2009-2011 WALLOWA COUNTY IMPLEMENTATION PLAN For … · 2009-2011 Wallowa County Implementation Plan, Page 3 We will ensure that this program is culturally competent and gender-specific

2009-2011 Wallowa County Implementation Plan, Page 1

2009-2011 WALLOWA COUNTY IMPLEMENTATION PLAN For Mental Health and Alcohol and Drug Prevention and Treatment Services

The Wallowa County Board of County Commissioners remains as the Local Mental Health Authority by statute and subcontracts with two independent non-profit 501(c)(3) organizations for service delivery.

Wallowa Valley Center for Wellness, Inc. (WVCW) is the subcontractor providing mental health services, alcohol and drug treatment services, and services to persons with developmental disabilities in Wallowa County. WVCW is administered by a nine-person board of directors and has Letters of Approval (LoA) from OMHAS for comprehensive mental health care, alcohol and drug treatment (A & D), and intensive children’s treatment services (ICTS) and Developmental Disability (DD) services.. WVCW recently completed an extensive HIPAA compliance program and conducts clinical practices according to HIPAA standards.

Wallowa Valley Together Project, Inc. (WVTP) is the subcontractor providing alcohol, tobacco, and other drug (ATOD) prevention services. WVTP is administered by a Board of Directors and has a current Letter of Approval (LoA) from OMHAS. WVTP provides the Prevention Coordinator who serves Wallowa County, who is a Certified Prevention Specialist (C.P.S.), as well as the staff person for the Local Alcohol and Drug Planning Committee-Mental Health Advisory Council (LADPC-MHAC), both advisory groups mandated in Oregon statute which Wallowa County has combined into one Joint Committee. 1. Provide a narrative of the county planning processes used to develop or update the County Plan. Describe also how the Plan will ensure that services are culturally competent and that minority populations have access to services designed to meet their specific needs. In the process of putting together the plan for the coming years Wallowa Valley Center for Wellness has spent a good deal of time listening to people from the overall community. Conversations have been held with the general populace, with significant community partners, with consumers, and with the families of consumers. Many of these conversations were conducted with individuals by the Executive Director of Wallowa Valley Center for Wellness. In addition the director has met with the staff or boards of various community partners to explore whether the current delivery of services was effective and to look at the need for change or expansion. The ability to participate with key community partners in the development of Wallowa County’s Comprehensive Plan Update (as required by SB 555) has been a great help in this process. The planning process required by the Comprehensive Plan necessitates


significant contact and interaction with the community. Several important recommendations related to mental health care emerged from this process. The stakeholders who were included in the planning process included:

a. Wallowa Valley Center for Wellness, Inc. b. Wallowa Valley Together Project, Inc. c. The Multidisciplinary Task Force d. Wallowa County Local Alcohol and Drug Planning Committee-Mental

Health Advisory Council Joint Committee e. Wallowa Valley Health Care Foundation f. Local Primary Care Providers (PCPs) g. Drug Court h. Wallowa County Disabilities Advisory Council i. Wallowa Valley Merchants and Community Association j. Juvenile Crime Prevention Steering Committee k. Early Childhood Committee l. Wallowa County Commission on Children and Families m. Wallowa Educational Service District Region #18 n. Building Healthy Families o. Local School Districts p. Consumers and families q. Students r. Youth organizations and groups s. Local Public Safety Agencies t. Faith community (pastors and other church leaders) u. Local physicians and other providers v. Seniors w. General public x. Greater Oregon Behavioral Health y. Blue Mountain Associates (Psychiatrists)

Stakeholders have been engaged via public forums, special meetings, at regularly scheduled committee meetings, through small group meetings, through written surveys, and through one-on-one discussions and dialogue.

A variety of key stakeholders have been asked to review this document, including the Local Alcohol and Drug Advisory Committee-Mental Health Advisory Council Joint Committee (LADPC-MHAC), the Wallowa County Commission on Children and Families Board, the Board of County Commissioners, the Boards of Directors for both WVCW and WVTP, and local community partners connected to these services. Consumer input was gathered for the Comprehensive Plan and the HB 3024 Plan with descriptions of those processes included in each of those works.


We will ensure that this program is culturally competent and gender-specific through offering all programs as gender, race, culture, religion and sexual identity inclusive and interchangeable (one program, a women’s issues group, is gender specific, as is Seeking Safety, a new program for women). There are few cultural minorities living in Wallowa County. Currently only 1% of all open clients belong to a cultural minority/underrepresented population. All programs will be culturally adaptable to meet the needs of individual culture and identity. All program participants, including employees and volunteers will be trained in cultural competency (if they have not already obtained this training). Dr. Stephen Kliewer, Executive Director of WVCW has been involved in cultural competence training for providers at Oregon Health and Science University and is currently working to expand cultural competence training in the county and a workshop was offered in May 2007. Another session is planned for fall 2008. We currently provide material in both Spanish and English and have a counselor who is able to work with Spanish speaking clients.

2. Describe current functional linkages with the State Hospital system and mental

health acute care inpatient providers.

WVCW maintains linkages with Blue Mountain Recovery Center (BMRC) through linkage agreements with the Eastern Oregon Human Services Consortium (EOHSC) and Greater Oregon Behavioral Health, Inc. (GOBHI). The linkage agreements provide for coordination of care, from admission, through inpatient placement and discharge planning. WVCW, as a member of EOHSC and GOBHI, participates in quarterly Systems Integration Management meetings with the Superintendent and Medical Director of BMRC. We are currently involved with other EOHSC and GOBHI counties developing alternative acute care facilities within the region due to the loss for BMRC as an acute care provider for Medicaid patients.

3. Identify the high priority needs for each program area (mental health, alcohol and drug prevention and treatment, and problem gambling services). What areas does the county needs assessment identify as critical for improving access and client or consumer outcomes? Mental Health Priorities The following priorities are those that were identified through the planning process. Some of these emerged from Wallowa Valley Center for Wellness (WVCW) and its internal planning process, some were suggested by the State/GOBHI site review process, and others emerged from the Comprehensive Plan process and discussions with community members.

