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Local Government Advisory Committee

Minutes - November 9, 2001

Room 473, Human Services Building, Salem

Minutes Not Final Until Approved By LGAC

Contents:


Introductions/Opening
Bylaws Discussion and Vote
House Bill 3024
Budget Reduction Options
State and Local Public Health Emergency Response
Other Items
Future Agenda Items
Next Meeting



Attending


Cindy Becker, DHS Chief Administrative Officer
Lennie Bjornsen, DHS Continuous System Improvement
Larry Cole, League of Oregon Cities
Jean Cowan, Lincoln County Commissioner
Pam Curtis, Governor’s Office
Bonnie Davidson, Community Action Directors of Oregon
Ron Dodge, Polk County Commissioner
Vic Falgout, Douglas County Juvenile Department
Bill Fink, DHS Community Human Services
Gina Firman, Assoc of Oregon Community Mental Health Programs
Linda Fleming, Conference of Local Health Officials
David Foster, Oregon Housing and Community Services
Gordon Fultz, Association of Oregon Counties
Robert Furlow, Douglas County Health and Human Services
John Hartner, Oregon Association of Community Corrections
Grant Higginson, DHS Public Health Officer
Jono Hildner, Consultant
Shirley Iverson, DHSCommunity Human Services
Chris Johnson, Yamhill County Health and Human Services
Lisa Joyce, DHS Legislative and Intergovernmental Relations Manager
Sue Kupillas, Jackson County Commissioner
Elizabeth Lopez, DHS Seniors and People with Disabilities
Donna Middleton, Oregon Commission on Children and Families
Bobby Mink, DHS Director
Linda Modrell (phone), Benton County Board of Commissioners
Mike Morgan, Deschutes County Commissioner
Madeline Olson, DHS Health Services
Jill Pearson, DHS Administrative Services
Anne Peltier, Conference of Local Health Officials
Toni Peterson, DHS Children, Adults and Families
Lillian Shirley, Multnomah County Health Department
Bill Wagner, Cascades West Council of Governments
Doug Wilson, DHS Finance and Policy Analysis


Introductions/Opening


Meeting called to order by Jean Cowan, Co-Chair. Roundtable introductions were made.

Minutes from the October 12, 2001 meeting were approved.


Bylaws Discussion and Vote


Handout #1Bylaws
Local Government Advisory Committee


Larry Cole suggested making corrections to wording on page 2, items G & K, and

Lisa Joyce agreed to make them.

With respect to membership representation for Children and Families on page 4, Donna Middleton expressed concern that she is not able represent both local and state levels. Joyce agreed to adjust the language to reflect a representative of local commission chairs and directors rather than listing the Director of the Commission on Children and Families.

Regarding representation of the Oregon Association of Community Corrections on page 4, John Hartner suggested adding the word Directors. Also on page 4, Hartner suggested adding a time frame of twelve months to item D, and that notification be sent to members prior to removal. Joyce clarified the new language as, missing two or more meetings may result in a removal in any 12-month period.

The Committee approved the Bylaws as amended.

Joyce will distribute the current list of members and the amended Bylaws to each represented organization, along with a request to submit the names of their representatives. 

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House Bill 3024


Handout #2Summary Outline
House Bill 3024: Planning for mental health services


Handout #3Memorandum to Board of County Commissioners, CMHP Directors
Subject: Local Mental Health Planning Process Instructions


Pam Curtis joined the group and presented her handout highlighting the major issues of HB 3024. Summarizing the contents of the document, she explained that HB 3024 is the result of an extensive, yearlong process of examining Oregon’s mental health system. This summary document is the result of work done by the Mental Health Alignment Workgroup. The full report is available on the Governor’s website and the DHS website. The Workgroup examined three areas: 1) The history of the system, 2) The needs of the system, and 3) Future directions based on the system’s needs. The Workgroup determined a need for a community-based system, which not only provides mental health services, but services which help maintain recovery. HB 3024 put into statute a complete description of our mental health system, as agreed upon by the Workgroup and reflected in their report. Additionally the bill has clarified the leadership in charge of mental health services.

