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HomeMy WebLinkAboutMinutes 1988MENTAL HEALTH BOARD MEETING MINUTES JANUARY 14, 1988 7:30 P.M. (Minutes Approved 2--11-88) Members :'resent: Staff : Community Representatives: Carol Hones (Chairperson), Marcia Nelson, Art Diers, Ann Graff, Alderman Gene Feldman. Lee Leggette. Janice Jones Jeanno Fox, Harvey Saver C. Louise Arown. Director, Evanston Health ❑epartment Ms. Henes called the meeting to order at 7.35 p.m. I. Meeting Minutes Ms. Graff moved to approve the minutes of the November 2. 1987 meeting. Mr. Feldman seconded the motion_ Motion passed 7 aye - O no. Ms_ Graff moved to approve the minutes of the November 10, IS87 meeting as corrected. Ms. Nelson seconded the motion. Motion passed 7 aye -- O no. II. Long Term Care Committee Recommendations C. Louise Brown, Director of the Health Department, joined the Mental Health Board to discuss long term care issues in Evanston. Ms. Hence indicated that the Long Term Care Committee had recently been Focusing on the Ridgeviow Pavilion because the Facility was not in compliance with the Long Term Care Ordinance. The goal of the Committee is to see that there are major improvements in the level of care and supervision for individuals on the third floor. Long Term Carr Resolution Ms. Graff introduced the Committee'3 proposed resolution rogardi ng lung term care. She expressed the Committee's disappointment with ions term care proprietors who were providing inadequate care and supervision for the rental Health hoard's target populations. Mr. LeRgette supported the resolution and said it shifted the focus in the right direction. Alderman Feldman said that it reflected an appropriate concern by the Mental Health Board for its responsibilities to its targeted populations. He said that the proposed changes should MHB Meeting Minutes/January 14, 1988 Page 2 be endorsed by the Mental Health Board and should have an extremely high priority. Ms. Nelson said that the resolution would serve as a public statement of the Mental Health Board's intent to tighten the Long Term Care Ordinance. Ms. Fox said that approving the document would establish public policy statement For the Mental Ilealth Board. Mrs. Graff and Ms. Nelson indicated that the Long Term Care Committee was not focusing upon all long term care facilities. The concerns expressed in the resolution were targetea at proprietors who are not providing appropriate levels of care. Mr. Diers recommended that there should be some acknowledgement of the good facilities which serve their populations well. Alderman Feldman proposed that an additional item be added to the resolution that would require the City to collect information :From all applicants for a long term care facility license about their professional history, and about their record of operations and sanctions in operating long term rare facilities. The Committee accepted the amendment. Ma. Graff moved to adopt the Long Tor= Cara Proposed Resolution, as amended_ Mo- Nelson seconded the notion_ Motion patssod 7 aye - Q no. Alderman Feldman indicated that he would inform the human Services Committee about the Long Term Care Resolution before its introduction to the Committee. R.idgeview Pavilion Update Ms. Brown reviewed the history of the denial of a license to the Ridgeview Pavilion. The Health Department had requested specific information to be included in a plan or correction, including objectives and time frames. The facility had recently submitted its nth revision of the plan. M--.. brown indicated that the latest document submitted seemed to bu a step in the right direction, and projected realistic time frames. Ms. Brown indicated that. pending a review by the City Legal Department. she will probably be issuing a conditional license. This will be accompanied by intensive monitoring of the fac i 1 i ty. If' there eire any major deviations from than accepted plan of correction, o conditional license can be pul li.)d immediately. Report of Meeting to Address lsaueis or the Chronically Mentally III A meeting was held on December �O. 1881, with various advocacy groups and (service provider3 which represent the concerns of the chronically mentally iil in Evanston. Two long MHBIMeeting Minutes/January 14, 1988 Page 3 terra care proprietors attended. The group has agreed to serve as advocates in the community for the needs of this population. Initially. they Will define the problems encountered by the population, and research What is being done in other communities to address these problems. Ms. Graff reported that a subcommittee is developing a format for the collection of data that will give a clearer picture of the situation in Evanston. She also said that the proprietors offered to defray some of the costs to the agencies that serve their residents. Work Plan Ms. Henes suggested that the Mental Health Board request time on the Human Services Committee agenda in February to present the Long Term Care Resolution. She also requested that the Long Term Care Committee begin to explore related issues as it considers revisions to the Long Term Care Ordinance. The Board directed the Long Term Care Committee to complete its recommendations for changes in the current Long Term Care Ordinance by August. 1J1i8. III_ Roview and Set Priorities for Mental Health Board Objectives for 1988-83 The staff recommendations for priorities and a work plan for the Mental Health Board objectives for FY E38-89 were reviewed. Staff Were complimented on the detail and information provided in the plan. Mr. Diers expressed concern that none of the objectiveB addresses issues specifically related to children. After Board discussion, Ms. Fox indicated that staff will provide additional information its their reports about the progress of issues and concerns as they related to children. The following changes were made in the recommended priorities: 1 (c) changed frog, Important to Desired 1 (d) changed from Desired to Important 5 (c) changed from Important to Maintenance 5 (e) changed from Important to Maintenance By conseTu3us. the Board adopted the recommended priorities. as amended, f o r F FY 88-83 Ob.i ect i v0es _ IV. Discussion of Raquoat for Agency Outcome Objectives Ms. Henes appointed a subcommittee of Mr. Laeggette and Mr. Diers to review the information provided, and to repurt back at the February tweeting. MHB Meeting Minutes/January 14. 1988 Page 4 f V. Inf'ormationai Items > A draft letter to provide testimony for Rep. Woods Bowman's hearing on Reform of Mental Health Services for MI and DD waa reviewed. The Board members were requested to submit their suggestions and recom- mendations For a 2nd draft. > Mr. Saver reported that IDPA will be out of funds to pay For day training programs and long term care facilities as of March 31. This may be a first step in an attempt to get a supplemental appropriation for Public Aid. Attempts are being made to determine the impact on local programs. Mooting adjourned at 1 O : 30 p.m. Respectfully submitted, �-n'11 0/1 eanne M. Fox SUMMARY OF DECISIONS MENTAL HEALTH BOARD MEETING JANUARY 14, 1988 1. The Long Term Care Proposed draft Resolution was adopted as amended. 2. The recommended priorities for the PY 88-89 Objectives and Activities were adopted, as amended, by consensus. 3. A Committee was appointed to review information about agency outcome objectives, and to make recommendations at the February meeting. MENTAL HEALTH BOARD MEETING MINUTES FEBRUARY 11, 1988 (Minutes approved 3-10-88) Members Present: Carol Henes (Chairperson). Lee Leggette, Art Diers, Ann Graff, Jack Lynch, Alderman Gene Feldman, Benn Greenspan, Janice Jones Staff: Jeanne Fox, Harvey Saver Community Representatives: C. Louise Brown, Director, Evanston Health Department; Jill Bobo, Northwestern University/Medill I. Community Comments Ms. Hones called the meeting to order at 7:40 p.m. and asked the audience to introduce themselves. II. Minutes of January 14. 1988 !!r. Leggette moved to approver the minutes of the January 14, 1988 meeting. Alderman Feldman seconded the notion. Notion passed 7 aye - 0 no. III. Community Long Term Care Issues - Update C. Louise Brown, Director of the City Health Department. .coined the Mental Health Board to provide an update about long term care concerns in Evanston. Ms. Brown said that the City is putting together an order- for the final plan of compliance for the Ridgeview Pavilion. The Law Department is writing the order. After both sides agree to the final terms, the document will go to the Hearins Officer to invoke as the legally binding order for a final plan of compliance. Ms. Brown indicated that Health Department recently received an application from a management team which will be taking over the ownership of the operations of the 4 long term care facilities being run by Dunhill and Spencer, Ltd. These Include the Ridgeview House and the Ridgeview Pavilion. The new operators will have to submit an application for licensure to the Health Department for each facility separately. ['Ls_ Brown said that from information she had received to date, it appeared that there would be no transfer of real estate. Woodstock Inc., the management group, would lease the buildings from Dunhill and Spencer. Ltd. Concern was expressed that Quality Health Care. Previous owner of the Ridgeview and Ridgeview Pavilion wasp still involved and obtaining financial benefit. ��p��91A�1I�'�I�II�"�� ���,il ��„�i����q���°!fir"IIII' il�� � � ��� �� ��o Fl�����II�IP�91���' �i-4, ir i _2_ In response to questions, Ms. Brown indicated that the eventual imposed plan of corrections for the Ridgeview Pavilion will be an obligation under which the new owners will have to operate. The agreed upon timelines will be binding upon their activities, as well. She said that she anticipated that the new owners would receive a probationary license, initially for 120 days, in response to an application for licensure as provided in the Evanston Ordinance. She then discussed some of the Implications of the implementation of the plan of corrections at Ridgeview Pavilion_ .Mr. Greenspan said that a revised Long Term Care Ordinance should contain constrictures against continuing financial gain or benefit for prior facility owners when a long term care facility changes hands_ Ms. Brown led a discussion about the followup to recent occurrences at the Evanston Ridgeview and at Raintree. Alderman Feldman said that the recent events highlight and emphasize the responsibility and need of the City to aggressively monitor the services being provided in long term care facilities. He also said that changes in the Long Term Care Ordinance should take the highest priority and should be implemented as soon as possible. Mr. Greenspan said that the Mental Health Board should be concerned not only with revisions of the ordinance, but also with the structure of the regulations to enforce the ordinance. He did not think that the ordinance and regulations had enough clarity to allow for aggressive and systematic followup of violations. Alderman Feldman raised concerns about the role of settlements and fines in the ordinance. He said that fines ,should not be able to be seen as simply the proprietors' cost of doing business. In response to a question from Alderman Feldman. Ms. Fox reviewed the agreed upon process for Board review of revisions to the Long Term Care Ordinance. Staff will prepare and submit to the Mental Health Board Long Term Care Committee recommended changes. Recommendations will address the stated issues and concerns of the Board. After careful review. the Lon$ Term Care Committee will bring their recommendations to the Board for its review and approval. Staff will research other models and seek information from other communities From which to make recommendations. A preliminary set of recommendations will be made to the Human Services Committee in August. Board members agreed that a lawyer with experience in regulations and/or health care is needed to help with this arduous process. Several names were suggested. All Board members will receive the Long Term Care Committee packets of -3-- information. Ms. Fox said that the long term care issue would not be able to be on the Human Services Committee agenda on Febriary 22. because of a hearing on the proposed smoking ordinance. The Issue will be on the March 14 agenda. Mr. Saver indicated that there had been some initial discussions at the State level to revise licensing and continuing education requirements for administrators of residential facilities serving developmentally disabled Individuals. These administrators are currently required by State statute to be licensed as Nursing Home Administrators. There is a move to replace this license with a Developmental Disabilities Administrator license. (At this point Ms. Jones Joined the meeting.) IV. Long Term Care Committee Report and Recommended Changes to Local Long Term Care Ordinance The Mental Health Board reviewed the proposed Long Term Care Resolution recommended by the Long Terse Care Committee. and the draft memo about long term care issues to be sent to Human Services Committee for the March 14 meeting. The following was added to the proposed resolution as a new section: Documentation of screening for criminal convictions of employees before their employment in local long term care facilities is needed. Long term care proprietors should annually verify that their licensed employees have a current. valid license. Mr. Groenspan moved to adopt the Long Term Caro Resolution, as amended. Mr. Leggette seconded the motion. Mt i o n paaa43d 8 aye - O no. Mr. Lynch moved to adopt the memo about long term care issues as amended_ Ms. Jones seconded the motion. Motion passed 8 aye -- O no. The Board discussed the development of a community coalition to work an revisions to the Long Term Care Ordinance. The discussion focused upon the Mental Health Board's need to work on its issues under its own timetable. while seeking input from other groups and concerned individuals. In a consensus decision, the Mental Health board agreed to ahare information about its efforts in the area of improving the quality of care in the long term care facilities and to cooperate with the -4- community representatives to consider changes in the Long Term Care Ordinance on February 24. V. Policy Guidelines for Contracts Mr. Leggette presented the report about contract policy suidelines and recommended their approval. Mr. Greenspan moved to adopt the Policy Guidelines for use with FY 88-89 contracto, with the inclusion of "age" between "race" and "creed" in the first line of Section 1.1. t1r_ Lynch seconded the motion. 