1. Increased access, including geographical access continues to be a major issue


2. Community education about mental illness, and stigma reduction. Suggestions included lunch presentations at Community Connections, training for the faith community, and training for people who are responsible for caring for people with mental illness.

3. Continued development of a solid continuum of care, including a multidisciplinary team that can effectively provide wrap around services. This would include a focus on the development of our Assertive Community Treatment (ACT) program.

4. Increased services for children (non ICTS) 5. Increased presence in the schools 6. Increased focus on consumers, including continued development of peer to peer

services. 7. Increased focus on older adults (who represent a growing percentage of the

County’s population – Currently around 23% of the County is 65 years-of –age or older).

8. Therapeutic foster care for children with mental health issues 9. Increase involvement of families (family therapy etc.)

Alcohol and Drug

1. Increased programming to address adolescent substance use and abuse 2. Development of intensive outpatient services

Gambling

1. Public education around gambling addiction 2. Expand screening for gambling addiction

Due to the fact that funding for theses services has not significantly increased for at least the last five years (although there were small increases for targeted programs this past year), it is difficult to respond to the top priorities that have been identified. WVCW has been working hard to be creative, and attempt to work “smarter” in order to keep up with the increasing demand for services. It is unrealistic to think that much additional can happen due to the fact that available resources are mostly gone by the time basic services are provided. Wallowa County has a very high number of people who qualify for the funding provided through these service elements, and this makes an expansion or enhancement of services reliant upon grants and other funding sources. It is frustrating to have people suggest there are “not enough counselors to go around” when the current funding levels do not support the number that currently are present.


Responses to the priorities identified 1. Increased access, including geographical access continues to be a major issue

WVCW has tried very hard to respond to this issue. At one point we were hoping to have satellite clinics in each community; however, funding issues have made this response impossible. However, we have chosen to make “community calls” when appropriate and have placed providers in settings that allow good access for people with geographic and transportation issues. A counselor is placed in each school district one day per week. Counselors provide services at residential programs, including Senior programs. Counselors see clients at secure settings in other communities, or at sites comfortable for the client (Wallowa, Imnaha, Joseph, etc.)

2. Community education about mental illness, and stigma reduction. Suggestions included lunch presentations at Community Connections, training for the faith community, and training for people who are responsible for caring for people with mental illness. We will continue to work at developing our educational/outreach programs. We have developed a speaker’s bureau around various issues and are developing a library of PowerPoint presentations around such topics as severe mental illness, depression, anxiety, and the like.

3. Continued development of a solid continuum of care, including a multidisciplinary team that can effectively provide wrap around services. This would include a focus on the development of our Assertive Community Treatment (ACT) program. We are working to develop a treatment team that includes PCPs, Psychiatrists, therapists, case mangers, skills trainers, and peer support counselors. We have set up meetings two days a week where the team “triages” each client in the community who needs intensive services.

4. Increased services for children (non ICTS) We are limited in our ability to respond to this identified issue. Currently we do not have a “waitlist” for children. The issue is that we have one clinician who is “preferred” by the community and this clinician has limited access. However we do have additional clinicians who can work with children. We are hoping that as more people become familiar with some of the other clinicians this issue will resolve. The clinician in the school is beginning, due to some changes in job description, to fill the gap effectively.


5. Increased presence in the schools Currently we have a small amount of additional funding from Juvenile Crime Prevention (JCP) to help support a counselor in the schools. We are proud that we have managed to maintain this presence at all, and hope to continue to keep a person in the schools. However without additional funding this will be increasingly difficult.

6. Increased focus on consumers, including continued development of peer to peer services. We have had 6 clients complete basic training as support counselors, and three of them are currently engaged in advanced training. Through a grant we were able to purchase a facility and develop a peer run drop in center. This is a very active place that provides socialization, peer counseling, and service opportunities for those with severe mental illness. We have two clients employed part-time as managers of this center. Other clients help prepare meals for various meal times. We have also developed a work crew that provides a variety of services in the community. This group is highly thought of and is very active

7. Increased focus on older adults (who represent a growing percentage of the County’s population – Currently around 23% of the County is 65 years-of –age or older).

We are currently continuing our efforts to work with our aging population. We have regular visits to various residential sites in the county. We are updating our PASSAR training in order to be able to provide that service. Current developments include • When possible use culturally sensitive evidence-based practices including peer

support. • Increase contacts with seniors through the implementation of outreach services at

locations appropriate for making contact with older adults (senior centers, long term care facilities, personal residences, seniors programs [Community Connections], etc.)

• Increase access to services through integrated healthcare (via co-location at primary health care offices/centers)

• Cultivate, utilize and integrate natural supports into continuum of care • Include consumer and family participation in interdisciplinary service and system

planning • Facilitate and support patient self-management and educational programs for older

adults. • Provide family and caregiver education and support • Provide transportation supports • Ensure that at least some clinicians from WVCW are trained in geriatric care.


8. Therapeutic foster care for children with mental health issues

We are currently seeking to identify families that might be interested in becoming therapeutic foster families

9. Increase involvement of families (family therapy etc.) This is an emerging issue. We sought to expand our program by being certified as a Functional Family Therapy (FFT) program, however determined that we would be unable to maintain fidelity for this program. We are currently looking at some additional evidence based programs that will allow us to involve families in a more meaningful manner.

Alcohol and Drug 1. Increased programming to address adolescent substance use and abuse

We have recently instituted a new program called “Seeking Safety” which is for women who have suffered from trauma and have substance use/abuse issues. We are participating in a grant that provides services to families with children where substance use and abuse is an issue that destabilizes the family

2. Development of intensive outpatient services . We have reviewed and will be implementing an intensive outpatient curriculum for teens. This can be adopted for use with adults as well.

Gambling 1. Public education around gambling addiction

Gambling funds are not received by WVCW.