Curtis explained that prior to HB 3024, statute required every county to put forth a biennial plan for mental health services, the guidelines for which were to be developed by DHS. HB 3024 removed this requirement from statute, and instead outlined that the guidelines not be developed by DHS, but rather mirror the ideal mental health system. DHS then created a workgroup to determine the new set of planning requirements.

Curtis distributed a memorandum from Madeline Olson of DHS (Handout #3), which outlines a set of draft planning guidelines developed by the workgroup, and includes four focus areas: 1) Ensure that services are consumer centered and community-based, 2) Ensure that intensive services are consumer-centered, 3) Suicide prevention, and 4) Interfacing with adult and juvenile corrections. Curtis further explained that the memorandum also includes a set of outcome measures, which match the four focus areas. All local plans are to be submitted by a deadline of March 1, 2002.

In response to Cole’s request for a definition of "communities," Curtis explained that the workgroup and legislative intention is for people with mental health disorders to receive service as close to their home community as possible. HB 3024 defines the local mental health authority as the board of commissioners within the geographic boundary of a county.

Cole expressed his concern that there are 240 cities in Oregon, some of which do not receive close access to state programs.

Curtis replied that there are two layers to examine: the responsible service entity, and the service delivery area. In some instances it may make sense for services to be delivered by the county, and in some instances delivery should occur in smaller geographic areas.

Cole further commented that a lack of adequate communication between county and city government with regard to where available services exist leads to confusion at the delivery level.

Cowan commented that it is key to distinguish the primary entity responsible for the provision of services. Counties provide certain services as do the cities, while some are overlapping, yet it seems that the counties provide most.

Linda Modrell agreed, while not sure of Portland’s service delivery.

Cole explained that his concern is that the use of the word "communities" is confusing as to which entities provide which services.

Cowan suggested that the state could help in clarification, and ultimately it is the responsibility of DHS that the services are provided through the local delivery systems. Clarifying language within the planning guidelines would be helpful.

Curtis replied that this feedback is important as new versions of the planning guidelines are developed, to ensure a link with city partners.

Cowan commented that within the funding provisions, $1 million is set aside for planning and $6.5 million for implementation. She expressed concern that while the planning is moving rapidly, the funding will not follow suit, and requested better clarification of the connectivity between the two.

Curtis responded by explaining that DHS has put forth a letter to the Emergency Board

(E-Board) requesting the initial $1 million allocated for planning. The Department of Administrative Services (DAS) and the Legislative Fiscal Office have both recommended that the E-board not act on this request until after the December revenue forecasts, due to other budget problems existing within the state.

Cowan asked how the March 2002 planning deadline be effected in the event that the

E-Board decides to delay the decision until January.

Curtis replied that there is no answer to this question, and that the Governor’s office and local partners might discuss the issue further, along with the E-Board.

Robert Furlow commented that it will take a lot of time to coordinate the efforts and to integrate them with the Senate Bill 555 planning process. He explained his concern that delaying the initial process could equate to failure. Furlow suggested that, even in the event that funds are not released by the E-Board, counties might want to continue with planning. He further suggested that counties draw upon contingency funds from the Association of Oregon Community Mental Health Programs to help underwrite the costs.

Cowan responded that this organization is already spending funds, with the hope that those funds can be recouped. The Association of Oregon Counties will continue the discussion this week.

Chris Johnson joined the discussion by commenting that the majority of mental health systems are strapped for money and will need the E-Board funds. The guidelines are general enough to provide rough plans for the March deadline, however detailed plans may be impacted by the E-Board’s decision.

Curtis replied that there has always been a requirement for biennial plans, and there will continue to be a need. The $1 million would assist with the depth and width of the new plans.

Gina Firman added that several counties have contacted her, and some will go ahead with the planning, but most do not have the money. She has sent a letter to E-Board members asking for the release of the $1 million.

Firman further explained to Curtis that she and Gordon Fultz were asked by Senator Derfler’s office to submit a letter requesting a delay of the plans to October 2002, pending funding. Firman asked, if the funds will not be available for these plans in a timely manner, does the Governor’s Office and DHS still expect counties to submit their HB 3024 plans?

Curtis replied that a decision has not been made at this time. She suggested waiting for the E-Board’s decision this week, yet a plan does need to be submitted, regardless of what it is and how it looks.

Firman asked if a meeting could be arranged following the E-Board between Curtis, Olson, and others, to which Curtis replied that it could.