11otion passed 8 aye - 0 no. VI. Committee Report and Discussion of Request for Agency Outcome- ObJectives Mr. Diers and Mr. Leszette presented the Committee's report and recommendations. They indicated that a substantial amount of information is already being collected from agencies and the reporting requirements have been increasingly routinized. Based upon priorities the Mental Health Board has established, the development of performance outcome obJectives was not something which could be established this year. They said that the Mental Health Board should continue to encourage agencies to enhance their program assessment capabilities. Mr. Greenspan recommended that the Funding Guidelines Committee investigate the development of a fundins criterion which would reward an agency for utilizing performance obJectives and for having the ability to demonstrate achievement of measureabie obJectives. Ms. Graff and Mr. Lynch recommended that staff help identify questions during funding hearings which would focus upon the accomplishment of specific outcomes. In consensus decision, the Mental. Health Board agroed not to pursue the development of outcome perforzsanc8 ob-iactives with agencies at the present time_ It also decided to consider including a criterion related to outcono obJectives in the Funding Gu ldell nes_ VII. Budget Transfer Mr. Lynch moved to authorize the transfer of S-?-3,0 from the budget line for Poaza:ge Charges in order to oetabl iah a Z430 budget line for Data Procesains Serwricen and a =00 budget line for Capital Outlay. Mr. Diem seconded the motion. Motion passed 8 aye - O no. VIII. The Board discussed the request of City Council for recorded minutes of Boards and Commissions as soon as they are typed. The Board, in a consensus decision, asreed to send approved minutes of the Mental Health Board to City Council. -5- IX. Executive Session The Mental Health Hoard unanimously voted to adJourn its resular session at 5:45 p.m. and to convene in Executive Session to consider a personnel matter. Respectfully submitted. 9ea�nneFox -6- Sue mary of Decisions Evanston Mental Health Board Meeting February 11, 1388 1. The Mental Health Board adopted the Long Term Care Resolution, as amended. 2. The memo to the Human Services Committee about long term care issues was adopted, an amended. 3. In a consensus decision, the Mental Health Board agreed to share information about its efforts in the area of improving: the quality of care in Ions term care facilities, and to cooperate with the community representatives on February 24 to consider changes in the Long Term Care Ordinance. 4. The Policy Guidelines. as amended, were approved for use with FY 88-89 contracts. 5. In a consensus decision, the Mental Health Board agreed not to pursue the development of outcome performance objectives with agencies at the present time. They also decided to consider including a criterion related to outcome cbJectives in the Funding Guidelines, and to develop questions which emphasize the accomplishment of measureable outcomes for UBP hearings. 6. The Mental Health Board approved the transfer of $730 from the budget line for Postage, in order to establish a $430 budget line for Data Processing Services and a $300 budget line for Capital Outlay. 7. In a consensus decision, the Board agreed to send approved minutes of the Mental Health Board meeting to the City Council. EVANSTON MENTAL HEALTH BOARD MEETING MINUTES MARCH 10, 1388 (Minutes Approved 4-14-88) Members Present: Jack Lynch. Benn Greenspan. Janice Jones. Lee Leggette, Ann Gruff, Art Diers. Carol Hones. Alderman Gene Feldman Staff: Jeanne Fox. Harvey Saver Community Representatives C. Louise Brown, Director Evanston health Department Mr. Leggette, Acting Chairperson. called the meeting to order nt the first sign of a quorum at 7i 36 p.m. 1. Minutes of February 11, 1988 Ms. Janos moved to approve the minutes of the February 11. 1988 meeting as amended. Mr. Lynch (seconded the motion. Motion panned 5 ayo -- 0 no. 11. Long Term Care Conun.ittee Report and Recommendations (Mr. Diers .joined the Beard at 7:45 P.m. ) C. Louise Brown, Director of the Evanston Health Department, joined the Mental Health Board to respond to questions and concerns raised in the March I Long Term Care Committee memo. Na. Brown shared the board's concern about the quality of care in lonx term care facilitie ,. There is a problem in that there are still no "ttandards spec i F is to mental illness and developmental disabilities which provide meranureable criteria For monitoring. No. Brown said that the board'o efforts would be helpful. I mplement i np, mewsureab le criteria and standards does root require a LTC Ordinance change. That can already be done within the Health Department's monitoring role. In reoponse to the concerns "bout levying fi rice^., Ms. Brown .:.a l d that these actions arc stipulated in the Lon T "rm Caro Ord i Far a 1t or C vi o I at ion, the Hecal th 5—s ornmEeot, has ` o wcii1. until a violation i v actualiy issued boVor" a time can be as2_ onne d. The fine maybe levied for the period r rom the time th" violation is issued until the time when it in corrected. This: .iln. ) applies to a reoccurence of a violation. If an id"ntif'ied problem io corrected by the timo ca violaation la iosuced, to Fine cannot. hu assessed, The oxcept i on in when thorp is Fa rooccurence of on identical violation to tho same pitro,on ill i e{cent iceal c i rcunrstancEeo. I I I r -2- (Ms. Hones Joined the Board at 8.00 p.m. ). Ms. Brown indicated that she will ask all facilities to post their current license and its status in a place visible to the public. Ms. Fox said that a facility is already required, by ordinance, to have a history of its violations available to the public. Ms. Brown also said that she will request that Albany House (formerly Evanston Ridgeview) resume providing park and street monitors. In response to questions, Ms. Brown said that the Health Department does not waive any fines. Ms. Graff asked what the impact was of reoccuring violations. Ms. Brown said that they could result in a conditional license or an increase in the severity of a violation. Ms. Brown reviewed the chart describing the long term care regulatory process. The source of a complaint can be from a patient. relative or anyone else who observes the problem or incident. An "A" violation (life -threatening or endangering the safety of a facility resident) will result in an immediate, minimum, $5000 penalty. This can be assessed from the time a violation is noted until it is corrected. For an A" violation, if the facility does not respond within 10 days. a violation is immediately issued. A "B" violation (endangering a patient, but not as dangerous as an "A" violation) can result in a violation of not more than $500. A "C" violation is one that indirectly impacts on a patient's care. The Mental Health Board considered the Long Term Care Committee memo of March 4. recommending the next steps to improve the quality of care in long term care facilities. Ms. Brown said that she accepted the Mental Health Board's recommendations for additional monitoring requirements, except as she noted in her March 10 memo. The Mental Health Board agreed to amend their recommendations per the reservations its. Brown had identified. Ms. Fox said that if the Mental Health Board staff develops the administrative tool to monitor facilities. they might be asked to show up at hearings. This would be a change in the Mental Health Board's role and would require that staff be in a regulatory role with long term care facilities. Mr. Lynch moved to accept the reco=monded action stepa. except as noted, and the First Step of the Long Terra Care Ordinance amendemont process;. Ms. .Jones secondod the motion_ Motion passed 7 aye - O no_ Cam Mr. Greenspan moved to accept the Second Step of the amendment process. Mr. Lynch seconded the motion. Motion Passed 7 aye - O no. Ms. Fox distributed the packet about long term care revisions which was being sent to Human Services Committee for the March 14 meeting. Included was the job description for a legal consultant to revise the Long Term Care Ordinance. The plan is to have someone hired by April 4. III. Funding Guidelines Committee Report and Recommendations Mr. Lynch reviewed the calendar For evaluating and revising the Funding Guidelines. In a consensus vote, the Mental Health Board adopted the planning calendar for preparing the Funding Guidelines for 1988 UBP hearings. Mr: Lynch presented the Committee's initial recommendations for areas to revise in the guidelines: > change in calculation > elimination of Funder of a criterion related objectives in the SPA; > development of a staff of Support Services Score; Recommendations and development to performance outcome assessment score. The Committee will also evaluate for revision the calculation of the Service Area/Mandated Population Scores. In a consensus decision. the Board gave .initial approval to the Funding Guidelines Committee to further develop its reco� dations For - changes in tho Funding Guidelines. IV. Needs Assessment Committee Report Ms. Fox reported on the Evanston United Way's project to implement a pilot needs assessment tool across the community. They are implementing the project as a test for the United Way of Suburban Chicago (UWSC). Ms. Fox said that there is potential to request UWSC to do a special sort of the data collected to answer questions posed by the Mental Health Board. However, the additional data run might require the Mental Health Board to pay a fee. (alderman Feldman .joined the Board at 9:20 P . m. ) . Ms. Henes led the Board in developing a brainstorm list of questions about community mental health needs which are unanswered or for which more information is needed. Questions About Need 1. Number of people in each target population group. 2. Historical trends in growth of each target popu- lation group. -4- _ 3. Origin of people in need of services. 4. Unduplicated count of all people with mental health needs/overlap of populations in each disability group. 5. Unduplicated count of families having mental health needs. 6. Age breakdown of #I. 7. Access to other funds or reimbursement to pay for services. 8. Accessibility and barriers to mental health services, e.g.. language. transportation. 9. In relation to need, what amounts. types and intensity of servvices are needed in relation to #1 (this item was identified as an outcome of doing a needs assess- ment). 10. Impact of a mental health -related problum on the community - how is it felt? What will the community tolerate? 11. Compare Evanston numbers with similar communities - what is the norm? Use of Needs Assessment Data 1. #8 above 2. Provide more accurate picture of what services to provide funds for, rather than funding Just the services that agencies offer in their proposals. 3. Basis for future answers about Zoning and licensure of new beds. 4. Compare and contrast with Evanston providers' rates ender treatment. 5. Allocation of dollars to fit need -- changing. limiting. rationing, limiting services offered in community. V_ Informational Items - Mo. Graff indicated that she participated in the community meeting organized by staff with the new Ridseview Pavilion administrator. She said that she was impressed with the Health Department's monitor who was appointed to the facility. and thought that his concerns and approach were con- sistent with the direction in which the Board has been moving. - Ms. Fox presented an update on legislation which was passed to amend the State 708 Board legislation. She is researching additional information about its impact upon local 705 Boards. - Mr. Loggette said that he had found it very helpful to have a summary of decisions in a meeting attached -5- to the minutes. Mr. Leggette moved to adjourn. Alderman Feldman seconded the motion. The motion passed 8 aye - 0 no. Meeting adjourned at 10: 30 p.m. Respectfully submitted, .reAnne M. Fox -6- SUi'MRY OF DECISIONS EVANSTON MENTAL HEALTH BOARD r1EETING rVUICH 10. 1988 1. The Board accepted the recommended action steps, as amended, and the two-step Long Term Care Ordinance amend- ment process which were outlined in the March 4. 1988, Long Term Care Committee report. 2. In a consensus vote, the Mental Health Board adopted tho planning calendar for preparing the Funding Guidelines for 1988 UBP Hearings. 