2. Expand screening for gambling addiction We now include a brief screening for gambling addiction for all clients

10. Provide a detailed narrative description of how the county will allocate and use

the resources provided by the OMHAS. Include a description of how the county will increase and improve the use of evidence-based practices in services for which the county receives funding from OMHAS. Describe in detail any changes in allocations to service elements or subcontractors and the rationale for those changes.


All funds for MHS 20, MHS 22, MHS 25, and AD 66 will continue to be allocated to Wallowa Valley Center for Wellness (WVCW). These resources will be used by the Center to provide services for both adults and children, to provide crisis services for the County in collaboration with law enforcement and the local hospital, and to aid in providing AD services along the continuum of care. As we look forward into the future we are guided by several principles. First, all efforts WVCW pursues using the resources provided by OMHAS will be collaborative in nature. The collaborative possibilities present in Wallowa County are well documented in the Comprehensive Plan developed by the County, but there are several partnerships that bear special attention. Wallowa Valley Center for Wellness (WVCW) works extensively with the Education Service District and the local School Districts. We have developed a mixed funding stream that has enabled us to place a mental health counselor in each of Wallowa County’s school districts one day per week. We also work with the ESD and the Student Assistance Program that provides bullying prevention services in the elementary schools. We have some joint programs with Building Healthy Families, including a class for the parents of teens and a program for parents who are recovering from substance abuse. We work closely with Safe Harbors in dealing with families that have been impacted by domestic violence. The county recently received a grant that provides funding for collaborative work with families affected by violence. We work collaboratively with other agencies in the County, including law enforcement and the Department of Human Services. Second, WVCW seeks to provide a comprehensive system of care at the local level. By developing a system of care framework we believe we will be able to effectively leverage the funds provided by OMHAS. A system of care framework incorporates critical principles such as early intervention, evidence based treatment, assertive community involvement, patient centered care, and active participation by clients and families.

Third, WVCW hopes to develop and implement programs that incorporate the Institute of Medicine, Continuum of Care model. It is our goal to develop components that address prevention, treatment and maintenance. This means not only developing good educational programs (prevention) but also developing effective and evidence-based responses to illness (treatment) and strong continuing support systems (maintenance). In order for us to address the continuum effectively expansion of the continuum of services available within each component of the spectrum will be needed. For example, the county has one level of residential care currently available. We would like to add a new level of residential care in order to better meet the needs of our severe and persistently mentally ill population.


Fourth, WVCW is committed to a recovery model. For WVCW recovery is seen as a complex reality. It is difficult to find a definition of recovery that is acceptable to everyone. However we have adopted the definitions outlined by the National Institute of Mental Health in England (NIMHE): • A return to a state of wellness (e.g. following a state of depression); • Achievement of a quality of life acceptable to the person (e.g. following an episode of

psychosis); • A process or period of recovering (e.g. following trauma); • A process of gaining or restoring something (e.g. one’s sobriety); • An act of obtaining usable resources from apparently unusable sources (e.g. in

prolonged psychosis); • Recovering an optimum quality and satisfaction with a life in disconnected

circumstances (e.g. dementia). In short, recovery is a personal process of overcoming the negative impact of diagnosed mental illness/distress despite its continued presence. In order to facilitate recovery we will focus on nine essential components. Those components are: • Clinical care (services provided by psychiatrists and other mental health professionals

to promote and enhance the recovery process) • Family support (caregivers identified by the resident as significant others who provide

natural supports for recovery), • Peer support and relationships (friends, colleagues and other people in recovery who

help to provide a common understanding of issues and experiences impacting recovery),

• Work and/or meaningful activity (as defined by the person in recovery and positively impacting the recovery process),

• Power and control (active personal engagement in and decisions about care and supports that promote recovery),

• Stigma (avoidance or minimization of stereotypes and attitudes about mental illness that hinder and/or negatively impact the recovery process),

• Community involvement (the engagement of the community as an extended therapeutic environment),

• Access to resources (ability to connect with people and places, use products, services, and technologies that promote recovery),

• Education (formal and informal methods for people to gain knowledge and information that will enable and support behavioral change(s) leading to wellness and the ability to live lives that are personally satisfying).

Our goal is to adjust our staffing as well as our programming to allow us to integrate these principles and goals into our daily work.


Fifth, WVCW is committed to increasing consumer involvement in planning, consultation, and delivery of services. This can happen at a number of levels. We have worked hard to include consumers, including consumers with severe mental illness, on existing boards, such as the county advisory boards, and the Quality Management Committee. We have established a consumer program here in the county, and this consumer group provides us with valuable input. We have also developed an array of consumer run programs including the drop-in center and the work crew.

Sixth, because of a lack of funding WVCW is planning on developing new models for

working with clients. A key will be an significant expansion of group therapy. We plan on developing a number of groups that can supplement individual therapy and all the program to reach more people with less funding. Some suggested groups are a DBT group, an emotive behavioral group and an OCD group

Finally, WVCW is committed to the use of Evidence Based Practices in all of our

programs. Currently we are working on the development of such practices (see below, p. 13). Although we recognize that current OMHAS funding does not cover many of the components of the mental health plan we are developing, we believe that our plan supports and optimizes OMHAS funded programs.

Funding allocated from the State to Wallowa County for Service Element 70 (AD-70) for alcohol, tobacco and other drug (ATOD) prevention will continue to be disbursed to Wallowa Valley Together Project (WVTP). WVTP has a current Letter of Approval (LoA) from OMHAS, and is contracted by Wallowa County through the Board of County Commissioners to provide prevention services throughout the County. Mental Health Services (State Mental Health Division Contract)

For the 2007-2009 biennium, Wallowa Valley Center for Wellness will contract to provide the following outpatient services to non-Oregon Health Plan eligible residents:

A. Adult (non-residential) mental health services (MHS20)

WVCW maintains a staff of QMHP’s (5 FTE), MD (0.2 FTE), QMHA’s (3.0 FTE) and a psychiatric nurse (.75 FTE) and appropriate support staff to serve the MHS 20 population. MHS 20 funding remains inadequate to provide the identified services and as such the agency augments MHS 20 income via contracts with GOBHI, EAP’s, private Insurance providers, grants, and private donations. MHS 20 funding enables this agency to provide a sliding fee scale to adults who do not qualify for OHP coverage and have no other third party payor.

