HUMAN SERVICES RESTRUCTURING TASK FORCE

Institutions and Facilities Subcommittee
MINUTES

December 11, 1997 - Sixth and Final Meeting

MEMBERS PRESENT

MEETING IN BRIEF

Minutes prepared by Nicole Haatvedt, Legal Editor
Organizational staffing by John Pollak, Committee Services Administrator

  1. Procedural Business.
  2. Eldora Juvenile Institution.
  3. Panel Discussion on the Role of State Institutions in Iowa's Service Delivery System.
  4. State Hospital-School and MHI Admissions Procedures Panel.
  5. Net-State Budgeting Briefing and Discussion.
  6. Iowa Noncompetition Law and Briefing.
  7. Review of Department of Human Services Inventory of Available Capacity at DHS Institutions and Department of Corrections Inventory of Facility Needs.
  8. Discussion of Draft Recommendations.
  9. Next Meeting.
  10. Written Materials and Documents Filed With the Legislative Service Bureau.
  11. Attachment - Draft Recommendations.

SUBCOMMITTEE BUSINESS

1. Procedural Business.
Convening. The meeting convened in the conference center of the Iowa Farm Bureau Federation in West Des Moines at 9:30 a.m. with a welcome from Chairperson Houser.
Overview. The meeting began with a presentation by Steve Huston, Superintendent at the Eldora Juvenile Institution. Mr. Huston was followed by a panel discussion on the role of state institutions in Iowa's service delivery system. Members of the panel were Linda Hinton of the Iowa Association of Rehabilitation and Residential Facilities, Margaret Stout of the Alliance for the Mentally Ill of Iowa, and Rik Shannon of the Governor's Developmental Disabilities Council. The institutions panel was followed by a panel discussion on state hospital-school and MHI admissions procedures with panel members Harold Templeman from the Department of Human Services, concerned parents Joy Higgins and Geneva Brungardt, and Merv Roth and Curt Sytsma of Iowa Protection and Advocacy Services. The Subcommittee continued with a working lunch, a briefing on the net state budgeting program by Margaret Buckton of the Legislative Fiscal Bureau, and a briefing on the Iowa noncompetition law by John Pollak of the Legislative Service Bureau. The briefings were followed by a review of the DHS inventory of available capacity at DHS institutions and the Department of Corrections inventory of facility needs by Charles Palmer, Director of the Department of Human Services, Walter "Kip" Kautzky, Director of the Department of Corrections (DOC), Mr. Templeman, and Fred Scaletta of the DOC, and a discussion of possible Subcommittee recommendations.
Minutes Approved. The minutes of the November 16, 1997, meeting were approved as distributed.
Adjournment. The meeting was adjourned from the Iowa Farm Bureau Federation at 5:07 p.m.
2. Eldora Juvenile Institution.
Superintendent Huston gave a general overview of the program at the State Training School for Boys (STS). He stated that the STS staff views the services it provides as preventive even though it works with the "most difficult" male youth_only one-third of the population of the STS goes to the adult corrections system. The programs and services available at the STS include 30-day court-ordered evaluations, 48-hour behavioral adjustments for intensive supervision programs in the community, an extensive substance abuse treatment program, a gang resistance and intervention program run by an ex-gang member, a sexual abuse program, religious services, an educational program, and extensive vocational programs.
In response to questions from Subcommittee members, Superintendent Huston stated that he believes there needs to be continuing care, especially support for educational endeavors, for some boys who have attended the STS once they turn 18. Currently this is left to juvenile court probation officers or DHS caseworkers because the STS is not staffed to perform these services. Superintendent Huston stated that nine to 12 months of follow-up is imperative, but not available. Follow-up services for younger youth are provided by DHS and the juvenile court. Ms. Dayhoff requested follow-up ideas from Superintendent Huston and suggested that support in counties which have decategorized funding might be an avenue to pursue. Senator Szymoniak suggested that the entire case file on a delinquent youth should be evaluated to identify the "failure point" at which the system did not meet the needs of the youth.
In response to a question from Representative Brauns, Superintendent Huston stated that the new housing which was approved by the General Assembly last year would be enclosed by Thanksgiving of 1998 so that work could continue on the interior of the new housing unit. Process on the construction of the new unit involved a request for proposals (RFP), selection of an architect, and consultations with the architect. Ms. Dayhoff opined that Eldora needs additional staff, especially with the new housing unit being built. Superintendent Huston stated that the STS is currently overcapacity in the living units and communities are prioritizing for which kids will be placed at Eldora. The STS has budgeted for 18 new staff for the new housing unit.
3. Panel Discussion on the Role of State Institutions in Iowa's Service Delivery System.
