HUMAN SERVICES RESTRUCTURING TASK FORCE

Institutions and Facilities Subcommittee
MINUTES

October 13, 1997 - Third Meeting of Five

MEMBERS PRESENT

In addition, Representative Todd Taylor was present for the meeting.

MEETING IN BRIEF

Minutes prepared by Nicole Haatvedt, Legal Editor, and Rick Nelson, Legal Counsel
Organizational staffing by John Pollak, Committee Services Administrator

  1. Procedural Business.
  2. Glenwood Advisory Board.
  3. Partnerships at Glenwood State Hospital-School.
  4. Hospital-School Services.
  5. Mills County Attorney.
  6. Concerned Parents.
  7. Clarinda Treatment Complex Overview.
  8. Clarinda Tour.
  9. Subcommittee Discussion.
  10. Next Meeting.
  11. Materials List.

SUBCOMMITTEE BUSINESS

1. Procedural Business.
a. Convening. The meeting convened at the administration building of the Glenwood State Hospital-School (GSHS) at 9:45 a.m. with a welcome from Chairperson Houser and Superintendent Dr. Bill Campbell, followed by a tour of the campus and facilities.
b. Glenwood Tour. Subcommittee members, public, and staff were escorted on a tour of facilities and programs located on the GSHS campus. Tour stops included the middle school gymnasium and auditorium, a residential setting, recycling work areas, health care facilities, adaptive equipment development area, aquatic physical therapy area, day camp and lake site, and building areas used by tenant On With Life, Inc.
c. Luncheon. The meeting continued with a working lunch at the GSHS Canteen. Dr. Campbell introduced speakers from the community, agencies working as partners with the hospital-school, and the hospital-school, as well as concerned parents.
d. Recess and Reconvene. The meeting recessed at 12:38 p.m. and reconvened at the Clarinda Mental Health Institute at 2:14 p.m.
e. Adjournment. The meeting was adjourned from the Clarinda Academy facility at 4:10 p.m.
2. Glenwood Advisory Board.
Mr. Larry Winum spoke on behalf of the Glenwood Citizens' Advisory Board. Mr. Winum stated that the board was established about five years ago because of the community's concern about the effects that downsizing of the hospital-school would have on the community and on the quality of services provided by the hospital-school. The main goals of the advisory board are to preserve and enhance the services and facilities of GSHS. The board seeks to reach those goals through contacts with the Legislature and the Governor and strategic planning relating to alternatives for use of the hospital-school resources and facilities. Mr. Winum emphasized the importance of the middle school as part of the Glenwood campus and the partnerships with other services and agencies. In response to a question from Representative Houser, Mr. Winum expressed the board's opposition to developing programs for the Department of Corrections at GSHS. The board believes these programs would not work well with the community programs already developed on the campus.
3. Partnerships at Glenwood State Hospital-School.
· Family Resource Center. Ms. Pam Bantz spoke on behalf of the educational programs at GSHS and the Family Resource Center. She expressed her support for the association between GSHS and the educational and collaborative programs. The educational programs include the middle school, the three preschools on the campus, the special education programs, the normally developing peers program, the at-risk program (which is grant-funded through the Department of Education), the Building Bridges Program (alternative school), the central school (for medically fragile persons with a developmental disability, mental disability, and other special populations), and attendance by consumers at other public schools in the area. The collaborative programs which have office space at GSHS but do most of their work out in the community include the SAFE Coalition Coordination and Prevention Specialist, the school-based interventionist (AEA), and the Kids' Place (day care).
· DHS Cluster Office. Ms. Jackie Rickert spoke on behalf of DHS, which was the first agency to partner with GSHS. The Mills County DHS office on the GSHS campus has 11 DHS staff members and is clustered with Montgomery and Cass Counties DHS offices. The office provides services to families with children, elderly persons, and others. The primary services provided by the office focus on case management, child welfare, and welfare. Currently, there are 1,500 Medicaid recipients, 813 food stamp recipients from 283 households, and 144 Family Investment Program families served by the office. Ms. Rickert expressed her opinion that GSHS is like a community center, providing many needed services to the community from a central place.
· Juvenile Justice Decategorization (Decat). The funding decategorization program known as "decat" operates under an agreement between a county or group of counties and DHS to pool certain juvenile justice and child welfare categorical funding. Ms. Patricia Russman is the Decat Coordinator for the multicounty cluster of Mills, Montgomery, and Cass Counties. Ms. Russman emphasized that decat work is primarily out in the community and is partnered with DHS. Community planning groups have been organized which consist of elected officials, child care providers, parents, and others in the community. Decat has a children and families focus associated with programs such as the Iowa Strengthening Families Program, outreach (mentoring), and the Healthy Lifestyles Activities for Youth program. Ms. Russman also spoke about the newly created Innovation Zone Site for the multicounty cluster. The participants in the zone chose to focus on truancy, as that issue touches many other issues such as teen pregnancy, drug use, and criminal activity. They will be searching for a Truancy Resolution and Innovation Officer (TRIO) which will be funded by three grants relating to substance abuse and family preservation support and also by carry-over funds this year. The TRIO may be partially funded by the schools next year, and the zone participants are trying to bring in other players. In response to a question from Ms. Arlene Dayhoff, Ms. Russman expressed her concern about the potential effects of the draft Request for Proposals (RFP) issued by DHS to include child welfare Medicaid funding in the same managed care contract with mental health and substance abuse service funding. Ms. Russman is concerned that a managed care agency might not be able to utilize the managed care techniques already being used by decat. She stated that collaboration of services and facilities has reduced costs so funding can be devoted to early prevention programs, and she is concerned about how a managed care agency may deal with that issue.