3. In a consensus vote, the Mental Health Board gave initial approval to the Funding Guidelines Committee to further develop its recommendations for changes in the Funding Guidelies. Ll EVANSTON MENTAL HEALTH HOARD MEETING MINUTES APRIL 14, 1988 (Minutes approved) Members Present: Carol Hones (Chairperson), Jack Lynch, Marcia Nelson, Janice Jones, Ann Graff, Art Diers, Alderman Gene Feldman, Lee Leggette Staff: Jeanne Fox, Harvey Saver Community Representatives: Marge Sandler (Mental Health Assoc. of Evanston; Ellen Szymanski (City of Evanston Asst. Corporation Counsel); Brian Braumbach, Ray Ganey, Dr. John Catala (St. Francis Hospital); Pat Doyle, Mary Ann Martinorsky (Horizon Health Management Company); Delia Wozniak (D. M. W. and Associates) Ms. Hones, Chairperson, called the meeting to order at 7:46 I. Minutes of March 10, 1988 Jack Lynch moved to approve the minutes of the !'Larch 10, 1988 meeting as mailed. Alderman Feldman seconded the motion. Motion passad 8 aye - O no. II. Development of Psychiatric Beds at St. Francis Hospital Representatives from St. Francis Hospital were invited to Join the Mental Health Board. Brian Braumbach, Vice -President of Operations and Support Services, indicated that the Hospital will be submitting a request for a Certificate Of ,geed (CON) for the development of a 20-bed, inpatient, acute psychiatric care unit. He introduced Dr. John Catala (psychiatrist at St. Francis) and Ray Ganey (Director, Adult and Child Guidance Center) from the Hospital staff. He also introduced the consultants who are assisting in the development 3f the hospital's plans: Pat Doyle and Mary Ann Martin�rsky (Horizon Health Management Company). and Delia Wozniak (Dr' and Associates). The following information was provided in support of St. Francis' plans: they want to expand services to provide for their own patients. Increasingly, they are having to refer people in need of inpatient psychiatric attention out of the community. In the previous 6-8 months. it has become EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14. 1988 Page 2 increasingly difficult to get people admitted to Evanston Hospital. Dr. Catala is on staff at both St. Francis and Evanston Hospitals. Evanston Hospital has been exceptionally busy, and their beds have been at approximately 100% capacity for 2 years. St. Francis' patients are either being placed on a waiting list, or being transferred out -of -the -community, both of which are creating undue hardships for patients and their families. The new unit will include geriatric beds, because a large number of the hospital's patient's need specific services for the elderly. In response to questions from Alderman Feldman, Mr. Lynch, Ms. Graff, Ms. Nelson and Ms. Fox, the following information was provided: Anticipated average stay In the new unit will be 13.5 days. People not able to be provided inpatient care in Evanston Hospital are referred to Old Orchard. Sheridan Presbyterian, Loretto and Highland Park hospitals. The new unit will be a locked ward, with primarily private patients. Evanston Hospital is not always able to provide inpatient psychiatric care for geriatric patients. The focus will be on people from the hospital's service area; approximately 50% will be Evanston residents. 15% of the psychiatric patients will be paid for by Public Aid; the unit will not service Public Aid patients from outside of St. Francis' planning area. The proposed unit may help nursing homes with medical stabilization of their residents, but only if the home guarantees, in writing, that they will take their people back. The unit will not take the place of the State Hospital system for the nursing homes. There is no specific discharge policy, but the proposed service population is not likely to become wards of the community because they will have a place to go, e.g.. home, retirement home, nursing home. Alderman Feldman said that there seemed to be a clear need for the proposed unit for the hospital and for the planning area, but was not clear that the local community's needs were being addressed. Ms. Wozniak said that the application for the CON would have to show that there is a sufficient number of people who have to go long distances for treatment, or whose treatment is delayed. They also have to demonstrate that the population to be served is from the planning area, i.e.. north suburban Cook County. Mr. Ganey said that ACGC has had very little access to Evanston Hospital's inpatient psychiatric beds. The proposed unit will be accessible and provide treatment for many private insurance clients who cannot get in to Evanston Hospital. Mr. Braumbach said that St. Francis Hospital has no experience with inpatient psychiatric care. They have contracted with Horizon Health Care for their inpatient EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14, 1388 Page 3 expertise, and have an initial 3-year agreement. Ms. Wozniak said that there are 4 hospitals in the planning area who provide psychiatric inpatient services: Forest (165 beds). Old Orchard (130 beds), Evanston Hospital (33 beds), Lutheran General (100 beds). If the application for the CON is approved, St. Francis could start admitting patients 10 months later. They have decided that 20 beds is an efficient use of St. Francis' available space, and project 85% occupancy in the first year's operation. Ms. Wozniak added that they are negotiating for DMH support for their CON application. but not seeking DMH funding. They are not trying to duplicate any of Evanston Hospital's psychiatric services. Evanston Hospital is planning on expanding their inpatient psychiatric unit by 2 beds, but they are in support of St. Francis' plans to expand community inpatient beds for private pay. Ms. Fox said that the community has a need for additional inpatient psychiatric beds for Public Aid clients. However, the Mental Health Board does not document the need for private pay patients. Ms. Nelson moved that the Mental Health Board not support St. Francis Hospital's request for support for their application for a Certificate of Need at this time, pending further study. Alderman Feldman seconded the motion. Motion failed: 2 aye (Henes, Nelson) - 6 no. Ms. Fox indicated that St. Francis has agreed to not be a police drop-off for inpatient psychiatric care for the City of Chicago. They have also agreed to develop screening criteria For the proposed psychiatric unit which complements the community's need. Mr. Lynch moved that the Mental Health Board write a letter of (support for St. Francis Hospital's application for a certificate of need. with support contingent upon the proposed acute psychiatric care unit developing screening criteria which complements the community's need. agreeing not to be a police drop-off for Chicago and agreeing not to accept transfers from surrounding inpatient psychiatric units. Mr. Legsette seconded the motion. Motion panned: 6 aye - 2 no (Nelson, Henes). III. Long Term Care Committee Report Ellen Szymanski, Assistant Corporation Counsel. joined the Mental Health Board to discuss legal issues regarding Evanston's Long Term Care Ordinance (LTCO) . Ms. Henes reviewed the Mental Health Board's areas of responsibility for revisions in the LTCO. The work of the EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14, 1888 Page 4 Mental Health Board, Commission On Aging and Health Department will be pulled together and integrated into a single document by August 1. This work will be done by the legal consultant. Mo. Szymanski reviewed the response to the Mental Health Board's questions, prepared by Herb Hill. She also -discussed some creative approaches to deal with facilities which attempt to stall or drag out the appeal process related to violations of the LTCO. Ms. Henes reviewed the committee's April 11 memo. She said that the committee was going to consider a certificate of need process for long term care beds, either free-standing or in a large facility, in the community. Jack Lynch moved to accept the LTC Committee's Principles, Definitions and Initial Recommendations. as stipulated in the April 11, 1988 memo. Alderman Feldman seconded the motion. Notion passed: 8 aye - O no_ IV. Funding Guidelines Committee Report Mr. Lynch reviewed the Committee's report. The initial decisions made about the Funding Guidelines will be,disstributed to agencies for comment. Final decisions and the adoption of the Funding Guidelines for FY 89-90 will be considered at the .tune meeting. Ms. Nelson moved to adopt the average of all SA/MP scores for the score for Support Services. M. Jones seconded the motions. Motion passed: 7 aye - O no - 1 abstain (IAMgette). Ms. Graff moved to accept the Service Area rankings and the ranking of mandated populations within each Service Area as presented in the Committee's report. Ms. Nelson seconded the motion. Motion passed: 7 aye - 0 no - 1 abstain (Diers). Mr. Lynch moved to accept the Board Community Priority Assessment Score, as modified. Ms. Nelson seconded the motion. Motion passed: 8 aye - O no. Mr. Lynch moved to accept the Quantitative Program Assessment Score ao it was used in 1987 hearings. Ms. Nelson seconded the motion_ Motion passed: 8 aye - 0 no. Mr. Lynch presented the revised Board Program Assessment Scale, to include a Program Effectivenese Subscale. There was discussion about whether to have staff also complete a rating on Programs, which would be factored in with the Board's ratings. Mr. Lynch moved to accept the revised BPA as recommended by the Committee. Ms. Nelson seconded the motion. Motion passed: e ays -- O no. The Mental Health Board asked staff to complete a rating on each agency program, utilizing the criteria in the EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14, 1388 Page 5 BPA. This score will not be included in the calculation of the program's Final Scare, but will be displayed along with the Final Score. V. Needs Assessment Mr. Lynch presented his analysis of the Mental Health Board's questions to be included in a needs assessment and whether they could be answered by the United Way Needs Assessment Survey. After a general discussion, it was decided to first determine whether the response to the Household Survey reflects the makeup of the Evanston population. If not, then the Mental Health Board will not pursue the purchase of the tapes and an analysis of the data. VI. Informational Items > 4 C's Budget Hearing. Mr. Diers and Ms. Jones reported on the 4C's budget hearings for day care centers. Title XX funds support 300 children, but there is a need for an additional 300 slots.' Two areas of additional need identified are for sick children of working parents who cannot be in school, and respite care for the families of children with special needs. 4C's will provide documentation about day care for children with special needs. > ESAPC Meeting. Mr. Leggette reported on the Council's meeting with the Police and the Park Departments on the subject of the use of chemical substances in the parks, which is illegal by ordinance. Policies and procedures were discussed at the meeting. An outcome of the meeting was that the Police will provide additional training to the Parks Patrol about dealing with youth who are drinking in the parks. > Computer MIS for MI Network. Ms. Fox reported that she will be meeting again with FMP Systems and Evanston Hospital to look at the ability to integrate the pro- posed MIS with the Hospital's data system. > Marge Sondler, Mental Health Association of Evanston, reported that the Community Companion Prograrn will be planting a vegetable garden in James Park. The produce will be donated to ACORN and soup kitchens. EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14, 1988 > Next Meet ing• Proposed State legislation will be discussed. Meeting adJ ourned at 10: 30 p.m. Respectfully submitted, t L-xx-w ' anM. Fox Page 6 G EVANSTON MENTAL HEALTH BOARD MEETING MINUTES/APRIL 14, 1988 Page 7 SUMMARY OF DECISIONS EVANSTON MENTAL HEALTH BOARD MEETING APRIL 14, 1988 I. The Board agreed to write a letter of support for St. Francis Hospital 'a application for a certificate of need, with support contingent upon the proposed acute psychiatric care unit developing screening criteria which complements the community's need, agreeing not to be a police drop-off for Chicago and agreeing not to accept transfers from surrounding inpatient Psychiatirc units. 2. The Board accepted the Long Term Care Committee's Principles, Definitions and Initial Recommendations, as stipulated in the April 11. 1888 memo. 3. The Board adopted the average of all SA/MP scores for the score for Support Services in the Funding Guidelines. 4. The Board accepted the Service Area rankings and the ranking of mandated populations within each service area as presented in the Funding Guidelines Committee's report. 5. The Board accepted the Board Community Priority Assessment Score, as modified. 6. The Board accepted the Quantitative Program Assessment Score as it was used in the 1987 budget hearings. 7. The Board accepted the revised BPA as recommended by the Funding Guidelinf:►s Committee. i EVANSTON MENTAL HEALTH BOARD MEETING CQNUTES MAY 12, 1908 (Minutou approved) Members Present: Alderman Gene Feldman, .lack Lynch, Marcia Nelson, Art Diers, Bonn Greenspan, Carol Hones StaFf: Jeanne Fox, Harvey Saver, George DeWolfe (Lentil Consultant) Community Representatives: Marge Sondler (MHA>r), Helene Lome (First Step), Mike Ross, Stig Lorentzen Ms. Hanes, Chairperson, called the meeting to order at 7:30 p . m. 1. Introduction and Community Comments Marge Sondler. , Executive Director of Mental Health Association of Evanston, announced that the Mental Health Association of EvFannton was sponsoring a Walk For Mental Health on May 21, and said that Mayor Barr had proclaimed May can Mental Health month. She also called the Doard'n attention to the grant notification letter sent by Illinois Department of Mental Health and Developmental Disabilities ( DIiHDD) to community service providers which states ca process for funding which has the potential of resulting in fewer mental health services being: provided to Evanston ronidonts. Il. DMHDD FY 08-139 Grant Notification Letters Ms. Fox reviewed information about DMHDD's proposed FY 813 111 auardn. She :ridicotud thcit they Suite's t,ulic-Y ie to offer to "qutal i f'itrd agenc iuo" [i 4% (:01.f) without of'Fori nR them any additional funds. 