B. Child/ Adolescent mental health services (MHS22)


Staffing levels mentioned above (MHS 20) will be available to children and adolescents. Clinicians will coordinate care with DHS-CPS staff as appropriate. In addition we have identified a QMHP as the lead provider for child and adolescent mental health services. WVCW is now a certified ICTS provider and is in the process of developing and implementing the infrastructure necessary for participation in that program. We have designated a QMHP as the Family Care Coordinator (FCC) for this program. Center staff will work with the schools, family members, Juvenile Crime Prevention, and the Department of Youth Services as appropriate. WVCW actively participates in Family Decision and Community Resource Team meetings regarding individuals who are clients of the agency. The clinic also has an active presence with the Commission on Children and Families. In collaboration with Wallowa Education Service District 18 and Wallowa Valley Together Project, WVCW provides masters’ level mental health care in the County’s four school districts. This program is supported by a variety of funds including a small amount of grant funding. The Center is working strategically with the ESD, the School Districts, and other community partners to develop a strategy to expand mental health care in the schools at all levels. This service will be linked to the ongoing MHS 22 services provided by WVCW, as well as to other community programs such as Wallowa Valley Together Project, Building Healthy Families and Safe Harbors (domestic and sexual violence). It will also link to the Student Assistance Program, which is a current ESD-funded and operated program.

C. Crisis mental health services, including pre-commitment services (MHS25) WVCW utilizes MHS 25 funds to finance 24/7 QMHP crisis intervention services through walk-in availability at the WVCW office during business hours. After hours site of service delivery varies on a case by case basis, and ranges from telephone consultation, visits at residence, site of law-enforcement involvement, hospital ER and primary care physician office. Crisis services are available to individuals, family members, residential care providers, primary care medical providers, hospital emergency room service providers, and law enforcement agencies.

These services will be provided primarily by the professional staff of the center: Mary Rose Nichols, LCSW, CADC III (clinical supervisor MED and A&D programs), Paul Spriggs-Flanders, MA, LPC (clinical supervisor, CSS program and crisis services); Linda Hilderman, MA LPC; Judy Wandschnieder, MSW, LCSW (Clinical Supervisor Children’s Programs); Maggie Hunt, BA, CADC II; Carolyn Dawson, RN (Psychiatric Certification), Stephanie Williams, MSW, CSWA, Stephen Kliewer, D. Min., Diana Jannuzzi, QMHA; Larry Wagner, QMHA, Psychiatric services are provided by Joel Rice M.D. and William Halstead, MD.


Alcohol and Drug Treatment Services: (State Contract for A&D) During 2007-2009, Wallowa Valley Center for Wellness will contract with the State Office of Mental Health and Addiction Services to provide the following services: WVCW will provide a range of services including assessment, treatment, and aftercare in a manner consistent with ASAM PPC-2R criteria. Treatment interventions include individual sessions, group programs, and monitoring of usage (AD 66). The DUII Information Program (AD 68) which provides shorter (12 hours minimum) didactic alcohol and drug education programs with an emphasis on the effects of driving under the influence is now supported by AD66 funds. The Center does work with law enforcement, the schools and other entities to provide these services when feasible. Services to those convicted of DUIIs (AD 78) are also now included in AD66. The Center provides services to those who have been charged with a DUII for the second or subsequent time(s) and are determined to be problem drinkers. Treatment plans may include monitoring, individual, group, or family counseling. Treatment services will be offered to both adults and children and are designed to restore independence, health, safety and sobriety for persons who are chemically dependent and/or have lost control of their use of chemicals. Following the Institute of Medicine guidelines, treatment services will include assessment, treatment, case management, and wraparound support. Using standardized Oregon Placement, Continued Stay and Discharge Criteria, the following levels of care will be provided as appropriate: Level .0.5: Early Intervention Level I: Outpatient Treatment Level II: Intensive Outpatient/Partial Hospitalization Treatment Level III: Residential Inpatient Treatment (Consisting of an out-of-county referral to a live in program which provides 24 hour treatment). Level IV: Medically Managed Intensive Inpatient Treatment

(Medically managed inpatient treatment) consisting of an out of county referral to a hospital based program providing both physical care and treatment for chemical dependency.

Program elements for AD 66

Individual Sessions Case Management Group sessions for youth (educational, treatment, relapse prevention) Group sessions for adults (educational, treatment, relapse prevention) Group sessions for women (educational, treatment, relapse prevention)

Family therapy sessions


Monitoring services (UAs) Groups sessions (Collaborative) focusing on parents with A&D issues

WVCW provides assessment for Dual Diagnosis and referral for appropriate concurrent MH treatment and works collaboratively with many agencies and groups within the county, including law enforcement, the court system, Safe Harbors (domestic and sexual violence), Building Healthy Families (Parents in Recovery Program), Wallowa Education Service District, DHS, Wallowa Valley Together Project, and the Commission on Children and Families. One of the QMHPs on the staff works in the three secondary schools in the county. We are currently engaged in the process of developing some Dual Diagnosis groups that will be in all three communities in Wallow County.

Outcomes Measurements For the efforts funded by OMHAS through MHS and AD funds we have been using the following outcomes measures: Mental Health

• Total number of hours of face to face, masters level, individual therapy provided monthly

• Total number of units of case management services provided monthly. • Total number of hours of group programming offered monthly. • Timeliness of service (within 7 days of discharge from hospital and/or acute care) • Numbers readmitted into the State Hospital or acute care hospital within 30 days of

original discharge. • Level of functioning (as determined by the clinician) • Session rating (using a session rating scale completed by the consumer) • Quality of Life improvement (as perceived by customer using an outcomes rating

scale) Drug and Alcohol

• Number of adult and youth completing A&D treatment and A&D educational programs per biennium.

