MAYOR’S HEALTH & HUMAN SERVICES GRAND FORKS CABINET MINUTES Thursday, October 18, 2007 I. CALL MEETING TO ORDER The meeting was called to order at approximately 12:10 p.m. by Don Shields. Those Members Present: Don Shields, Karen Schelinder, Julie Anderson, Keith Berger, Craig Knudsvig, Mary Amundson, Jon Green, Margaret Tweten, Mark Lambrecht, Lee Lipp, and Jacob Kerbeshian. Others present: Betty Hitterud, Tami Byzewski, and Roger Johnson from the NorthEast Human Service Center; and Keith Westerfield. II. OLD BUSINESS 1. Review and Approval of Minutes of July 19, 2007 Meeting: Minutes were reviewed and approved with no changes. 2. Community-Based Public Mental Health Services - Northeast Human Service Center (NEHSC): - Roger J. passed out a client overview sheet and a brochure, and gave a summary on what services are offered (see attachments). 3,211 people received services from NEHSC last year (2,265 adults and 946 children), in 4 counties (Grand Forks, Walsh, Nelson, and Pembina), with 78% of them from Grand Forks county. The greatest number of referrals they get are self-referrals, who contact NEHSC directly. Different types of services are offered, which range from just one type (with mental health only, that comprised the largest), to multiple services combined. The NEHSC is the primary provider of public-funded mental health services in the region, but not the only one. There is a full-time satellite office in Grafton. There are others that contracted with providers, such as with Prairie Harvest Service Foundation; and other supported-service organizations that are mostly for mental health. We are one of eight Human Service Centers in the State. The concerns that you have about certain clients, are certainly concerns that we have as well. There is a group of 25-30 clients that are ‘very visible’ and ‘very problematic’, and cause continuing problems for multiple agencies within the communities where they live. Jon G. asked if someone is an East Grand Forks, MN resident, are they served through Polk or Crookston’s Mental Health? Roger J. said Northwest Mental Health would be their designated center for them, with an office in East Grand Forks. Jon G. also asked how are NEHSC services funded, and how do you increase your funding? Randy J. answered that they get a budget allocation from the state of ND. The primary funds that go into that are federal dollars, with the biggest part being Medical Assistance dollars. They also receive Block Grants (Mental Health, Substance Abuse, and Title 4) dollars; State General Fund dollars; money collected from insurance billing; and from individuals paying (on sliding fee scale). So, there’s: Federal dollars, State dollars, Insurance dollars, and client dollars, in that order of magnitude. NEHSC budget is part of the Governor’s budget, so when we do our budget process, we submit a request to the Department of Human Services, then it goes to the Office of Management and Budget, and they work with the Governor’s office. The Governor then makes a budget request to the Legislature. Once the Governor has decided on a budget request, it’s our own request. Legislature can make changes though in the allocations. One thing that is misunderstood is that if we collect more money in one area, such as significant increase in Insurance collections, that doesn’t mean more money in our budget. It just means there’s less State-funded (General) dollars to go into our budget. We can’t exceed our budget unless Legislature gives us the authority to do so. We don’t get a bigger pie; if one piece gets bigger, another piece just gets smaller. Roger J. was asked by Mary A. with the 1-800 number for 24-hour crisis, does NEHSC make use of 211 at all? NEHSC uses 211 as a referral for people. The 211 is a State number, who would assess the situation, but they have NEHSC number to give someone. Leland L. asked if Vocational Rehabilitation was part of NEHSC’s budget, or was it part of the city’s budget? Roger J. said, yes, it is part of NEHSC budget. - Tammy B. is the Coordinator of the Extended Care Unit, and a Case Manager for the mentally ill at NEHSC. There are 14 of us; three Case Aids, 10 Case Mangers, plus one Case Manager in Grafton. Our job is to find the best resources for the clients that come in, whether they’re at NEHSC or out in the communities. We do a lot of referrals to Red River Valley Community Action, St. Vincent DePaul, and the Salvation Army; it’s just knowing where the resources are and where to direct those clients coming in. We also do a lot of work with Prairie Harvest, and some of the services they provide are: Direct Care service, medication monitoring, supportive employment, and Representative Payee (where that person is not capable of managing their own finances due to such things as addiction). Prairie Harvest also has a Residential Program: two Lodging programs (one house for men, one house for women); Harvest Homes, with 12 individual apartments and a 24-hour staff; a