1'he State proposes to accomplish this by of'foring the option to tagencion to incroaso their- services unit costs by 4% through a corresponding 4% roduct i on in the number of :, rvico units which the ciao#nc:ion will contract to provide, without iany c-haragur in tho grant. lovel. I Fox :-aid t.11�3t Fv.ua:;t.nrt had iirt)od.y :atay,ot•itatod ea :serwick, r*�(Iuf.t ion f'or the• C0IT]!nK ycarir, tit, iI1. inK t,hi:; t)r—oc .9f3. Fveiriston Iio-';I,ltaI will MO. turn c:l iunts rawiiy. but, wi I I riot bee geld rccount,ibi : For cite rruiny unite of services. In response to queotions frc,rn the Montail Health tloard, Helene Lome, Director of Fi r-ol Stop, said thi%I, hor program would not bo i ti a poni t i on to runs -,end to tho c11+t. i on being of'FOr- 3d by DrIHDD_ First Stop could not, 1 rjy of'f' :;trit'F to cut costs, nor, would they cut back on client. s,orvicos. 11 "1111 1-1 1111 11 � I i nI1 1 1 1 1 IIIIi�I�jl !I! 111 fl i Ih�111I II ' I I I I !11'1 Jill I II �I1 III �Ip� I Mental Health Board Minutes... -?_- Ms. Fox said that ACORN has also stated that its agency will not cut services or staff. In a consensuo docinion, the Mental Ifealth Board agreed to Bond a lotter to Director Kiley protonting DMHDD•s policy for nosotiatinu nranta with auoncies for FY '89. III. Nominating Committee Ms. Honed reported that she had appointed Mr. Lynch, M. Jones and Mr. Diers to the Nominating Committee for Mental Health Board officers. Mr. Diers will chair the committee. IV. Minutes of April 14, 1988 Mr. Lynch moved and Mr. Greenspan nocondod a motion to approvo the minutes of April 14. I988 an corrected. The motion wan passod unanimously_ Ms. lienea reported on a communication from the City Manager. lie indictatod that there was no option for Boards and Commissions about when to send minutes to City Council. It is a City Council policy that minutes should be sent as soon as they are sent to the Mental Health Hoard. It will be indicated that the minutes are not approved. V. Long Term Care Committee Issues Ms. Henea provided can overview of the Long Term Care Care Committee's work to develop appropriate standards of care and supervision for the Mental Health Board's populations in long term care facilities. She steatod that the committee's approach has focused on two areas: to revise program and staffing standards and to put more tooth into the ordinance to onrable more prompt and consis3tont enforcement. She also providnd an update on the status of the commi ttoo ' a work. Sho ntrat.ud that. t-he Health Department and Commission On Aging works working on their revisions to the Long Torm Care Ordinanco. 11. l=lix han beam working with staff from thoon dopartmonts to shier(, the Committe3o's rovisions, salad to obtain their input. Mo. Fox outlined the philosophy which the comrni ttcao adopt -Oct to guide its (leCiGion3. She said that the current. I.orig Term Caro Ordin,anc:o hue standards passed upon Ea rrsediccal v—dol of care, ni,,ik(i 1,tyop 1 u wee l l , provi (fe mead i c:ca 1 and nur•s; i n-� (,ortl sit+rvic ofs. Ihta commit.too'o work io hoing Kuidod by + ti+,vtalop monttal model, which emphanizets tr.sining Eand habi 1 tt-ataon servicon to encourage growth. Residents' cares in za f�ac: i 1 i ty ohould he provi(lod for in small, family -like uni tu, and staff (should work with consistent groups of people. The committee's emphfan i ss i o upon what is best for the r os3 i dent btsaed on the individual 'ss care plan (IC1a). The ICP is the hub around which citicisiono :should bta made. Mr. Groonspan taddod that the r_om- m.t,t.ue iss shifting the focus of thy? Lone Ttirm Care Ordinance Mental Health Board Minutes... --3- from institutional outcomes to outcome measures for each individual. Alderman Feldman commented that the proposed changes would require additional City monitoring and staff time in order to ensure that there is compliance with the ordinance. He also discussed the need for qualitative measures as a standard against which to judge facilities. Mr. DoWolfe discussed differences in the structure of legislation, such as the Long Term Care Ordinance, in relation to how it is implemented. One way is to provide broad guidelines. which are then implemented through the promulgation of administrative regulations. The other is to stipulate, in great detail all of the items for implementation in the legislation, leaving little discretion for administrative rulo-making_ [to stated that the current Evanston Long Term Care Ordinance in not consistent in its Format and not well -organized to facilitate monitoring by the Health Department Surveyors. He is working with all City staff to have a uniform way of dealing with the implementation of the revised ordinance. Mr. Greenspan, Alderman Feldman and Mrs. Hanes commented on the following: increased ,judicial challenge if too much latitude is provided for interpretation in the ordinance; the need for additional regulatory staff to establish, develop and implement policy if the rule -making is not specific; a balance between need for specificity in the ordinance and not being ham -strung by lengthy processes to fine-tune and make small changes to the ordinance. No. Hanes stated that the Mental Health Board would be looking to City Council to ensure that the revised ordinance is aggressively enforced. In response to questions. Mr. DoWolfe led a discussion about issues in Constitutional and Illinois Law which might preclude some of the changes discussed by the Long Term Care Committee about i nf'ormat i on to be required in an employee background check. l'L3. Fox and Mr. DoWolfo led the Mental Health Board through a review of the first group of revised standards which were developed and distributed to the Mental Health Board. They also pointed out changon, roviniono and additional definitions which City staff recommended. Mr_ Lynch mo%mxl and Mr_ Grtxznspan noconded it motion to tac:c.capt the initial not of reviLWA long term carts Estand4arda and r. r i ter i a an amendod. Motion passead unanimously. Mrs. Nelson moved and Alderman Feldman seconded a notion to nonci tho send the initial not of rovivad standards and critcaria to tho Human Sorvicos Comsaittoo, community agencies and long torts caro providers for review and count. Plot i on passed untsnimoussly. -jqllilowrl�,,�ril IIi1 i'I.I 1 11 111 " i'�i �P�' 1 h11111 !11II " 11I11111 11' 11 1 Mental Health Board Minutes... -4- (Ms. Hanes loft the meeting at 9: 50 p.m. Mr. Lynch served as Acting Chairperson.) V1. Consideration of State Legislation Aldorman Feldman moved and M1e. Wolfson seconded a motion to accept staff rocommondations to support and endorse the following pieces of legislation: Compreheneive Community Mental Health Network Act of 1988 (HD 849). Community- Integratod Living Arrangements Licensure and Certification Act (HB 3857). Amendments to Mental Health and Dovulopmontal Disabilitio's Code (HB 2934). and Amendments to the Discharge Suction of DMHDD Powers and Duties Code (HD 3401 )_ Motion passed unanimously. Mr. Groonspan moved and Me_ Nelson (seconded a motion for the Mental Health Board to write a letter exprossing opposition to SD 2201, amending the Nursing Home Reform Act. !lotion passed unani moufsl y. V1I. Informational Items - Needs Assessment: Ms_ Fox reported that the initial analysis of the data from the United Way Community Survey showed that the respondents were not ropresontating the diversity of the total community. - Computer Management Information System for MI Network: Mr. Savor reported that FMP had placed one of their terminals at Evanston Hospital for agencies to begin to provide input about their data collection needs. Ms. Fox indicated that on May 31. the Mental Health Board would he host to a delegation from !long Kong Council on Social Welfare. They will be taken on a tour of the agencies working with the chronically mentally ill and will have o lunch diacunsion with providers. The Evanston/Elgin/Read Network will be P"otiw with the now superintendent of Read 'Lone Center on Juno 14 to evaluate the community's rolationuhip with the facility. Meeting adjourned at 10:05 P.M. Respectfully submit -Led, mm 4 SUM1ARY OF DECISIONS EVANSTON M4TAL HEALTH BOARD l_ETINB MAY 12. 1988 1. In a consensus decision, the Mental Health Board agreed to send a letter to Director Kiley protesting DMHDD's policy for negotiating grants with agencies for HY 89. 2. The Board accepted the intial set of revised LTC Standards and Criteria as amended. 3. The Board agreed to send the initial set of revised LTC Standards and Criteria to Human Services Committee, community agencies and long term care providers for review and comment. 4. The Board accepted the staff recommendation to support and endorse H8 849, HB 2934, HB 3401 and HB 3857. 5. The Board agreed to write a letter expressing opposition to SB 2201, amending the Nursing Home Care Reform Act. EVANSTON MENTAL HEALTH BOARD MEETING MINUTES JUNE 9, 1988 (Minutes recorded, not yet approved) Members Present: Art Diers, Ann Graff, Janice Jones, Marcia Nelson, Jack Lynch, Alderman Gene Feldman, Carol Henes Presiding: Staff : Community Representatives: I- Call To O'rde e- Carol Hones FlU Jeanne Fox, Harvey Saver. George DeWolfe (Legal Consultant) Jerry Gulley (SHORE); Marge Sondler (MHAE); Laura Guilfoyle (AMI-GC); Arlene Panfil (Chicago Read - DMH Community Placement); Teri Holter, Colleen Nolan (Raintree); Annette Saltzman, Shirley Weiner (Dobson Plaza); Helen McCarthy (Director, Health and Human Services) Ms. Hones called the meeting to order at 7: 15 p.m. II. Special Recognition Ms. Fox announced that this would be the last meeting that Carol Hones and Lee Leggette would be serving as officers of the Mental Health Board. On behalf of the Board, Ms. Nelson presented the following testimonial: "Carol, tonight we want to say thank you for three years of excellent service as chairperson for the Mental Health Board. Carol Hones was appointed to the Mental Health Board on 10-8-85, In the midst of the final process of passing the Group and Residential Care Ordinance. Then - much to her surprise - in June, 1986, she was elected Chairman -- oops -- Chairperson as she wanted to be known_ She was told it was going to be an easy Year for the Board, nothing controversial -- so she agreed. But it was not a quiet year_ In August the Board lost its Assistant Director and had to aggressively defend its need For two professional staff persona. Carol was 'thrown' into the Political arena during the budgeting process to defend the Board's budget decisions. It was a particularly difficult year because the Board had reduced funding to Family Counseling Services by $10.000. Carol handled all these crises like a pro and set high standards for the work of the staff in support of -2- the Board. Carol, as the chairperson for the Board, had two goals: 1) to involve all the Board members in the work of the Mental Health Board and 2) to have the issues coming before the Board to be thoroughly discussed with opportunity to hear all diverse opinions. All can attest that Carol expects a significant time commitment by Board members. Committees were utilized by Carol to study many of the issuers coming before the Board. She also expected a lot of herself and served on many of the committees herself. The Following are measurable "Performance outcomes" of Carol Hones as Chairperson: - She led the Board through a six month evaluation of its mission and goals, by-laws and procedures, resulting in a revised Mental Health Board Orientation Manual. - Funding guidelines were developed and implemented for allocating the Mental Health Board's monies for pur- chased services. - The funding base of the Mental Health Board was maintained throughout her tenure in spite of several attempts to reduce it. - The Mental Health Board continued to provide community leadership for, and emphasis on, cost effectiveness. accountability and performance outcomes for human services. - Under her leadership the concern for quality care and supervision of the developmentally disabled and mentally impaired living in the long term care facilities evolved into the development of proposed revisions to the Long Term Care Ordincinc:E:. Carol - we are glad we are saying thank you for three years of excellent leadership and not good bye -- you've set the standard and you'll be a hard act to follow. These gifts are a token of our esteem and thanks For a ,job well done." Ms. Hones thanked the Board and staff members for he gifts and for their support and help during the past three years. III. Introduction and Community Commernta M. Hones asked members of the audience to introduce themselves. She then indicated that tho Board would invite comments from those individuals who were there to address the 11c,-ntal Health Board's proposed revisions in t:ie Long Term rare Clyd i nance. -3- [.aura Guilfov.le. Executive Director. Alliance for the tgDtally I11 of Greater Chicago. expressed concern that the section on Admission and Screening Criteria be worded more carefully. She stated that three years was too long a period of time for which to exclude someone for suicidal or ascaultive behavior; that some terms being used were overly broad; and, that the proposed changes could be interpreted to exclude anyone who was mentally impaired. She also stated that some revisions would punish residents when staff failed, or were unable, to complete a social history. MarRa Sondler. Executive Director. Mental Health Association of Evanston. referenced several points in her written comments to the Mental Heal-th Board. She emphasized that the standard on unannounced absences was overly broad, and should focus, rather, on individuals who require supervision. She also expressed concern about a lack of coordination among consultants at facilities and recommended a standard requiring meetings and coordination of a facility's consultants to develop an overall plan for the home. Teri Holter. Social Services Director. Raintree. highlighted comments From her written testimony to the Mental Health Board. Arlene Panfil. Communitv Placement. Chicago Read Zone Center. raised concerns about the emphasis upon behavioral outcomes in the revisions, when many of the staff may not be trained or able to develop the descriptions. She said that the screening criteria were too restrictive in excluding people with a history of substance abuse in previous three years, especially when 75% of people with a mental impairment have a substance abuse problem; it may not be active or the individual may be recovering. She stated that 30 days was too long a period for an evaluation prior to admission, when the facility may have only one week in which to evaluate a person coming out of a hospital. She also said that the four day period was too soon to develop a care plan. She thought that a 2 -- A week period was necessary and that an initial adjustment period would be needed by the resident. Gerald Gullev. Executive Director. SHORE. said that the Initial four days was too short to develop a care plan. The State's standard is thirty (30) days, and it is needed in order to do a comprehensive .lob. Ms. Henes acknowledged and thanked respondents for their comments. She said that the Long Term Care Conunittae would review them and de3terminQ which ones to incorporate into their final recommendations. I V. Mi nut©u of May 12. 