• Percentage of adult and youth residents enrolled at a level of care appropriate for their assessed need (using ASAM criteria).

• Percent of adults and youth engaged in treatment who successfully complete (graduate from) the program and are not abusing alcohol and/or other drugs one year after graduation.

• Percent of adults and youth engaged in treatment who do not re-offend (possession, DUII, etc.) within one year of graduation.


Evidence Based Practices In response to existing legislations (ORS 669) and due to a desire to improve the quality of care delivered to its clients, Wallowa Valley Center for Wellness is working to document current evidence-based programs/practices and identify and implement new programs appropriate for our client population/county. Practices currently in use or in the process of being implemented include:

• Assertive Community Treatment (ACT): Assertive Community Treatment is a team treatment approach designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness such as schizophrenia.

• Illness Management and Recovery (IMR): The goal of IMR is to empower consumers with severe mental illness to manage their wellness, find their own goals for recovery, and make informed decisions about their treatment by teaching them the necessary knowledge and skills. The core components of this approach are psychoeducation, behavioral training for medication management, relapse prevention training, and coping skills training. This approach is time limited, lasting 3 to 6 months on average. This program will supplement the UCLA modules already in use.

• Supported Employment: Although we do not currently provide Supported Employment, we are committed to developing a Supported Employment program if it is feasible. We have entered into conversations with several employers and are currently exploring the possibilities.

• Peer to Peer Programming: Develop peer to peer programs such as peer counseling or a peer run drop-in center.

• CASII: An evaluation tool that helps place children at the appropriate level of service.

• ASAM-PPC-2R: An evidence based tool for assessing customers with potential alcohol and drug issues. Helps determine appropriate level of care

• Motivational Interviewing: An interactive technique that allows therapists to work with clients around issues such as addictions. Helps assess the clients status in terms of readiness to change, and then helps move them through the recovery continuum.

• Seeking Safety: Seeking Safety is a present-focused therapy to help people attain safety from trauma/PTSD and substance abuse. The treatment is available as a book, providing both client handouts and guidance for clinicians. The treatment was designed for flexible use. It has been conducted in group and individual format; for women, men, and mixed-gender; using all topics or fewer topics; in a variety of settings (outpatient, inpatient, residential); and for both substance abuse


and dependence. It has also been used with people who have a trauma history, but do not meet criteria for PTSD.

Wallowa County anticipates proposed funding allocations to be similar in 2009-2011

as in the current fiscal year. This includes the targeted additions that were added this year. Neither Wallowa Valley Center for Wellness nor Wallowa Valley Together Project have intent to subcontract for provision of any services.

AD 66 funds is projected at $55,481 per year for a total expenditure, 2009-2011 of $110,962. These funds are for the use of alcohol and drug services for outpatient clients that are not OHP eligible and are eligible for a sliding fee. Funds cover salaries and benefits for a CADC I (1.0 FTE) and various QMHPs (LPCs, LCSWs, PsyD, etc.) (0.5 FTE). Also helps cover costs for educational materials and services such as urine analysis. CHANGE TO SERVICE ELEMENT DUE TO NEW TARGETED FUNDS Intensive Treatment and Recovery Services for Addicted Families: It is the plan of Wallowa Valley Center for Wellness to enhance its program by addressing the needs of parents and families who are either at risk or already involved in the child welfare system due to addiction problems. Due to the constraints of funding we will focus our energy primarily on intensive outpatient addiction treatment. The need for intensive services has long been identified in the Comprehensive Plan developed by the County.

In designing our enhanced program we will use a recovery focused model and will use the principles espoused by the Screening and Assessment for Family Engagement, Retention and Recovery (SAFERR) program. Some of these key principles include a focus on the family (not just the individual); a collaborative approach that understands that screening, assessment and intervention work best when collaborative and coordinated. No one agency or person can effectively do this alone; and an understanding that when families get into trouble many factors are involved, including poverty, addiction, mental illness and a lack of skills.

Behavioral Health Management (BHM) is another concept that will play a key role in this response. BHM has a recovery focus which dictates the way one addresses the client’s issues. A recovery focus means, for example, that the focus is on strengths as well as issues and client empowerment and a destigmatization of mental illness are key priorities. Using this model will also mean that we will attempt to use evidence-based practices (EBPs) whenever appropriate and viable. For example, Motivational Interviewing (MI) can be used effectively to help people become more open to change and recovery. For working with youth within a family system a program such as Hazelden’s Adolescent Recovery Plan will be used.

This model also includes the concept of service integration, which is also a part of the SAFERR concept and suggests the use of an integrated, recovery-oriented system of care involving a wide spectrum of community partners. The model also takes advantage of a variety of resources, including peers, physicians, family, churches, and the like.


The target group for this element will be people (and their families) who meet the criteria for American Society for Addiction Medicine (ASAM) Level II intensive outpatient treatment.

Community partners who will be engaged to ensure that this program is effective will include Wallowa Valley Together Project (prevention), DHS, Drug Court, various local Courts, the schools, Department of Youth Services, Oregon Youth Authority, local primary care providers (PCPs), and CASA.

Wallowa Valley Center for Wellness already uses a recovery oriented approach with its clients, has excellent ongoing relationships with community partners, and has already been working toward the development of intensive outpatient services for people with addiction issues. This has been driven in part by the lack of residential programs in the region. We have been working to focus on evidence-based practices and have been successful at increasing our use of such elements. The focus on recovery, the use of EBPs, and our collaborative coordinated approach will all allow us to effectively implement these services.

