
Next meeting is Thursday, March 3rd at 12:30. Movement made to adjourn, seconded, and closed.
https://www.dhs.state.il.us/page.aspx?item=142981
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