1988 Hoeti na -4-- Ms. Nelson moved and Alderman Feidman seconded a motion to approve minutes of the May 12, 1988 meeting as corrected_ Motion approved unanimously_ V. Nominating Committee Report and Election of Officers Mr. Diers presented the report of the Nominating Committee, comprised of himself, Ms. Jones and Mr. Lynch. Mr. Diers moved and Alderman Feldman seconded a motion nominating Ann Graff as Chairperson and Jack Lynch ae Vice --Chairperson of the Mental Health Board for a one year term beginning July 1, 1988. Motion passed unanimously_ VI. Long Term Care Ordinance 1. Discussion of Review and Comment on First Set of Draft Standards Ms. Hones reviewed the Mental Health Board's goals to develop long term care standards for persons who are mentally ill and developmentally disabled, and to develop legal and due process mechanisms. Mr. DeWolfe reviewed and summarized the comments received about the first set of draft standards. He indicated that some revisions may need to be made in order to avoid concerns about discrimination of the handicap. He also said that Medicare was going to require the development of a care Plan within 4 days. Mr. DeWolfe discussed the concept of an Authorized Representative and said that a facility currently has to get a legal guardian within sixty (60) days For anyone who is admitted to the facility and is ,judged legally incompetent. He said that the Committee's concern about a person languishing in need of treatment, or without having a guardian at the point at which they become incompetent, could be dealt with by requiring individuals to name a person with a durable power of attorney, Alderman Feldman asked how they might be able to mandate people in facilities to name such a person if they alreacy were not socially connected or did not have a family to ass,ime responsi- bility. Ms. Fox said that it would require creative planning and work with community grouper such as National Association for Down Syndromes, Alliance for the Mentally 111 and Mental Health Association of Evanston to develop a core group of volunteers. Ms. Graff suggested that the issue be referred back to the Long Term Care Committee for additional consideration. Ms. kienes, referring to Mr. DeWolfe's memo, said Ini-it the Long Term Care Committee's initial work set very high standards and has not considered costs involved at this point. She said that Ms. Fox and Mr. DeWolfe. based upon the review and comment, would make futher recommended revisions of the draft standards to the Long Term Care Committee. Mr. DeWo1Fe said that the 1 u iA i u IT "I, i i i i u i i it i I 11; I � --5- comments presented had been very thoughtful, well informed an professional. He also said that the proposed changes may require several years to phase in. ii. Discussion of Second Set of Mental Health Board Standards Ms. Fox reviewed the philosophy involved in the development of the second set of draft standards. (At the request of the Mental Health Board, Ms. Fox's statement is being entered into the record): "These are draft model standards developed to respond to specific issues and concerns of the Board and to ensure the highest possible level of care and supervision for mentally impaired and developmentally disabled residents. In developing these standards to solve some problems, other problems are created. As an example, in an effort to provide the highest level of supervision for the resident, a standard called Facility Plan for Unannounced Absences was developed. Although we want to encourage residents' independence, for the facility to comply with this standard a paternalistic environment may be created. We also do not know if these standards will be able to be achieved or what the cost will be to the facilities or to the City to implement these standards. This needs to be assessed. Of particular concern is the new method proposed for determining staffing levels. We need to do, as Helen McCarthy, Director Department of Health and Human Services had suggested earlier, a pilot test to determine if it will work. This takes time. Some problems could not be addressed directly by the standards, e.g., the need for the administrator of a facility to be trained and know- ledgeable regarding the care of persons who are MI or DD. The State's Administration Licensing Act prohibits any additional requirements by another governmental entity. Therefore, in response to this concern, we have added a requirement for a trained coordinator for each facility or distinct part of a facility serving persons who are MI or DD. Standards also cannot address the lack of resources, - staff or monies " Ms_ Fox reviewed the standards for minimum staffing require- ment$ and said that they set the stage for the implementation of the individual care plan. She also discussed the five criteria and three levels of client needs to be used to determine the level and intensity of staffing needed. Mr. Lynch said that the proposed changes sounded costly and would require significant changes in staffing levels. He expressed concern about creating an ordinance which would be unenforceable or would drive facilities out of business. Ms. Fox estimated that it might require a 25% increase in staff. Alderman Feldman said that the increase in payroll could be i� appreciably greater, depending upon which additional staff were required. Fie also said that the Mental Health Board had initially Indicated the need to obtain objective information about expenses and profit margins for a well --run facility, in order to guide it in making decisions. The Mental Health Board requested a cost impact statement of the proposed staffing requirements upon facility staff costs at Raintree, Saratoga, Albany House and distinct parts in other facilities for the July meeting. In response to questions, Ms. Fox estimated that the Mental Health Board's responsibilities under the Long term Care Ordinance already take about 20 hours/month to perform. The proposed revisions might require a 67% increase in time. Ms. Fox discussed the Commission On Aging Ombudsman as a model for expanding the role of advocacy for persons in long term care, e•g., guardians. Mr_ Lynch momad and Alderman Feldman seconded a motion to integrate the revised First oat of draft long terse care standards with the second not of draft standards and to nand them out for public comment. Motion approved unanimously. iii. Discussion or Due Process and ComDliance Mechanisms Mr. DeWolfe reviewed and highlighted his interim report and tentative recommendations on "due process" in the Long Term Care Ordinance. iv. Discussion of Timetable Ms. Fox said that she anticipated receiving comments from service providers in time to process them for the July Board meeting. The plan is to submit programmatic and staffing standards to the Human Services Committee by July :5. later in the summer a public hearing on all revisions from the Health Department, Mental Health Board and Commission On Aging. (Ms. Jones left the meeting at 9:20 p.m.) Ms. Hones invited Helen McCarthy, Director of Health and Human Services, to comment upon the work being done by all the Departments involved with revisions of the ordinance. Ms. McCarthy responded by noting the difficulty in integrating the current ordinance Format with the recommendations which are being considered. Alderman Feldman indicated that the packet to be submitted to the Human Services Committee should be accompanied by an estimate of the costs and personnel requirements associated with implementing the proposed ordinance revisions. VI I_ Discussion and Update on State Legislation 7-- Mr. Saver provided an update on the legislation which is being monitored. Alderman Feldman moved and M. Graff seconded a motion to support an increase in expenditure in the State Budget which would provide for a COLA and expanded programs in community services_ Motion passed 4 aye - 2 no (Lynch. Nelson). VIII_ Funding Guidelines Committee Report Ms. Henes invited Marge Sondler. Mental Health Association of Evanston, to comment upon the proposed Funding Guidelines. Ms. Sondler highlighted comments from her correspondence to the Board, raised concerns that services for the chronically mentally ill were being given a lower priority, and questioned the definition being used by the Mental Health Board for High Risk. Mr. Lynch responded that the guidelines were only one factor in the Board's decision -making process and that the changes the Mental Health Board made will have a very small impact in the overall final score. He also said that the Mental Health Board is attempting to balance the needs of all of its mandated populations. Ms. Henes asked that the cover memo for the Funding Guidelines include additional information about performance objectives. She asked that agencies explain objectives for programs that were not quantifiable, or did not directly impact clients. Me Nelson moved and Ma. Graff seconded a motion to send the Funding Guidelines to Human Services COasaittee and to inform them abou the changes. Motin passed unanimously. I)L Informational Items - Ms. Fox reported that the Evanston Elgin/Read Network would be conducting a formal evaluation of the move of Evanston's acute beds to Read Zone Center and to discuss combining in patient "K" unit with Northwestern. "D" unit. - In response to a question, Jerry Gulley, Executive Director of SHORE, discussed the difficu,'.ies his agency has had in receiving payment for bay Treatment and Intervention services from Saratoga. - Mr. Lynch moved and Alderman Feldman secondod a motion to adjourn. Motion passed unanimously. Meeting adjourned at 10: 00 p.m. Respectfully submitted, Jeanne M. Fox SUMMARY OF DECISIONS EVANSTON MENTAL HEALTH BOARD JUNE 9. 1988 1. The members elected Ann Graff as Chairperson and Jack Lynch as Vice Chairperson of the Mental Health Board for a one year term beginning July 1. 1988. 2. The Mental Health Board voted to integrate the revised first set of draft long term care standards with the second set of draft standards and to send them out for public comment. 3. The Mental Health Board voted to support an increase in expenditure in the State Budget which would provide for a COLA and expanded programs in community services. 4 5 The Mental Health Hoard voted to adopt the Funding Guidelines for FY 89-90. The Mental Health Board voted to send the Funding Guidelines to Human Services Committee and to inform them about changes. 'Ili II In r �i��� I � 19jI Illnl� �,I I I I�i� i� iii�� ii Ili �� ����il i� i ii � � �i '�I11i����,R������l,��pi��� ►�I i� �,I�q!�°��������i��'����I��°��,II11ll,��ll� � 1i�P °I'�i��� �' II I EVANSTON MENTAL HEALTH BOARD MEETING MINUTES JULY 14, 1988 (Minutes approved) Members Present: Presiding: Staff: Community Representatives: I. Call to Order Janice Jones, Jack Lynch, Art Diers, Marcia Nelson, Carol Hones, Bonn Greenspan, Alderman Gene Feldman, Ann Graff Ann Graff Jeanne Fox, Harvey Saver Marge Sondler (Mental Health Association of Evanston); Kate Mahoney (PEER Services); Arlene Panfil (OMH Community Placement); ❑iane Goodson, Les Inch (Early Childhood Development Center); John Buckley, Jane Berlin, Tana Paul (Family Counseling Services); Ray Ganey (St. Francis Adult 8 Child Guidance Center); Ron Rozensky, Nancy Jensen (Evanston Hospital Outpatient Psychiatry); Timothy Wenberg, Judy Mikules (The Georgian); Teri Holter (Raintree Health Care Center); Phyllis Semelroth (The Mather Home); Robert Hedges (Albany House and Saratoga of Evanston). Ms. Graff called the meeting to order at 7:15 p.m. II. Introduction and Coa unity Coe ents Ms. Graff asked members of the audience to introduce themselves. She invited comments from individuals who were there to address the Mental Health Board's proposed revisions of the Long Term Care Ordinance. Marqe Sandler. Executive Director, Mental Health ,association of Evanston, expressed concern that the programming->tandards were too specific. They have the potential to overwhelm individuals with mental health problems, providing too much stimulation and too much stress. She also said that the assumptions in the developmental model were more appropriate for individuals with developmental disabilities, but that individuals with mental illness did not learn or progress in the same way. She recommended that there be more room to individualize the amount and type of programming required for each person. -2- C. Louise Brown, Director, Evanston Health Department. commended the Board for the amount of work, creativity and thought they had put into the proposed revisions. She said that, from a regulatory standpoint, the specificity of the revisions will be difficult to implement. She added that the revisions could overwhelm the long