Wallowa Valley Center for Wellness is the only Alcohol and Drug provider in Wallowa County, as well as the only mental health provider. This, along with our close relationships with community partners makes us effective at providing continuity of care and care coordination for families at various points in the recovery process. Once a family is reunited we will stay in contact with our community partners, but will also develop some new approaches to keep families moving toward recovery. WVTP will provide the Strengthening Family Program (10-14), and WVCW will work with a local agency, Building Healthy Families, to help develop parenting skills in these families using the Parents in Recovery program. WVCW already provides an aftercare program and is in the process of developing a family group for families in recovery. Thus as a client moves from inpatient of intensive services down to lower levels of care there will be appropriate treatment options available to help them. These options will be incorporated into coordinated planning developed with community partners. Additional funds: $19,013.39 AD 70 funds MHS 20 funds will equal $159,992 for the Biennium 2009-2011. These funds provide adult (non-residential) mental health services. WVCW maintains a staff of QMHP’s (4.5 FTE), MD/PMHRNP (0.2 FTE), QMHA’s (3.0 FTE) and appropriate support staff to serve the MHS 20 population. MHS 20 funding remains inadequate to provide the identified services and as such the agency augments MHS 20 income via contracts with GOBHI, EAP’s, and private Insurance providers. MHS 20 funding enables this agency to provide a sliding fee scale to adults who do not qualify for OHP coverage and have no other third party payor. CHANGE TO THIS SERVICE ELEMENT


Jail Diversion Services: WVCW will work with community partners to provide enhanced services to people arrested, in jail, or referred to OSH for “aid and assist evaluations” under ORS 161.370. The purpose will be to reduce the number of people with mental illness serving time in local jails and reduce the rate of admissions to OSH of the aid and assist population with low level crimes through the development of jail diversion programs. We will ensure that all recipient of these MHS 20 funds are enrolled by CPMS in Service Element (SE) 20 Additional funds = $5,674.88 Case Management Services: Wallowa Valley Center for Wellness plans to use the additional funding provided here for case management services in Wallowa County. These funds will be used primarily to support Assertive Community Treatment for adults at risk of state hospitalization who are not eligible for Medicaid. Funds will also support peer delivered services including a peer run drop-in center. Additional funds = __$2,910.19 MHS 22 Funds will equal $40,000 for the Biennium. These funds are for Child/ Adolescent mental health services (these services are described in the narrative on page 3). CHANGE TO THIS SERVICE ELEMENT Additional funding for Non-Medicaid Intensive Children’s Services. 1. Identification/Assessment.

When children are referred from the schools, DHS or other agencies they will be screened using the CASII to determine the level of services required. We will also use CRTs to help determine resulting services

2. Service coordination planning. The family will identify the "family & community team" which will meet on a regular basis to identify strengths and needs and develop a service coordination plan which addresses all of the child and family domains. These teams commonly include the parents and other significant family members, school, primary care physician and mental health. Other community service providers are invited to be part of the team if they are seen as meeting a specific need and the family agrees with their involvement. Mental health services which includes a variety of evidenced-based modalities; educational opportunities through WVCW and Building Health Families related to parenting skills (love & logic), problem solving & addressing specific child behaviors. Psychiatric services provided through WVCW . Respite care, transportation, housing and fuel assistance through Community Connections. Mentors, School Aides, Trackers, through Juvenile Dept., WVCW and School. Crisis care through Juvenile Dept. and DHS-Child Welfare.

3. Transitions/Continuity of Care.


The critical piece of providing intensive services is that the family & community team meet on a regular basis to update each other, continue identifying strengths/successes, and needs, and determine how those needs are going to get met, by whom, and by when. These plans are agreed upon by the entire team with conversations occurring in between meeting times as needs fluctuate. If there are barriers we brainstorm ways to overcome barriers, invite other community partners to provide input to overcome barriers, and consult with a regional youth specialist if necessary. With regards to transitions, whether it be to a higher level of care, lower level of care or different but same level of care, we discuss what resources are needed to ease the transition; what kinds of behaviors do we expect; and make sure there is a crisis plan in place and contact phone numbers in case extra supports are needed. Releases are reviewed and signed regularly so that communication can occur confidentially and with team members and service providers as necessary. Specific transition plans are developed during the regular family & community team meeting, whenever a transition is expected.

4. Service Utilization. a) Special reports can be run which identify which clients are receiving intensive services (those enrolled in ICTS) which also includes the types of mental health services they are receiving. b) Other services being received are provided in the monthly Service Coordination Plan, found in each client's file. c) Level of need determination is also found in each client's file. d) All CASII screenings are entered on a client data base (regardless of level of need determination & regardless of payor source) and reports can be generated by the Regional Youth Specialist (GOBHI/EOHSC). Additional Funds = _$4,794.44

MHS 25 Funds will equal $53,882 for the Biennium. These funds are for Crisis mental health services, including pre-commitment services. A detailed description of these services is available in the narrative, page 3). CHANGE TO THIS SERVICE ELEMENT Crisis Services: It is the intention of WVCW to enhance the provision of community

crisis services for adults and children in Wallowa County We will ensure that all recipients of these MHS 25 funds are enrolled in MHS 25 in

CPMS. The additional funding will be focused on providing crisis assessment services, and

other crisis services designed to prevent hospitalization, implementation of civil commitment holds, and triage and intervention services.

We will use a variety of evidence based practices, in the ASIST and QPR for the identification and prevention of suicide, ACT for working with crisis clients who have severe and persistent mental illness, and practices such as Trauma Focused CBT for those who engaged in crisis services. Additional Targeted Funds: $4516


PREVENTION PLAN Wallowa Valley Together Project, Inc., (WVTP) will address alcohol, tobacco, and other drug prevention through family, peer, school, community, and social/environmental strategies in the 2009-2011 biennium. Specific outputs and outcomes are addressed in the prevention strategy sheets (Attachment 10). Unhealthy community norms and beliefs will be targeted through community mobilization, information dissemination, and prevention education efforts. Our primary focus is reducing underage drinking through prevention, education, and raising awareness.