· Public Health. Ms. Barb Kaiman spoke on behalf of the Public Health Office. Ms. Kaiman emphasized the positive relationship her office has with GSHS. The Public Health Office has 30 staff, including registered nurses, sanitarians, and family skill development workers. The office's primary focus is home visits to consumers. The Public Health Office has tripled its space at the campus and could expand its staff and programs. Ms. Kaiman stated that the office has daily collaboration with many of the agencies and programs located on the campus.
· Area Education Agency. Mr. Michael Farlie represents the Area Education Agency (AEA) and the Toddler Program. The AEA provides educational support services to six school districts. Mr. Farlie stated that the AEA collaborates with GSHS in many areas. The AEA provides audiologist services to GSHS and GSHS provides occupational and physical therapy services to the AEA. The AEA provides school-based interventionists and will be the fiscal agent for TRIO. Mr. Farlie agreed with other speakers that the relationship between GSHS and individual agencies and programs is a true collaboration which is beneficial to all involved.
· Central Point of Coordination (CPC). A CPC is the access point for mental health and developmental disability services administered by a county or multicounty cluster. Ms. Monica Murray is the CPC administrator for Pottawattamie County and discussed the partnership with GSHS and Pottawattamie County for vocational services. Ms. Murray explained that GSHS offers a variety of work programs for consumers in Pottawattamie County. Twelve consumers from that county are currently participating in the programs. Ms. Murray stated that the consumers and their parents are very pleased with the arrangement. Ms. Murray also emphasized that GSHS is a community resource, not just a hospital-school. She would like to see the community resources expanded. Ms. Murray also expressed her desire to see the restrictions concerning admissions dropped. The restrictions often affect consumers in her area.
· Workforce Development. Ms. Kelley Hunter from the Iowa Workforce Development Center stated that the center provides job placement, unemployment, and insurance services. The center has an automated labor exchange which provides clients with home access to job postings and other employment news. The center also provides resume services and testing. Ms. Hunter told the Subcommittee that clients of the Workforce Development Center are also served by other agencies on the GSHS campus.
· Foster Grandparent Program. Ms. Jane Butler spoke on behalf of the Foster Grandparent/Senior Companion Program and Project Renaissance. Ms. Butler told the Subcommittee that the Foster Grandparent Program on the GSHS campus is supported by federal funds and is the largest Foster Grandparent Program in the state. The Senior Companion Program is similar to the Foster Grandparent Program, except that it serves persons over age 21. Most of the volunteers for the programs are low-income elderly. The Foster Grandparent Program is going to be expanding in cooperation with the Head Start Program. Project Renaissance focuses on preservation and development of the natural resources on the campus and receives assistance from the United States Department of Agriculture (USDA), the federal Soil Conservation Service (SCS), and the Iowa Department of Natural Resources (DNR). The area around GSHS has the largest amount of cultural resources in the state, including various archeological sites. The project has a goal of establishing a state preserve on the campus.
· On With Life, Inc. Mr. Scott Steinmetz spoke on behalf of On With Life, Inc. On With Life, Inc. is a not-for-profit agency based out of Ankeny which focuses on sub-acute medical management and acute care for "younger adults". It is licensed as a skilled nursing facility and provides services to persons with brain injuries and other disabilities. On With Life, Inc. is looking to expand its space on the GSHS campus. It would like to provide a continuum of services including long-term vent care and outpatient therapy services. A recent survey conducted by On With Life, Inc. concerning its partnership with GSHS revealed a 95 percent approval level.
4. Hospital-School Services.
Ms. Diana Hoogestraat spoke about Time Limited Assessments, admissions, Home and Community-based Services (HCBS) Waiver Programs, HCBS Home in Glenwood, and RT/SS. Ms. Hoogestraat told the Subcommittee members that a 1995 survey concerning mental health services revealed a perceived gap in such services, including respite care and supported community living, especially if the consumer had behavioral problems. As a result of the survey, GSHS has tried to focus on bringing services to the people. It has received certification for the Medicaid HCBS Waiver Programs and for rehabilitation treatment services (children's services under Medicaid) and has established respite care on the campus and in the community. It provides home and vehicle modification services, skills development, therapy, and counseling. One community-based home has been established for persons who kept returning to GSHS from unsuccessful community placements, and more homes are planned. GSHS provides Time Limited Assessments, which are short-term admissions for persons who have temporary medical problems or persons who need help getting started with a new program. The assessments are preventive and provide a means of keeping people in their homes and involved in the community. In response to a question from Representative Foege, Ms. Hoogestraat stated that respite care is typically a one-year service with service gradually decreasing and providing in-home therapy.