term care facilities because they would require a complete change in systems and in the training and orientation of staff. She projected a need for a substantially increased number of City staff to implement and monitor the revised ordinance. Timothy Wenberq, Director, The Georgian,said that the proposed revisions would be cost prohibitive and would be difficult for his facility to implement. Robert Hedqes, General Partner. Albany House and Saratoqa of Evanston, indicated that it would cost $2 million for each of his facilities to implement the proposed ordinance revisions. He said that the State's rate -setting methodology would not support the increase in costs to implement the proposed program requirements in Evanston's local ordinance. He submitted written comments. Teri Holter. Social Services Director, Raintree Health Care Center, submitted written comments. Arlene Panfil, Mental Health Community Placement, Chicaqo Read Zone Center, raised concerns about the staffing ratios and said that it would be very expensive to implement. She also said that it would be difficult to motivate clients to participate in the full extent of the proposed programming levels being required. She also submitted written comments. Ms. Graff acknowledged and thanked respondents for their comments and reminded the providers of the special meeting to be held on August 3, 1988 at 7:30 to discuss their concern. The Board requested that the providers submit written concerns, recommendations, cost -projections and alternatives before this meeting. III. Minutes of June 9, 1988 meeting Ms. Hones moved and Alderman Feldman seconded a motion to approve the minutes of the June 9, 1988 meeting as mailed. Motion approved unanimously. IV. PEER Services' Early Intervention Program for Adolescents Kate Mahoney, Executive director of PEER Services, provided a program update on the Early Intervention Program for adolescents. They recently completed their first full year of -3- service with Y.O.U., during which time they expanded the program to include services at Family Focus. Young people have been excited about the groups and have asked to be included, because it has given them an opportunity to explore issues and concerns in a non -threatening way; PEER Services projected serving 156 youth and served 212 in their first complete year. Ms. Mahoney said that the youth don't have to have a drug problem. They only have to have an interest in exploring issues and concerns, and developing different decision -making and social skills. The program met its objectives, but is looking for better measures for effectiveness and to set expectations. Ms. Mahoney indicated that her staff's major frustration has been the lack of available or financially accessible residential substance abuse treatment for youth from low or middle income families. They have identified several who could benefit from such services through the Early Intervention Program. Ms. Mahoney provided the following information in response to questions: While facilities such as Parkside and Glenbrook are available if financial resources are available, there are no State -supported facilities nearby for low income youth. About 95% of the youth are Evanston residents. While the program was designed for high school -age youth, there has been substantial involvement from younger levels - some kids as young as 9. Low income youth comprise 92% of the kids in groups at Family Focus and 80% at Y.O.U. About 10 -- 15% of the youth continue from the Introductory Groups to the focus Group. They are not always dealing with issues of their own chemical use, but may be from an addictive family. The program defines success by using an evaluation at the end of an 8-week Introductory Group, based upon self -report and center staff reports of the decrease in use of substances and if an individual is chemically free. They hope to be able to implement a follow-up for a longer period this year, but they cannot ask for evaluative information from the youth's school unless they have a signed consent form. V. Discussion with Members of Four Agency Coalition on Child Abuse The following individuals joined the Board to discuss the Four Agency Coaliton on Child Abuse. John Buckley, Executive Director, Jane Berlin, Assistant Director and Tana Paul, Coordinator of Child Abuse Services of Family Counseling Services; Ray Ganey, Director of St. Francis Adult and Child Guidance Center; Ron Rozensky, Director, Evanston Hospital Department of Outpatient Psychiatry; and, Diane Goodson, Director and Les Inch of Early Childhood Development Center. Mr. Buckley reviewed the history of the Four Agency Coalition. The group originally organized as CAFAE in the early 70's, before professionals were being trained to work with child abuse. Federal funding provided seed money to enable the 111111 F I^ 11 - - I I I ' 1 I llO I Ir . I I I I 1!N1 11I11- 1 " 11! 11 I1� III �I I'll 11111111 lu,1111 1 'H ' . 1.111 1 I I 1 -4- project to provide this training. The Four Agency Coalition developed out of this effort. Family Counseling Services does case screening and assigns cases to each of the other agencies involved. Mr. Buckley said that none of the clients pay a fee. DCFS provides funding for founded cases; the Mental Health Board's money funds services for high risk clients. He provided a 3-year history of referrals to the Four Agency Coalition and indicated that for the year July 1, 1987 - June 30, 1988, 2,374 interventions were provided for 202 cases. Written responses will be provided to the written questions which were raised. In response to questions from the Board, the following information was provided: Each agency has a liaison; they meet regularly for training issues and to resolve system issues; about 80% of the Coalition's cases are from Evanston; good relationships have been developed with the hospitals' emergency rooms and the Police Department around the identification of early signs of child abuse; most of the self -referrals are former clients. VI_ Recognition of State Representative Woods Bowman Ms. Graff reviewed a draft letter to State Representative Woods Bowman. Mr. Lynch moved and Ms. Nelson seconded a notion to send the letter to Representative Bowman, thanking him for his advocacy and leadership on behalf of mental health -related issues during the past legislative session. Motion passed 7 aye - 0 no (Mr. Greenspan not voting). VII. Long Term Care Ordinance C. Louise Brown, Director of the Evanston Health Department, joined the Board. Ms. Hones, Chairperson of the Long Term Care Committee, indicated that the most recent draft of standards distributed to the Mental Health Board is what will go forward to the Human Services Committee. Ms. Brown reviewed the timeline to incorporate all proposed revisions into the draft ordinance package by August 8. In response to Ald. Feldman's questions, she estimated that the City would need to hire a minimum of 4 FTE surveyors/monitors, and additional administrative and clerical support, in order to followup on the Mental Health Board's proposed revisions to the Long Term Care Ordinance and to provide the additional technical support needed to help facilities become familiar with the changes. Ms. Hones indicated that the projected timeline may be changed after the Mental Health Board's meeting with providers on August 3rd. -5- i. Cost Impact to Facilities and the City to Implement the Proposed Standards. Ms. Fox reviewed the proposed cost impact study of the Mental Health Board's proposed revisions. She indicated that the tools currently available to do an analysis of individual functioning levels are not adequate. The Mental Health Board recommender that a cost analysis be developed for a hypothetical facility, using a mix of types of residents and levels of need, comparing staffing costs under the old ordinance and the proposed revisions. ii. Discussion of Proposed Revisions to First Set of Draft Standards. Ms. Fox reported that the section on Authorized Representative had been amended to give the individual the opportunity to name an Authorized Representative, without requiring it. The facility would need to go to court to determine whether the person had become incompetent. Ms. Nelson moved and Ms. Hones seconded a motion to send the current draft of standards and a cover memo to the Human Services Committee for the July 25 meeting. Motion passed unanimously. iii. Institutes for Mental Disease. Ms. Fox reviewed the Long Term Care License categories and the facilities which fall under each category. She indicaated that, under Medicaid funding, by October, the Federal government will no longer be able to provide reimbursement for Institutes for Mental Disease, defined as more than 50% of the facility population having a mental health problem. She raised the concern that those facilities not able to receive Federal matching funds may reduce their level of service to board and care. VIII. Informational Items - Ms. Fox reported that John Steimetz, Facility Director at Read Zone Center, had announced that there would be a one-year delay of the combination of D and K Units. In response to a question, Ms. Fox indicated that the units will still be overcrowded. - Mr. Saver provided an update on mental health --related legislation in Springfield. He also indicated that Governor Thompson had signed the DMHDD Budget for FY88-89 as the Legislature had passed it, with an additional $34 million for mental health programs in the community. X. Special Recognition of Lee Leggette On behalf of the Mental Health Board, Mr. Lynch read the following testimonial for Lee Leggette, who was stepping down from the Board: ffm "On behalf of the Mental Health Board, we want to thank you for your service and committment to the Evanston Community as a member of the Board from 1983-1988. "Lee was always ready to serve - He was Vice Chairperson of the Board for three years and chaired the Personnel Committee for 2 years. He also served on the following committees: Contract Policy Guidelines, Performance Contracts, Funding Guidelines, and Substance Abuse. 'Lee will be remembered for his advocacy on behalf of the chronically mentally ill and his concern for substance abuse prevention. As a representative of the Mental Health Board on the Substance Abuse Prevention Coalition for the past four years, Lee has helped to advocate for changes in policies at the high school and to advocate for State and local laws to prevent substance abuse by adolescents. 'Lee please accept this gift in honor of your work on behalf of the Board's interests, as a token of our esteem and thanks. We'll miss you.' X. Adjournment Alderman Feldman moved and Ms. Jones seconded a motion to adjourn at 10:00 p.m. Motion passed unanimously. Respectfully submitted, Deanne M. Fox 0 _7_ EVANSTON MENTAL HEEALTH BAORD SUMMARY OF DECISIONS JULY 14, 1988 1. The Mental Health Board agreed to send correspondence to Representative Woods Bowman, thanking him for his advocacy and leadership on behalf of mental health --related issues during the past legislative session. 2. The Mental Health Board agreed to send the current draft of the Board's proposed revisions to the Long Term Care Ordinance and a cover memo to the Human Services Committee for its July 25 Meeting. !1% EVANSTON MENTAL HEALTH BOARD MEETING MINUTES AUGUST 11 , 1988 (Minutes approved) Members Present: Presiding: Staff: Community Representatives: I. Call To Order Marcia Nelson, Ann Graff, Jack Lynch, Art Diers, Senn Greenspan, Alderman Gene Feldman Ann Graff Jeanne Fox, Harvey Saver, George DeWolfe, (Legal Consultant) Representative Woods Bowman; Collette Croze (IDMHDD); Nancy Jensen (Evanston Hospital); Teri Holter (Raintree); Ken Macho (DMHDD-Elgin); Bob Hedges, (The Saratoga/Albany House); Kayla Chase (St. Francis Hospital Adult and Child Guidance Center); Helene Lome (First Step); Vaughn Gordy, Sue Ebersold (ACORN); Sharon Harris (Health Dept.) Ms. Graff called the meeting to order at 7:30 p.m. II. Minutes of July 14, 1988 meeting Mr. Diers moved and Ms. Nelson seconded a motion to approve the minutes of the July 14, 1988 tweeting as wailed. Motion approved unanimously. III. Changes in Federal Legislation Affecting Funding and Services for Persons who are Residing in Long Term Care Facilities State Representative Woods Bowman and Collette Croze, Deputy Director for Community Program Operations for the Illinois Department of Mental Health and Developmental Disabilities, joined the Board. Ms. Croze discussed changes in the Nursing Home Reform Act brought about by the Omnibus Budget Reconciliation Act (08RA) of Federal FY a7. It has mandated that state mental health authorities pay more systematic attention to individuals with developmental disabilities or mental health problems who are in nursing facilities. States will be required to do several things. First, by January 1, 1989, they will have to establish _2.. a pre—screening and admission criteria for anyone with a r. diagnosis of MI or on to be placed in a long terra care facility (LTC). The persons: need for active treatment in the LTC will have to be established. These individuals will need nursing services or medical care in order to be placed in a nursing facility. Second, by April 1, 19SO there' will have to be a comprehensive assessment performed for- all individuals in nursing facilities who have ar diagnosis of MI or DD (exclusive of Alzheimer's Disease or senile dementia). Ms. Craze estimated that this would be required for 3,000 DO individuals in SNFs or ICFs, and for 9 — 12,000. MI individuals in LTCs. The estimates area available for 00 from the- assessments performed for the Taylor Institute study, but those assessments do not most HCFA's comprehensive requirements. Third, by April, 1990, everyone in a LTC with an MI or OD diagnosis will have to be appropriately placed or have an alternative disposition plan. Nursing facilities will