IARRF. Ms. Hinton made a presentation, which is also set forth in a handout, on behalf of the Iowa Association of Rehabilitation and Residential Facilities (IARRF). Generally, Ms. Hinton opined that the state has not made an adequate investment in community-based services for persons with disabilities and that movement toward privatization and leveling the playing field between the state-operated programs and private providers is in order. Certain specialized services that the state institutions have developed to meet the needs of low incidence or particularly difficult populations should be retained and can be used as a resource by community-based providers.
AMI. Ms. Stout spoke and presented a handout on behalf of the Alliance for the Mentally Ill of Iowa (AMI). She emphasized that many of the questions associated with an institutional setting are quality of life issues. Members of the AMI believe care, including care for those persons who are so ill that they need a short time in a structured environment at an institution, should be provided in a local facility that does not have to be near a correctional facility or a long way from home.
DD Council. Mr. Shannon of the Governor's Developmental Disabilities Council also spoke and presented a handout. He emphasized that now is the time to examine the needs of Iowans with disabilities and their families and find solutions that maximize existing financial resources and promote the development of community-based supports and services that create options through flexibility and emphasize the individual as the focal point of quality.
Questions. In response to a question from the Subcommittee, Ms. Stout stated that the state institutions are a necessary part of the system but four MHIs is too many and other community-based services need to be developed to pick up the absence of those institutions. She opined that the MHIs near correctional facilities create a stigma for the persons receiving treatment at those MHIs. She also suggested that such MHIs should be used to treat the mental health population in the correctional facilities. Ms. Hinton stated that specialized services such as treatment for sex offenders are necessary at state institutions. State institutions operate with higher salaries and have fewer constraints than those experienced by community-based programs. The Subcommittee discussed the possibility of using money that was taken away from the mental health budget as a result of downsizing for the development of community-based services.
Ms. Schmidt questioned why local hospitals average three- to five-day stays for inpatient treatment when the state institutions average stays of about one month. Ms. Stout responded that local facilities have more pressure to stabilize patients and act quickly. She stated that there need to be individual evaluations of each patient which are not focused by financial pressures. The Subcommittee and panel members also noted the lack of adequate insurance coverage for mental health treatment.
4. State Hospital-School and MHI Admissions Procedures Panel.
DHS. Harold Templeman, DHS Division Administrator, spoke and presented handouts regarding admissions policies at SHSs and MHIs. Mr. Templeman stated that when admissions policies were reformulated in the 1980s the focus was shifted to really evaluate whether community services are available for a potential client. There is a prescreening process for voluntary admissions_they must go through the local county central point of coordination offices (CPCs). CPCs can also be involved as to where clients who have been involuntarily admitted are placed. The Conner lawsuit and consent decree affected the SHSs and more clearly defined the admissions policies and required that community-based services near the client's home be used if possible. Mr. Templeman emphasized that there is a practical side to the admissions policies because there are only so many beds. The SHSs have been running at capacity for the last two years. In response to a question from the Subcommittee, Mr. Templeman stated that in the last few years DHS has been emphasizing in-state placements. Previously there were about 400 out-of-state placements and now there are between 50 and 60 such placements.
Parents. Ms. Higgins, a concerned parent and representative of ARC of Southern Iowa, spoke about her personal experiences with the admissions policies at Glenwood SHS. Ms. Higgins opined that there is a need for community-based services but that there is also a need for state institutions.
Ms. Brungardt told the Subcommittee about her experience with trying to get her son admitted to Glenwood SHS. Her son was placed at Glenwood for a 30-day assessment and did well. Ms. Brungardt wanted her son to stay at Glenwood but was told that, because of the Conner decision, her son would have to utilize community-based services. The community-based facility utilized by Ms. Brungardt is about 60 miles from the Brungardts' home. It provided very poor care for her son and she saw almost immediate regression in her son's behavior. Ms. Brungardt stated that she has continued to try to get her son admitted to Glenwood but has encountered numerous bureaucratic barriers.