Cowan expressed her concern over raising expectations for a great deal of change in the planning, and then not having the funding to implement it. 

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Budget Reduction Options


Handout #4Working Principles for Identifying 10% Reduction Options

Handout #5DHS Programs and Reduction Options

Handout #6Department of Human Services
10% Reduction Options Use in Development of 2001-03 Budget


Not in Priority Order

Wilson began his presentation by explaining that the Governor has asked DHS to reduce administrative and program costs equal to ten percent. Ten percent of DHS’ program costs equal $250 million in general fund, which is just over $2.5 billion. The reduction effort will likely affect all DHS programs in some way. Complications include a $27 million problem, including two major factors. The first is that caseloads of the Oregon Health Plan (OHP) are up, driven in part by the increase in food stamp caseloads, which are up by one third in the last month.

Additionally, Wilson explained that the caseload projections are underestimated now, as projections were based on discussions with the state economist, who in early October thought that the state’s economy would balance out. The state economist is now expecting a longer downturn in the economy. DHS staff is now working on another set of caseload projections, in anticipation of a special session in early 2002. The $250 million is what the Governor recommended, and there are additional serious issues within our existing budget.

The second major factor complicating the rebalance process is that the use of mental health acute community care beds at hospitals has risen over $9 million. DHS will address the E-Board on Psychiatric Acute Intensive Treatment, which would lower the $9.5 million impact, as DHS would be able to develop another secure residential facility.

Bill Wagner asked if the demographic group involved in the OHP caseload increase is a new group.

Wilson replied that the group includes the low income working poor, and is not a new group. He further explained that food stamps are all federal funds, however no staffing was provided for the caseload increase in the food stamp program. TANIF staff has moved over to assist with food stamps, resulting in a raise in TANIF caseloads.

Wilson distributed and summarized three handouts, the first of which outlines five working principles for reaching program reductions. The second and third documents list options that DHS is examining while making reduction decisions.

Cowan asked if Wilson could compile percentages into a pie chart, so that the information would be more visual.

Wilson agreed to do this, and will bring it to the Tuesday meeting in Pendleton. The document will show both legal and numerical constraints.

Wagner asked that the chart be e-mailed, and that it indicate which are federal mandates and which are administered by local partners.

Cowan commented that the tobacco settlement funds should go to public and mental health. Constituents are under the impression that these funds are dedicated to health care; tobacco money should be related to health care.


State and Local Public Health Emergency Response

Cowan opened the discussion by explaining the need for group discussion addressing concerns with respect to bio-terrorism. With the potential for a terrorist event, there is a need to know how state and local leadership would respond. Additionally, how is the leadership dealing with over arching threats?

Sue Kupillas expressed her concern for how this area will be funded.

Grant Higginson joined the discussion by assuring the group that the public health system has been working toward emergency response for decades. State and county public health organizations are confident and prepared to respond to an incident. The public health system began bio-terrorism response preparations long before the first case of anthrax, yet improvements are needed. Additionally, there is a difference in preparedness across the state. The Portland Metro area has received grant funding, and therefore is better prepared than other areas.

Higginson explained that while the state is under-resourced, there are substantial federal resources available. In his visit to Oregon this week, Secretary Thompson committed $3 million specifically for bio-terrorism. Thompson also spoke of increasing vaccine production and stockpiling antibiotics, in addition to increasing the availability of Center for Disease Control (CDC) officers for state assistance.

Cowan suggested that perhaps we could receive assistance from the CDC for dealing with non-events, or hoaxes.

Kupillas commented on the need for more local testing capability to deal with the non-events, rather than relying on external protocols for each occurrence.

Higginson responded that while the need for local capability exists, it might not be needed for testing. He explained that other states comparable in size to Oregon have labs which have been inundated with samples, none of which have tested positive. He believes that Oregon law enforcement and hazardous materials response has been effective in sending only credible threats to the public health lab.

Cowan replied that she is concerned that the public may not understand this.

Higginson responded by explaining that there is a need to ensure that public health officials are acting appropriately and with the best practices.

Ann Peltier emphasized the need for local capability. Counties are working hard at developing a system for threat assessment, whether in receiving calls, or as people visit their personal doctors. Work is being done to avoid over-testing.