no longer be considered an appropriate placement, however a person can choose to stay at one of them& facilities if they have been there for longer than 30 continuous aoonths. For those individuals who do not want to stay in this type of facility, federal legislation requires that the State provide assistance• and take- action to develop appropriate placements for them. Ms. Craze indicated that Illinois DMHDD will probably ask for an extended period to develop MI placements. Ms. Craze said that this version of OBRA is targeted at states, such as Illinois, which have a high census of individuals with mental health problems in nursing facilities. It was not the Federal intent to subsidize care for MI individuals, historically the States' responsibility, through Medicaid. This position has been supported through recent Federal Court decisions. As a result, Medicaid will no longer reimburse states for care in nursing facilities which have populations greater than 50% of individuals with mental health problems. These are referred to as Institutes for Mental Disease (IMD). Ms. Craze said that Illinois' proposed solution will be to license IMD's appropriately, convert thee' to a new type of care, and reimburse theca for appropriate care. The cost to convert 10 facilities she estimated at S30-40 million. She also said that the State already has new standards they are ready to use which will require more emphasis on psychosoical rehabilitation, psychiatric technicians, socialization and activities in daily living. Ms. Croze reported that, it an individual's assessment indicates the need for another placement, and s/he does not most the test for requiring nursing/madical care, the State must get that person out of the nursing facility, regardless of the -3-- percentage of MI individuals in that facility. The intent of the Federal guidelines is to have only the greatest levels of physical needs in SHF, ICF and ICF/D0 facilities. In response, to questions, Ms. Craze indicated the following: The, State has developed new licensing authority for community facilities of 8 or fewer beds. DMHDD is not going to ask for an increase in larger -types. of facilities, but will seek licensure authority for facilities of 15 and under for MI. The anticipated licensure category for IMD's (Community Care Facility) will be developed with admission criteria, and should result in IMD's having individuals with no greater degree of intensity for services required, severity for types of problems or utilizations of state psychiatric facilities. For MI, DMHDD will not delegate decisions on discharge planning to State facilities, but will likely use some type of contractual arrangement with community agencies. Evanston would probably be able to continue to exercise its licensing authority, but would have to include a definition for Community Care Facility in the Long Term Care Ordinance. The State is looking for ways to make Community Care Facility licensure* attractive to facilities so that MI beds in then community will not be lost. Mentally disabled persons will have to get accurst& asses3ment and treatment, determined not only by diagnosis but also functioning level. Representative► Bowman indicated that the only way the State would be -able, to develop and disperse small community facilities, as appropriate, placements out of larger Facilities, would be to pre-empt home rule on this issue specifically. Alderman Feldman said that communities would need timely and good information about the potential impact of changes to enable them to deal with rumors and fears which would develop. He asked DMHD❑ to work with local mental health boards and communities about transition plans and the local .impact. Ms. Craze said that more information will be sent to the Mental Health Board after agreements about Community Care Facility standards are signed with the Departments of Public Aid and Public Health. In a separate matter, Ms. Craze said that community agencies will receive their 79x increase in DMHDD funds after they revise their agency plan forms. They will get their increase for July - December in their November payment. After that they will receive their new level of funding in monthly payments. How they spend the 7% COLA is at their discretion, but high priority programs must be maintained at their current level. IY. Long Term Care Issues George OeWolfa, Legal Consultant, and Sharon Harris, Division Chief of the Health Department, joined the Mental Health Board - Mr.. CeWolfe reviewed the. draft of administrative processes for the Long Terns Care ordinance revisions and the changes being. introduced- Her indicated that the definition for 'recurring violations` do. not need for be- to the same individual or for the very same, violatioct. Mc-. DeWolfe= also, reviewed the section oft Licensing Requtr ments and discussed additional provisions being requested by the► Long Terns Caret Committee. He included Language about criminal convictions or evidence' of moral turpitude because, it is also in- the* State ordJxance- Ms_ Gra " reviewed the LTC Committee's 2 meetingm on August 3 wittr facility, owners. She reported that the Comalt-tee invited representatives of the owners to a subsequent :meeting to discuss their owxt recommendations about staffing and programming standards. Mr. Lynctr raised questions about the Health Department's staff shortages and its impact upon enforcement of the Long Term Care Ordinances. Mr.. Grsenspaer moved and Ms_ Nelsom seconded. a srstion, for exprerastor the, City Manager- the► Mental Health- Board's 171g, t level of cancer's regarding. the vacant staff positions La tha Health Oepartameert"% Division of Long Term Cars, and to urger that the City move am quickly as possible to fill these positions for monitoring and regulating long term cars facilities and that 17t aggressively, enhance the level of monttoring and enforcement of th• current Long Tenn Caro Ordinance. Motion► approved unanimously. V. Budget Process Mr. Lynch reviewed and presented the, Executive* Committee's recommendations for then FY 89-90 Mental. Health Board budget. The level of funding for- the Mental Health Center is frozen, with increases only for those (.tears determined by the City. It was recommended that the remainder of the 1.53% increase, as indicated by City Budget Guidelines, $5,374, be allocated to Purchased Services. Ms. Nelson moved and Mr. Greenspan seconded a motion to accept the Executive Committee's recommendations. Motion approved unanimously. VI. Budget Transfer - Ms. Fox explained the need to arrange a budget transfer to permit the Mental Health Board to purchase a Magnavox Videawritar, in lieu of replacing an older typewriter. Mr. Greenspan moved and Mr. Lynch seconded a notion to transfer S600 from membership dues to establish a new budget line for Capital Outlay for Equipment in the FY 88--89 Budget. Motion approved unanimously. --5- VII. Informational Items - Ms. Graff commended the Mental Health Board staff for the accomplishments reported in the 5-month report on Activity on Mental Health Board Goals and Objectives. - Ms. Fox reported that the Legal Department responded to the LTC Committee's request about differential treatment of proprietary and not -far -profit LTC facilities. The report stated that they can not be treated differently. - Ms. Graff appointed Mr. biers and Ms. Jones to a Subcommittee to review the administrative manual and bylaws, and to develop FY 89-90 objectives. Meeting adjourned at 9:55 p.m. Respectfully submitted, 1 5?2--X J nne M. Fox EVANSTON MENTAL HEALTH BOARD MEETING DECISIONS AUGUST 11, 1988 1. The Mental Health Board approved a motion to express its high level of concern to the City Manager regarding the vacant staff positions in the Health Department's Division of Long Term Care, and to urge that the City move as quickly as possible to fill these positions for monitoring and regulating long terra care facilities and that it aggressively enhance the level of monitoring and enforcement of the current Long Term Care Ordinance. 2. The Mental Health Board approved the Executive Committee's recommendations that $2,758 be allocated to the Mental Health Center and $5,374 be allocated to Purchased Services in the FY '89-90 Mental Health Board Budget. 3. The Mental Health Board transferred $600 from Membership Dues to establish a now budget line for. Capital Outlay for Equipment in the FY 88-89 Budget. L: EVANSTON MENTAL HEALTH BOARD MEETING MINUTES SEPTEMBER 8, 1988 (Minutes approved) MEMBERS PRESENT: PRESIDING: STAFF: COMMUNITY REPRESENTATIVES: I. Call to Order Carol Hones, Jack Lynch, Janice Jones, Ann Graff, Art piers, Alderman Gene Feldman Ann Graff Jeanne Fox, Harvey Saver, George DeWolfe (Legal Consultant) C. Louise Brown (Health Department); Claire McCarthy Peterson, ~large Sandler, Joanne Harford. Vicki Seglin, Emily Ronne, Joan Mitchell (Mental Health Association of Evanston) Ms. Graff called the meeting to order at 7:32 p.m. II. introductions and Community Comments Members of the Public Policy Committee of the Mental Health Association of Evanston (MHAE) introduced themselves and indicated that they had come to observe the meeting. Claire McCarthy Peterson of the MHAE presented information about the Comprehensive Health Insurance Plan (CHIP) which was passed by the State Legislature in 1986. She indicated that the bi1l had never been funded. Governor Thompson vetoed a ijO million allocation in the 88-99 State Budget for CHIP, shich was part of a balanced budget submitted to him. She said tnat an overrides will be introduced Ln the: fall Legislative Session. !large Sandler. MHAE's Executive Director, gave some specific examples which illustrated the types of health care prooiems which CHIP was designed to address. Ms. Sondler c:rculateri Pat 1 `. tons seeking support f n an override of the !• ,,,.-vnr , .eto. Ms. Gra? T indicated that the Board Nould ns ' ` t! issue on its business :agenda. III. Minutes of August 11, 1988 Alderman Feldman moved and Ms. Jones seconded a motion to ;accept the minutes of the August 11, 1983 meeting as written. Motion passed unanimously. I ^Il, A 11 A i A -z- IV. Long Term Care Issues Update George DeWolfe and C. Louise Brown, Director, 5vanston Health Department, joined the Mental Health Board. Mr. DeWolfe said that much of the material which the Board had received had already been revised by staff, and that there was a staff draft of the entire ordinance. He indicated that his contract with the City had been completed, but that he would available for any public hearings on the revised Long Term Care Ordinance. Ms. Brown indicated that the specific changes with which the Mental Health Board is concerned are integrated throughout the draft ordinance. She added that all of the Mental Health Board's recommendations were not specifically identifiable for servicas for persons who are mentallv ill or developmentally disabled, but were included as generic recommendations. Ms. Fox explained that all of the Mental Health Board's recommendations were included, but not necessarily in the requested format. After th#; work is completed with the providers, the final format will be considered for revisions. Ms. Henes reported on the Subcommittee's August 18 meeting with LTC providers. Issues and concerns were aired, ind the group broke into sub -committees to develop new language for some sections. Ms. Fox said that the providers viore working with the Mental Health Board and Commission On Aging Staff to develop recommended staffing standards. There was a general discussion about the current state and local standards which determine the need for staff, and how facilities use these to determine their staffing levels. The Subcommittee's recommendations drill be reviewed at a follow-up meeting on Cctober 13. Ms. Graff thanked Ms. Brown for her response ':7 th,s Mental Health Board's resolution aL)L)trt enforcefnent it —e :--C Ordinance, Ms. Brown sala she had hired a nur:;e for the position in geriatrics and expected to fill the; other position in the next week. Ms. FoA provided an update on the issue regar,ing Inst-1- tutt,% for Mental Disease. She clarified that Coll:•!*te Craze remarks. at the August meet :ng, were from :a 3MH The tundipc} issues ;are nor :l anaiea by DMH. The•.,> be Jiscussed and determined at i meeting which Ms. .= -A would be attending the next day. -3- V. Mental Health Board Budget Mental Health Center Budget The Mental Health Board discussed the line items being recommended by staff for the FY 89-90 Mental Health Center budget. Ms. Hanes moved and Ms. Jones seconded a motion to adopt the line items proposed for the FY 89-90 dental Health Center budget. Motion approved unanimously. 1989-90 Mental Health Board Obiectives. Ms. Jones and Mr. Diers discussed their Subcommittee's recommendations for objectives for FY 89--90. There was a general discussion about the proposed new objectives. Ms. Hones was asked to develop an objective for the Mental Health Board's consideration related to improving the quality of care or reducing violations in long term care facilities. 14r. Lynch moved and Mr. Diers seconded a motion to accept the proposed Objectives 41 and 03 under System Improvement from the Subcom=ittoe's August 29, 1988 report. Motion passed unanimously. These will be ranked as Desired priorities until there is some determination of available staff and student time for the next year. Ms. Hones moved and Alderman Feldman seconded a motion to change Objective #1 under Planning to read '...to have assisted an agency to establish at least one alternative housing option...' Motion failed: 2 aye (Hones, Feldman) - 4 no. Ms. Hones moved and Mr. Lynch seconded a motion to change the priority of Objective .