Crisis Residential Center, with 13 beds for the mentally ill, that is used as a temporary facility (with a lot of transitions from Altru); and NEHSC itself has a Transitional Living Facility, with Patty Straw as the Director. Some of the groups that we run at NEHSC, through the Extended Care program are the Life Solution Group, which works on daily living skills; the Supportive Employment program (job coaching), where the goal is full-time employment; and Mountain Brook, which is the social center downtown, has a membership of about 166 people, and where clients can spend their days at shooting pool, watching big-screen tv, or playing foosball. Jon G. was wondering if Mountain Brook was still understaffed, but there are two full-time staff working there now. Margaret T. was wondering what the break-down of gender and ages were. Roger didn’t have the answer at this time, but Tammy B. said there are problems with placing the elderly, more than there was ten years ago. Craig K. of the Grand Forks Housing Authority was asking if Roger could characterize the income level of the people NEHSC serviced (was it across the spectrum?), and how many are able are to pay their rent or are they using some sort of support for that? Roger answered that a great majority of them are low-income level, because they have fewer choices (such as no insurance); and most clients, especially the severely mentally ill, would not be able to afford their rent. Craig also said a disability; such as mental illness, or a physical or non-physical disability, helps them with eligibility for housing assistance (in addition to the low-income issue.). We house a lot of people with mental health issues (trying to let them live independently), and that is a national issue of concern among housing providers. Roger stated that there are two levels of problems there. We have clients that are truly dangerous, and we can usually do something about those (a vast majority of clients do not cause any problems in their community). But, then we have clients that don’t do anything that is dangerous, but they annoy people; their behavior is annoying, and sometimes the results are scary. These are the difficult people for us to deal with. Those people usually either don’t want to have anything to do with us, or we are unsuccessful in the intervention that we are doing with them. But, they don’t meet the criteria for treatment (commitment). They cause problems and are very visible, but we don’t have a good answer as to how we get them to comply, participate, or respond. Don S. asked what’s the best way to start that process, and how do we try to manage their behavior? There is a lot of one-on-one getting together on this issue, but not a group coming together. Is there a way to bring together four or five people? This was discussed by the board, with board members; Keith B., Karen S., John P., Craig K., and Don S. volunteering for this meeting. Roger J. will be setting up a meeting with the board and other departments. Roger and Dr. Kerbeshian also mentioned a Mental Court, which Grand Forks does not have, that has a specially trained panel; but you have to commit a crime to get there. III. NEW BUSINESS 1. Northwood Tornado Agency Assessment and Assistance: The board went around the room to see if any of the agencies assisting Northwood had any comments or concerns (see attached Issue Listing). Margaret T. of the Grand Forks NDSU Extension Services stated that they were looking for a couple of daycare providers, possibly students. Craig K. of the Grand Forks Housing Authority said that the Housing Authority is a County Housing Authority, and has been involved with Northwood. One of the things with the people who live there is that’s where they want to keep living, and if there isn’t housing available, that makes it difficult. Jon G. read a statement and questions from Mary A., saying “The need for crisis intervention is great. How can this group help, or who can help?” Also, “How can this group help empower our construction industry to help the residents; either charging a fair price, or ensuring quality products?” Don S. noted that several Northwood residents have met with the NEHSC. He also told that Grand Forks Public Health helped provide staffing for the homeless shelter out there, and cleanup assistance. 2. Member Update: The Mayor’s Health and Human Services Cabinet Members list (see attachment) was given to present members to review and update. IV. OTHER: None V. ADJOURNMENT The meeting adjourned around 1:15 p.m. VI. NEXT MEETING: Thursday, January 17, 2008 12:00 noon – 1:30 p.m. (lunch will be provided by Altru Health System) Altru Hospital (Lower Level, Multi-Media/Board Room) MEETING HANDOUTS: - Clinical Services Brochure, NorthEast Human Service Center - Client Overview Sheet, NorthEast Human Service Center - Mayor’s Health and Human Services Cabinet Members list, 18 Oct 07 - Issue Listing: Northwood Tornado Public Health Assistance Update, 18 Oct 07