Information Dissemination Families of all K-12 grade students in local public and alternative schools will receive direct mailings of information, including Oregon’s underage drinking laws, alcohol use in the family, tips for talking with children about alcohol, tobacco, drug use and other issues, alcohol poisoning, prescription and over-the-counter medication abuse, and more. WVTP provides the prepared postcards and other mailers, and the local schools provide their student mailing lists. WVTP is an Associate Resource Center through RADAR and AMH. We have numerous brochures, booklets, videos, posters, and books available. We also maintain displays of many of these materials at various locations throughout Wallowa County to be more accessible and visible to the general public. Some of these locations include the Justice Center, the Courthouse, the local DHS branch office, restaurant and bar bathrooms, Laundromats, local Post Offices, the schools, doctors and dentist offices, grocery stores, and the offices of community partners. Locally designed and produced print and radio ads and public service announcements (PSAs), as well as national campaign ads and PSAs, are distributed throughout the County in various formats. Print media is displayed in the local newspapers, at the movie theatre during their pre-show advertising, and at various locations such as those listed above. Ads and PSAs as well as on-air interviews are aired on the local radio station. One key time slot WVTP targets advertising is during the broadcast of all local high school sporting events. WVTP currently has three paid billboards and two road signs in four locations. If funding allows, we will maintain at least one of these billboard that is in a prime location. The road sign locations will remain, as they are located on private property and therefore cost us nothing to rent. In addition, we will continue to seek additional locations for road signs in other locations throughout the county. We are in the process of changing the road sign displays from a permanent sign to a


blank board that ads printed in banner material can be attached to, which will allow for the ad to be changed easily, quickly, and relatively inexpensively. Community Mobilization As discussed in the section below on Coalitions, Wallowa County has two very active student prevention coalitions. Our goal is to establish a third by the conclusion of the 2009-11 biennium. WVTP will continue to collaborate with other entities throughout Wallowa County. WVTP is part of the following groups:

• Wallowa County Local Alcohol and Drug Planning Committee-Mental Health Advisory Council Joint Committee (LADPC-MHAC)

• Wallowa County Reducing Underage Drinking Task Force (RUDTF) • Wallowa County Juvenile Crime Prevention Steering Committee (JCPSC) • Wallowa County Teen Pregnancy Prevention Council (TPPC) • Wallowa County Youth Suicide Prevention Steering Committee (YSPSC) • Service Integration Team • Early Childhood Committee/Family Preservation Council/Local

Interagency Coordinating Council • Victims’ Impact Panel Advisory Board • Wallowa County Traffic Safety Committee

WVTP established a website two years ago that continues to prove to be a valuable tool and resource both locally and beyond. We will continue to maintain this website and promote it in all advertising, print materials, publications, and presentations. Education WVTP and local partners will receive facilitator training in the Spring of 2008 for the evidence-based Strengthening Families Program 10-14 (SFP 10-14). Thereafter, SFP 10-14 will be offered a minimum of twice each year in varying locations in the county. Several evidence-based curriculums are available to local schools for implementation in the classroom, including Protecting You, Protecting Me; Project Northland; Steps to Respect; and Second Step. As schools and individual teachers identify specific needs and requests these programs, WVTP provides the curriculum and/or implementation as indicated by the schools. Teachers are provided with an overview of these options at least once each school year. An additional program that has received a tremendous amount of support locally from the schools, parents, youth, businesses, and general public is the “Every 15


Minutes®” Program. Though not yet an evidence-based program, the value has been quite substantial. As stated by one school superintendent:

“It [local survey results] has been a positive conversation piece on our Administrative team as has the continuing positive impact of the Every 15 Minutes event. …we have discussed the event on many and varied occasions in all kinds of school and community settings. The Every 15 minutes event was simply the BEST teen awareness program I have seen to date and it has had a genuine impact at reshaping the way our students view each other, their families, teachers, staff, and their relationship with alcohol.”

We have also received a great deal of feedback from community partners about the impact the “E15M” Program has had in improving relationships with other partners. We will continue to implement this Program, with the goal of offering it each year and rotating among the three local high schools. WVTP’s Director is approved through the Oregon Liquor Control Commission (OLCC) as an instructor for OLCC’s Alcohol Server Education (ASE) program. WVTP will continue to offer local ASE classes at least four times each year. In addition, on-site retailer trainings are provided as requested by individual retailers. Individual trainings for events and festivals for their volunteer servers are provided as needed, as is alcohol monitoring of these events. Community Awareness WVTP promotes several annual awareness campaigns county-wide each year. These include but are not limited to Alcohol Awareness Month, Teen Pregnancy Prevention Month, Red Ribbon Week, and Drunk and Drugged Driving (3D) Prevention Month. During the 2009-11 biennium, we will also promote the Problem Gambling Prevention Week campaign. The local student prevention coalitions participate in many of these campaigns as well, with particular emphasis on the school campuses. Other community partners collaborate on some campaigns as well, such as Teen Pregnancy Prevention Month.

Consistency with County’s Comprehensive and Coordinated Plan (SB 555) During the planning process for the 2008-14 County Comprehensive Plan (Comp Plan), three primary issues were identified: youth substance abuse, violence, and poverty. This is the first time the community has identified a need or stated a collective concern regarding youth substance abuse. This would indicate that efforts over the past four years to raise community awareness have been successful. Coalitions


As of the 2007-09 biennium, Wallowa County has two active prevention coalitions, both being student coalitions. The Enterprise High School (EHS) chapter of TADA (Teens Against Drugs and Alcohol) is currently in its third year. The Wallowa High School (WHS) TADA chapter is in its first year. Our goal is to have a third chapter at Joseph High School (JHS) active by the conclusion of the 2009-11 biennium. Funding for these coalitions in 2009-11 will come primarily from AMH dollars, supplemented with profits from local fundraising activities. The EHS chapter of TADA has been very productive over its three years, and the WHS chapter is proving to be just as motivated. The two chapters will host a joint community forum in April 2008 to showcase the research projects and displays they have completed this school year. They will also provide host forums in their respective schools to educate their peers in at least grades 7-12. Highlights from the past three years of the TADA-EHS chapter include:

• Promotion of National 3D (Drunk & Drugged Driving) Prevention Month in December all three years

For 2005, TADA members helped to create a brief lesson they taught in every K-6th classroom at their school, with the themes of “Think Don’t Drink” and “Sober Drivers=Safer Riders.”