Protection and Advocacy Services. Mr. Roth, Executive Director of Iowa Protection and Advocacy Services, discussed the Conner lawsuit and consent decree. Mr. Roth stated that Conner was prompted by the conditions at SHSs and the state essentially "forcing" residents to remain in these facilities when they did not need to stay by failing to provide leadership and funding to serve these individuals in the community. Mr. Roth opined that community-based services are less restrictive of the rights of these individuals, are less expensive, thereby freeing up funds to serve more individuals, and are more conducive to promoting skill development, fewer behavioral problems and medications, and more family involvement. Mr. Roth advocates that at least two MHIs be closed and the funds allocated to those MHIs be reallocated to develop community-based services.
Mr. Sytsma, Staff Attorney at Iowa Protection and Advocacy Services and counsel for the Conner consent decree, related the results of an Oklahoma study performed after the closure of a large state mental health facility. Mr. Sytsma stated that the study showed dramatic enhancements in private care after the closure of the facility. Oklahoma used the funds that were available for the state facility to develop small home situations which provided much better care. Mr. Sytsma also opined that caps and restraints are hindering Iowa's development of community-based services pursuant to the Conner consent decree. He stated that CPCs have financial incentives not to keep children in the community because the county is required to pay more if a child is placed in a community-based program than if the child is placed in a state institution. Many parents accept what state and county agencies say without question. Mr. Sytsma emphasized that there needs to be a procedure for notification of parents as to why local services cannot be used.
Questions. In response to a question from the Subcommittee regarding admissions policies and consideration of local placement, Mr. Templeman stated that the placement process starts at the local level. It begins with a court order or a voluntary admission and usually goes through the local CPC. DHS has been hearing complaints that the local decision makers, to protect the group foster care cap, often seek ICF/MR placement or a home-based waiver for children with mental retardation. Mr. Templeman emphasized that although there may be an available bed, there may not be an appropriate bed. He stated that more ICF/MR beds and RCF/MR beds are not the answer to many of the issues raised at this meeting.
5. Net-State Budgeting Briefing and Discussion.
Ms. Buckton of the Legislative Fiscal Bureau spoke and presented a handout on net-state budgeting of DHS institutions. The Glenwood SHS and Independence MHI are currently operating under net-state budgeting pilot projects for fiscal year 1998. Independence is using a trial budgeting system assuming a net-state appropriation in a paper-only format while maintaining the existing budget system for actual operations. The rationale for implementing net-state budgeting is three-fold: to clearly show the actual cost to the state to operate the institutions; to create consistency with other DHS budget processes; and to create a responsive environment for provision of service.
6. Iowa Noncompetition Law and Briefing.
Mr. Pollak of the Legislative Service Bureau spoke and presented a research memorandum on Iowa Code Chapter 23A concerning noncompetition by government. Generally, a state agency or political subdivision cannot, directly or through or for another state agency or political subdivision, produce, sell, rent, or distribute goods or services to the public which are offered by private enterprise unless the goods or services are to be used or consumed only by the state agency or political subdivision. However, the agency or subdivision may engage in these activities if authorized by statute, rule, ordinance, or regulation, or if the activity meets one of the specific exceptions listed in the statute. One of those exceptions is for the offering of goods or services to the public as part of a client training program operated by a state hospital-school. However, the price of such goods or services must reflect the actual cost to produce the goods or services. The statute also includes a local government purchase preference. If cost and other considerations are relatively equal, the local government is to consider making the purchase from a locally owned business. Chairperson Houser suggested that if the institutions are encouraged to become more entrepreneurial, the Legislature may want to consider additional changes to this law.
Ms. Hinton and Ms. Stout commented that if state institutions were privatized, competition by government would not be an issue.
7. Review of Department of Human Services Inventory of Available Capacity at DHS Institutions and Department of Corrections Inventory of Facility Needs.
DHS Inventory. Mr. Templeman spoke and presented a handout on available space at DHS institutions. In response to a question from Chairperson Houser regarding whether there are any buildings for which it would be more cost-effective to tear down the building than to renovate, Mr. Templeman stated that Grove Hall at Independence, Hilltop at Independence, and 102 Central at Glenwood should all be demolished. Mr. Palmer stated that, although many buildings have been underutilized in the past and some continue to be underutilized, programs have been expanded in many of the buildings in recent years. Representative Brauns commented that corrections populations could be used for the demolition of these buildings.