Ms. Marilyn Prien spoke briefly about outreach services provided by GSHS. Although outreach services have been provided by GSHS for years under a different name, a formal outreach services program was established July 1 of this year. Consumers have a choice between in-facility services and community outreach services.
Due to time constraints of the Subcommittee, Chairperson Houser suggested moving on to comments from the Mills County Attorney and concerned parents.
5. Mills County Attorney.
Ms. Connie Anstey is the Mills County Attorney. Ms. Anstey expressed the need for long-term treatment for persons with mental illnesses. She indicated concern about forcing persons out into the community who are not ready to function in the community. Many families need help with long-term care for family members who are no longer juveniles. Ms. Anstey maintained that these families should not have to wait until something happens which permits an involuntary civil commitment. She stated that persons with mental illness should not be forced to become homeless or commit a crime because they are not able to receive treatment.
6. Concerned Parents.
Ms. Kathy Norris spoke on behalf of concerned parents in the Glenwood area. Ms. Norris has a 16-year-old daughter with physical and mental disabilities. The Norrises have cared for their daughter at home for 16 years. Ms. Norris believes she and her husband now need out-of-home placement for their daughter but is frustrated by the admissions process at GSHS. Ms. Norris stated that the family's case manager has submitted the required paperwork to the regional screener and that the screener has refused admission twice. Ms. Norris disagrees with the admission decision being made by one person. She told the Subcommittee that no other out-of-home services are available in the area and she does not believe she should have to use a group home which is located across the state. In response to a question from Representative Brauns, Ms. Norris stated that the case manager has been very helpful and believes the regional screener is the problem. In response to a question from Ms. Dayhoff, Ms. Norris responded that other services have been provided by DHS, including the HCBS waiver and respite care. Senator Freeman commented about the effects of downsizing and shortage of funds on the admissions process. It was noted that the federal court consent decree known as the "Connor Consent Decree" is a factor in requiring a strict review of admissions to the state hospital-schools. Representative Foege suggested holding a public forum on the issues raised by Ms. Norris.
Ms. Sybil Finken distributed the federal Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1993 relating to the rights of persons with developmental disabilities and their parents.
7. Clarinda Treatment Complex Overview.
Senator Angelo introduced Clarinda Treatment Complex Superintendent Mark Lund for opening remarks. After welcoming Subcommittee members, Mr. Lund provided an overview of the physical layout of the Clarinda Treatment Complex and summarized the structure and administration of the major psychiatric, geropsychiatric, correctional, and youth program services provided at the complex.
8. Clarinda Tour.
The following locations were viewed during the tour of the treatment complex with the indicated information provided during the tour:
9. Committee Discussion.
The Subcommittee inquired as to the average length of stay in the acute psychiatric care unit and was informed that, on average, a patient stays 35 days in the course of a year. There was discussion of the impact of caps causing relatively fewer juveniles to reside at the Academy and the number of states outside of Iowa sending youth to the facility. It was noted that staff turnover at the MHI is unusually low, which enhances the quality of care provided to patients. In the geropsychiatric area, over 50 percent of the staff have been employed for 10 years or longer. Additional discussion concerned the lack of facilities within the state to care for patients with Alzheimer's syndrome or dementia subject to frequent physical outbursts and a recent recommendation by the Council on Human Services to add beds to the geropsychiatric program. In response to questions by Subcommittee members, geropsychiatric unit statistics regarding age breakdown, county of residence, discharge rate, death rate, diagnoses range, and waiting list length were summarized.
10. Next Meeting.
The next meeting of the Subcommittee will take place on October 23, convening at 9:30 a.m. at the Independence Mental Health Institute and reconvening later that day at the Toledo Juvenile Institution.
11. Materials List.
· A packet of materials assembled by the Glenwood State Hospital-School.
· A videotape produced by the Glenwood State Hospital-School.
· A general description and map of the Clarinda Treatment Complex.
· Statistics and a brochure concerning the geropsychiatric program at Clarinda MHI.
· A brochure concerning the Clarinda Correctional Facility.
· A packet of materials concerning the Clarinda Academy program.
· A copy of the federal Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1993 distributed by Ms. Sybil Finken.

OTHER INFORMATION FOR THIS COMMITTEE:

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