Participated in the annual Winterfest Parade in 2007 • Promotion of National Alcohol Awareness Month in April all three years

In 2005-06, created a PowerPoint presentation highlighting some of the effects of alcohol on adolescent brains and bodies; some differences between alcohol a generation ago and what they are facing now; and some suggestions for what youth, parents, adults, and retails can do to help prevention underage drinking. The members hosted a community forum during which they shared their presentation.

• Promotion of National Teen Pregnancy Prevention Month in May all three years For the 2006 campaign, the students researched the costs of a few basic

needs for babies, calculated the monthly expense of these, and designed a print advertisement. This ad was made into a poster and displayed not only at the school but other locations throughout the county as well. It was also run as an ad in the local newspaper and as a “Silver Screen” ad at the local movie theater.

• Promotion of National Red Ribbon Week in October 2006 and 2007 to all K-6 students at their school (almost 200 children), going as many as 7 days to the same elementary classroom.

• Promotion of sober Super Bowl Sunday 2008 in their school, community, and neighboring town

• In March and again in May 2006, TADA members enlisted the help of their peers to stage a mock underage drinking party as part of a training exercise for a local


training of regional law enforcement officers on conducting controlled party dispersal operations.

• In 2005, TADA helped WVTP come up with a name and design a logo for our underage drinking prevention social norms campaign. We wanted a single campaign that would target all populations – children, adolescents, parents, other adults, retailers, alcohol licensees, hotels, other businesses, and the general public – and would be fit with all issues related to underage drinking. The result was “none before 21” with a logo appealing to youth as well as adults that also makes people stop and think.

TADA members helped with the creation of some posters and other advertising for the “none before 21” campaign.

TADA members are also helping WVTP with a new addition to the “none before 21” campaign focusing on alcohol’s effects on athletic performance.

• From 2005-07, TADA assisted WVTP in designing a student survey on youth alcohol attitudes and use, with the goal being to administer the survey in all three local high schools to gather much-needed data. A number of issues contribute to Wallowa County students not being included or well-represented in the annual Oregon Healthy Teen Survey, resulting in a lack of accurate or available data for our area. They also assisted with the design of an accompanying parent survey.

In early 2006, members approached all three local school districts’ superintendents and principals with information about their efforts and requesting permission to administer the survey to all 8-12 grade students in the three schools. In March, prior to Spring Break, the survey was administered and then TADA members assisted WVTP with tabulating and collating the data. Members assisted with the writing of the Executive Summary.

• TADA members have written ads for underage drinking, drunk/drugged driving, and teen pregnancy that they also recorded at our local radio station; these ads were aired throughout the year and received additional airtime during broadcast of local high school sporting events.

• The President of TADA-EHS, a third-year member, attended the National Prevention Network’s annual conference held in September 2007 in Portland in order to promote the “none before 21” social norms campaign at WVTP’s exhibit booth.

• Three TADA-EHS members will attend the annual Oregon DUII Multidisciplinary Conference in Bend this March, where they will host WVTP’s exhibit booth for the “none before 21” social norms campaign in addition to participating in a panel presentation on current efforts occurring in Oregon to reduce and prevent underage drinking.


Though only in existence for two months, the TADA-WHS chapter already has these accomplishments:

• Promotion of National 3D (Drunk & Drugged Driving) Prevention Month in December 2007

• Promotion of sober Super Bowl Sunday 2008 in their school, community, and neighboring town

• Promotion of National Alcohol Awareness Month in April (in process) • Promotion of National Kick Butts Day in April, a youth tobacco prevention

campaign (in process) • Promotion of National Teen Pregnancy Prevention Month in May (in process)

Cultural and Gender-specific Issues Rural communities themselves have their own culture, and therefore, addressing the issues of the community addresses the culturally-specific issues. For example, providing childcare and meals as part of programs is essential to the overall success of the program. Whenever possible, funds to cover these components are incorporated into grant requests. WVTP’s Director, also the Prevention Specialist for the County, has received extensive training in cultural and diversity issues and attends additional workshops regularly, which is also required for maintaining status as a Certified Prevention Specialist. While Wallowa County still has a Caucasian population of over 90%, there are increasing numbers of Hispanic and Latino, as well as Asian and Pacific Islander residents. Whenever possible, WVTP provides materials in Spanish or English/Spanish. The prevention strategies and curriculums implemented in Wallowa County are universal in nature and do not separate males from females. Should a need for separate gender programs be identified, WVTP would identify appropriate evidence-based programs and/or curriculums to implement locally.

Professional Development Commitment WVTP is committed to ensuring that the Prevention Specialist maintain certification and staff is able to access trainings that provide updated and pertinent information, as funding and scheduling allow. Our local priority is to serve the public and meet the identified needs of youth, families, and community partners as identified in the County Comprehensive Plan. Therefore, providing direct services is always a key priority that will take precedent. The majority of funding necessary for such trainings is provided for separately from the AD-70 funds, as Wallowa County is a minimum-grant county through AMH’s formula distribution. Whenever possible, WVTP coordinates efforts with other local entities to either sponsor partners to attend trainings outside of Wallowa County and/or to bring quality trainers to


our area. In addition, WVTP hosts an annual prevention conference for the surrounding counties and open to anyone, with topics of interest for a variety of community partners. PROBLEM GAMBLING SERVICES PLAN Wallowa County subcontracts gambling services to Umatilla County. It receives no funds for these services. Mental Health professionals at WVCW have recently received training in screening for gambling issues. Screening tools have been adopted and will be used as a regular part of mental health and Alcohol and Drug assessments and screenings. Clients who are identified as having gambling issues will be referred to the regional gambling treatment program.

Documents

2009-2011 WALLOWA COUNTY IMPLEMENTATION PLAN For … · 2009-2011 Wallowa County Implementation Plan, Page 3 We will ensure that this program is culturally competent and gender-specific