Space Needs. Representative Brauns inquired about how much space is needed per person at each institution and how many people could be served by the available space. Mr. Templeman explained that space requirements are established in accrediting standards. Mr. Templeman stated that approximately 100 square feet per person in an individual sleeping room and 80 square feet per person in a multiple-unit sleeping room is necessary in addition to hallways, common areas, and office space. Wards hold about 20 to 25 people. Mr. Palmer commented that space requirements differ for mental health, juvenile, and corrections facilities.
Corrections Needs. Mr. Kautzky reiterated previously discussed interest in developing a 100-bed facility for female inmates with special needs at the Mt. Pleasant campus, a 100-bed facility for higher-risk female inmates who are medically limited at Oakdale, a 200-bed special needs facility at Ft. Madison, and pre-release offender facilities. He provided written materials concerning projections for inmate growth, a special needs study, relative costs for renovation at Clarinda and Mt. Pleasant, and a draft plan for reengineering of prerelease procedures, and responded to questions from Subcommittee members. Mr. Kautzky stated that there are three needs in relation to correctional populations: special needs categories (of which only low-risk populations will be considered); violator populations; and prerelease offenders (averaging about 300 offenders at any given time). Subcommittee members raised concerns about utilization of existing staff at the MHIs and the financial impact of utilizing MHIs for DOC needs. Mr. Palmer and Mr. Kautzky responded that some duties could be performed by crossover staff such as business office duties and physical and medical services. They also stated that as DOC populations are added to MHI campuses, some of the costs decrease and subsequently the per diems at MHIs decrease.
Subcommittee members also discussed issues of increasing the success of persons once they leave the correctional institutions. Issues included special prerelease programs, sex offender "after care," including the possibility of civil commitment, and intensive substance abuse treatment. Mr. Kautzky suggested developing two prerelease facilities in the state, one in the east and one in the west.
8. Discussion of Draft Recommendations.
General Comments. Each of the members made general comments concerning their work with the Subcommittee. Members who have an institution in their district noted their initial interest in that institution was greatly expanded from the visits to the other institutions around the state. Other general comments included the high percentage of DHS employees who work in institutions and the need for additional field staff, the need for a continuum of care and the role of the institutions in that continuum, the relatively good level of maintenance in the physical facilities, the increasing usage of space by local governments and private providers, the need for regional availability of mental health and substance abuse services, and the friction between policy needs for controlling costs and for providing appropriate services.
Draft Document. A draft list of 34 recommendations was compiled from notes developed by Chairperson Houser from the various discussions among Subcommittee members and from presentations made to the Subcommittee. Chairperson Houser requested Brad Trow of the House Republican Research Staff to explain each of the items in the draft listing of recommendations. Members made the following suggestions for changes:
Other Recommendations. Members noted that time would not permit continued discussion of the remaining proposed recommendations. Staff were directed to revise the recommendations to reflect the discussion and to mail the revised draft to members for comment and suggestions for further revisions. In addition, staff were directed to develop a draft vision statement reflective of the views of the members concerning the future of the institutions. Members decided to meet informally together for dinner at Lacona's on Fifth restaurant with any members of the public who wished to attend on Wednesday night prior to the full Task Force meeting on December 18. At that time, members would discuss the redraft and determine whether there was interest in proposing additional changes during the full Task Force meeting.
9. Next Meeting.
The full Task Force meets on Thursday, December 18, at the Iowa Farm Bureau Federation in West Des Moines. Subcommittee members who are not members of the full Task Force were invited to attend the meeting.
10. Written Materials and Documents Filed With the Legislative Service Bureau.
a. Eldora State Training School FY97 Annual Report.
b. Iowa Association of Rehabilitation and Residential Facilities handout.
c. AMI of Iowa memorandum.
d. Governor's Developmental Disabilities Council handout.
e. Iowa Protection & Advocacy Services handout.
f. Net-State Budgeting handout from Margaret Buckton, LFB.
g. Iowa Noncompetition Law memorandum from John Pollak, LSB.
h. Draft of Reengineering of Prerelease Procedures Project Proposal.
i. DHS Institutions Available Space Table.
j. DOC Special Needs Study Preliminary Findings Presentation.
k. DOC handout on relative costs for renovation at Clarinda and Mt. Pleasant.
l. DOC projections for actual and estimated inmate population and capacity.

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