Fultz commented that he believes public perception is that everything is fine, when in fact the system is under-funded. He believes the public needs to be informed, and that federal funds may be all the state receives. He relayed further concern that the Governor’s office is utilizing results from surveys conducted prior to September 11, 2001. There is a need to be on the same page with the public in assessing the existing problems, and what level of response is needed.

Higginson replied that there was a meeting on November 8 including members of the Governor’s Security Council, and will occur again today addressing this very issue. He explained that there is recognition that assessment needs to be done at the local level. This assessment may be conducted through the League of Oregon Cities and the Association of Oregon Counties.

Johnson asked if the Health Department is the first line of response in the event of a credible threat, or if counties are expected to add a 24-hour, seven day per week response capability.

Higginson responded that the Health Department currently covers those counties who do not have this capability. Resources are limited for after-hours calls requesting general information, however.

Furlow expressed his support for Grant’s philosophy of the need to build a credible public health response structure in every county.

Jono Hildner suggested discussion on response in the event of a credible threat to a DHS facility, and the need for relocation of offices.

Kupillas replied that such a situation could be responded to on a local level, and that response information should come from DHS administration, followed by integrated meetings throughout the state.

Cindy Becker explained that DHS will be developing disaster recovery plans for each office location.

Johnson suggested a focus on sharing more practical information, including mail handling, initial response, and building evacuation in the event of a credible threat.

Higginson responded that DAS has developed guidelines in place, which address mail-handling procedures.

Cowan commented that the focus shouldn’t only be on the mail system. Additionally, criteria for determining the need for a contingency plan must be agreed upon.

Becker replied that DHS is trying to leave contingency plans at the local level, working with local police and hazardous material teams, etc.

Higginson explained that there are things which can be done to reassure employees, including information about how disease is spread. Only 12 national cases of cutaneous anthrax have been reported.

Kupillas commented that every county should have an emergency plan in place.

Higginson replied that every county does have an emergency manager, as well as an emergency plan.

Cowan expressed her appreciation for the discussion time Higginson provided the group, and explained that she will be leaving the meeting at this time.


Other Items


Handout #7DHS Performance Measurement Report
Oregon Department of Human Services
Fall 2001


Lennie Bjornsen referred to the feedback form, located on the last page of the report document (Handout #7). He asked that the group review the report and return this form, as feedback will be helpful for the second report, expected to be completed in February, 2002. Bjornsen added that if anyone is interested in a dialogue, please contact Continuous System Improvement and arrangements will be made.

Bobby Mink commented that much work has been done on this report, and explained that this is the Department’s first effort. The report needs fine-tuning, and some of information in the charts is missing due to the absence of available data. Detailed discussion will continue.

Bjornsen explained that to date, this report has only been released to the DHS Cabinet, to this group, and will be distributed to the Stakeholders group this afternoon. It will be posted to the DHS website once conversion to appropriate software takes place.

Kupillas referred to a recent phone survey on the progress of the DHS Reorganization, which is being conducted by an entity other than DHS. She asked when the results of the survey would be available.

Joyce explained that the results are being compiled and should be available for discussion at the next meeting.

Becker asked Joyce if the Community Contracts task force minutes were available for distribution. Joyce replied that they will be mailed to everyone following the meeting.


Future Agenda Items*


Budget Update (E-Board, Special Session?)

Reorganization

HIPPA

Membership

Organization Update

Performance Measures

Radar Screen Project

Facilities Issue
*Actual agenda is dependent upon a meeting with the LGAC Executive Committee.


Next Meeting


Date: December 14, 2001
Time: 9:00a - 12:00p
Location: HSB 473

Note: 2:00 pm-4:00 pm Stakeholders/Partners Meeting
Location: HSB 137 A-D



If you would like copies of the handouts, contact:

Dena Comer
DHS Director’s Office, 4th Floor
500 Summer Street NE, E-15
Salem, OR 97301-1097
Telephone: (503) 945-6843

Americans with Disabilities Act Notice: Do you have a physical or mental impairment that makes it hard for you to communicate? If so, you can get this document in Braille, computer disk, large print or oral presentation by contacting Jessie Ferge, Department of Human Services, Director’s Office, (503) 945-6609, TTY (503) 945-6214.

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