#1 under Planning from Desired to Important. Motion passed unanimously. VI. Mental Health Board Bylaws and Administrative Guidelines Ms. Jones presented the Subcow,=ittoe's annual review of the Mental Health Board Bylaws and Adrainistrat ive Guide] znes. Ms. Jones moved and Ms. Hones seconded a motion that the Bylaws, Article V, Section 3, Torms of office, be amended to specify from July I - Juno 30...' as a torso of office for officers of the Board. Motion approved unanimously. Ms. Jones moved and Ms. Hones seconded a -not ,on that the Administrative Guidelint-,s, procedure 8-87-C, Section 2. be amended to read 'The lettor of t.ntent shall be subiaitted by June 1... ' Motion approved unanimously. i t 11i 1IIP 0 i ^ i i I A i i -4- VII. Unified Budgeting Schedule Mr. Saver reviewed the process that would be used for collecting the information for the Board Program Assessment rating forms for the FY 89-90 Funding Guidelines. He also presented a draft format for the presentation of the Board's and staff's assessments of programs. Ms. Fox reviewed changes in the Mental Health Board's schedule for tall meetings and hearings. She reported that the Alliance for the Mentally Ill of Greater Chicago had decided not to submit a proposal for Mental Health Board funds for 89-90. VIII. Review of Position Staternents of the Commission to Revise the Mental Health Code of Illinois Ms. Fox reported that she has been attending meetings of the Commission to Revise the Illinois Mental Health Code. She indicated some of the directions being considered for the revisions. She anticipated having recommendations for the Mental Health Board to consider at a future meeting. IX. Informational Items - Ms. Fox presented the application for Ellen Browne, the new individual nominated to tho Mental Health Board by the Mayor. - The City representatives to UBP will utilize the same Funding Guidelines and priorities as they did last year. Ms. Fox arranged for the new Director of K Unit at Read Zone Center to attend the Evanston Network meeting to discuss the merger of D Unit and K Unit. On October 1, R-�focus Zvi ll move to the Fami:/ Focus; Our Place building. ACCESS will move its space and combine with Refocus in the downstairs area of the building. - ACGC has been given 2 apartments by the 5t. Francis Hospital Corporation for rr-,nsitiona€ hous_rg for persons seen by the ouf.p.it:en't clinic. the YWCA lost the piece of property for 'IUD grant application for transitional family `;ol.sing because of apposition in the neighborhood. Ms. Graff th.rnked the United Nay For di;tr;out.ng the information from t he., r- nHe:c's assesnwent f;,r ^utnan services. -5- X. New Business Ms. Diers moved and Ms. Jones seconded a motion to send a letter to local legislators supporting a legislative override of Governor Thompson's veto of the allocation for CHIP in the State's FY 88-89 Budget. Motion approved unanimously. Mr. Saver presented information about the Substance Abuse Awareness Poster Contest being sponsored by the Evanston Substance Abuse Prevention Council for students in the Evanston and Skokie School Districts #65 and #202. Mr. Lynch moved and Alderman Feldman seconded a motion for the Mental Health Board to support and endorse the Evanston Substance Abuse Prevention Council's 2nd Annual Prevention Poster Contest, to ask the Mayor to proclaim the week of November 14 - 21 as Substance Abuse Awareness Week, and to encourage the Mayor and City Council to provide appropriate support and recognition for the poster contest and the winners, where possible. XI. Adjournment 14s. Hones moved and Ms. Lynch seconded a motion to adjourn at 9:12 p.m. Motion approved unanimously. Respectfully submitted, Jeanne M. Fox EVANSTON MENTAL HEALTH BOARD MEETING SEPTEMBER 8, 1988 DECISIONS OF MEETING 1, The Mental Health Board adopted the line items proposed for the FY 89-90 Mental !health Center budget. 2. The ,Mental Health Board accepted the proposed Objectives #1 and :3 under System Improvement from the Subcommittee's August 29, 1988 report. 3. The %lental Health Board changed the priority of Objective �l under Planning from Desired to Important. 4. The Mental Healtti Board amended the Bylaws, article V, Section 3, Terms of Office to specify '... from July I - June 30..." as a term of office for Officers of the Board. 5. The ?Rental Health Board amended the Administrative Guide- lines, Procedure 8-87-C, Section 2 to read The letter shall be submitted by June 1... ' 6. The Mental Health Board agreed to send a letter to local legislators supporting a legislative override of Governor Thompson's veto of the allocation for CHIP in the State s FY 88-89 Budget. 7. The Mental Health Board adopted a resolution to support and endorse the Evanston Substance Abuse Prevent -on Council's 2nd Annual Prevention Poster Contest, to ask the Mayor to proclaim the week o` November 1, - 21 as Substance Abuse Awareness Week, and to encourage the Mayor and City Council to provide appropriate support and recognition for thv poster contest and '!tie v:+�•ers, oner-� possible. EVANSTON MENTAL HEALTH BOARD MEETING MINUTES OCTOBER lit 1988 (Minutes Approved) MEMBERS: Art Diers, Marcia Nelson, Ann Graff, Ellen Browne, Carol Hanes PRESIDING: Ann Graff STAFF: Jeanne Fox, Harvey Saver, Joy Workman, Nicole Romano COMMUNITY REPRESENTATIVES: Marge Sandler, Rosalie Greenberg, George Cyrus, Jr. (Mental Health Association of Evanston); Diane Goodson, David Seaman (Early Childhood Development Center/ Children's Home and Aid Society of Illinois) I. CALL TO ORDER Ms. Graff called the meeting to order at 7:35 p.m. ;I. INTRODUCTIO"S AND CCNNUMITY CCKMENTS Ms. Graff introduced and welcomed Ellen Browne, the new appointment to the Mental Health Board. Ms. Fox introduced Joy Workman and Nicole Romano, interns to the Mental Health Board from the University of Chicago School of Social Services Administration. III. MINUTES OF SEPTE SER a, 1988 MEETIMG The minutes of the September 8, 1988 meeting were distributed. They will be considered for approval at the November meeting. IV. BUDGET HEARINGS - The Mental Health Association of Evanston tqd the Earl, Childhood Development Center were heard. The Mental Health Association is requesting $11,500 from the Mental Health Board to support the 'Volunteer Training Program. This roquest is the same amount as last year's allocation. The Early Childhood Development Center i; requesting $47,250, a J.8A increase over last year s Mental Health Board allocation. (Norking notes have been distributed ' *no Gotha -2- members and are available upon request by calling the office - 866-2919). V. LONG TERM CARE UPDATE Ms. Hones provided an update on time lines for and revisions to the Long Term Care Ordinance. The Department of Health and Human Services staff and representatives of the Commission On Aging and Mental Health Board's Long Term Care Committee will do a group edit and resolve differences before presenting a final draft. In response to questions Ms. Fox indicated that some of the materials in the packet have already been revised. She also said that the Ordinance is being separated into 2 sections; The first packet will have enforcement, due process and administrative concerns. 'he revised packet will have staffing and special program issues. This will enable us to move -t through the steps of the approval process more effectively and will give us time to integrate the State and Federal changes. VI. MENTAL HEALTH BOARD OBJECTIVES Ms. Fox reviewed the amended and new objectives which were being proposed by Ann Graff and Carol Henes. These will amend proposed FY 89-90 objectives. The entire packet of objectives will be approved, and priorities established by the Board at its November meeting. Ms. Henes moved and Ms. Nelson seconded a motion to adopt the proposed new Objective 04 under Promoting System Improvement, with a ranking of Important. Motion approved unanimously. Ms. Brown moved and Ms. Nelson seconded a motion to adopt the proposed new Objective 0 4 under Advocacy, Education and Prevention, with a ranking of Desired. 14otion approved unanimously_ Ms. Nelson moved and Ms. Henes seconded a motion to amend Objective 07 under Funding to read '...advocated for and assisted in securing a minimu© of $30,000... 0 14ation approved unanimously. VII. REVISIC?lS TO THE `iEATAL HEALTH CODE Ms. Fox reported that the Evanston Elgin/Read Network of agencies have reviewed the proposed changes to date to the Mental Health Code by thti Commission to Revise the '4anta' Health Code. The Network has sunmztted written comments and supp-L the Commission's preface to all changes that states. '.any changes in the Code and current implementation of -~ne Code require additional significant resources tar the L-.,te -,ri(; It 'r community services for the mentally ill". VIII. EVANSTON SUBSTANCE ABUSE PREVENTION COUNCIL (ESAPC) POSTER CONTEST UPDATE Mr. Saver provided an update on the progress of the Evanston Substance Abuse Prevention Council Poster Contest. He indicated that as a result of the Mental Health Board's request the 4Mayor issued a proclamation in support of the contest and for an Evanston Substance Abuse Awareness Week November 14 - 21. The Mayor also agreed to allow the beginning of the November 21 City Council meeting to be used to announce the winners. Ms. Nelson moved and Ms. Browne seconded a motion to allocate $50 for the ESAPC to use for prizes for the ESAPC Poster contest. Motion approved unanimously. IV. REQUEST FRCM CCkNISSION ON AGING Ms. Fox provided information about the Commission on Aging's (COA) request for support to increase their Ombudsman's position to full-time. She indicated that they are looking for support because the additional time would further a goal of the Mental Health Board to increase the quality of care in long term care facilities for persons who are mentally ill or develop- pmontally disabled and increase their FY 89-90 budget above the 1.5% Budget Office guidelines. In response to questions Ms. Fox described the Ombudsman's roles and responsibilities. She pointed out that the additional time for the position was reflective of the need for time for monitoring and advocacy in LTC facilities for individuals with developmental disabilities or mental health problems. Ms. Hones moved and Ms. Browne seconded a motion to send Human Services Committee a letter supporting the Commission On Aging's request to increase the Ombudsman's position to full-time. Motion passed unanimously. ?t was clarified that 'dental Health Board's support was for additional time for the Mental Health Board's populations. X. UNIFIED BUDGETING PROCESS There was a general discussion and update abr,u* the Community 'Development Block Grant (CD) budget hr.:tr 3 for Pub Iic Service requests, agency vrsits, and the collect: .f Board Program assessment Forms. Mr. Diers will represer, the 'dental Health Board at the October IS CD Hearing. XI. INFORMATIOMAL ITEMS -- Ms. Fox reported on the ,Network meeting A_tn Dr. Wooten and Ralph Dunn regarding Read Lone Center red Evanston community system coordination issues. -4-- - St. Francin Hospital received their Certificate of Need for 20 inpatient psychiatric beds. - There will be a public nearing on the continuation of the Homeless Shelter on October 24. The meeting was adjourned at 9:40 p.m. Respectfully submitted, Jptinne M. Fox u 4 EVANSTON MENTAL HEALTH BOARD DECISIONS OF MEETING OCTOBER 11, 1988 1. The Mental Health Board adopted new Objective #1 under Promoting System Improvement and ranked it Important. 2. The Mental Health Board adopted now Objective #4 under Advocacy, Education and Prevention and ranked it desired. 3. The Mental Health Board amended Objective #7 under Funding to read "...advocated for and assisted in securing a minimum of $30,000..." 4. The Mental Health Board allocated $50 for the Evanston Substance Abuse Prevention Council to use for the Substance Abuse awareness Poster Contest. 5. The Mental Health Board agreed to send Human Services Committee a letter supporting the Commission On Aging s request to increase the Ombudsman's position to full-- time in the FY 89-90 budget. EVANSTON MENTAL HEALTH BOARD MEETING MINUTES NOVEMBER 1, 1988 (Minutes approved) Members Present: Presiding: Staff: Community Representatives: I. Call To Order 0 Jack lynch, Carol Hones, Janice Jones, Art Diers, Alderman Gene Feldman, and Benn Greenspan Jack Lynch, Vice Chairman Jeanne Fox, Harvey Saver, Jay Workman and Nicole Romano Kate Mahoney, PEER Services, Inc.; Jane Baker, Mental Health Association of Evanston; Ray Ganey, St. Francis Adult and Child Guidance Center; John Buckley, Family Counseling Services Mr. Lynch called the meeting to order at 6:35 p.m. Mr. Lynch stated he is chairing the meeting because Ms. Graff is ill. Ms. Hones relayed Ms. Graff's thanks for the flowers sent to her by the Board. Ms. Graff hopes to be able to join the Unified Budgeting Panel meeting on November 5, 1988. II. Introductions and Coe unity Comments Members of the audience were asked to introduce themselves. No comments were given. III. Minutes of September 8, 1988 and October 11, 1988 Carol Hones moved and Alderman Feldman seconded a motion to accept the minutes of September 8, 1988 as written. Motion passed unanimously (6-0). Janice Jones moved and Art Diers seconded a motion to accept the minutes of October 11, 1988 as written. Motion passed unanimously (6-0). IV. Montal Health Board's FY 89-90 Objectives and Priority Ranking The Board reviewed the amended FY 89-90 Board objectives and proposed rankings. Ms. Henes stated that objective 1 under the Planning goal should be ranked important per Board discussion at its September meeting. She recommended that objective 7 under the Monitoring goal be changed to a ranking of important to reflect the Board's concern about this is5uc- By -2- consensus the Board supported Ms. Hones' recommendations. Art Diers moved and Janice Jones seconded a motion to accept the amended and corrected Mental Health Board FY 89-90 objectives and their priority rankings. The motion passed unanimously (6•-0) . V. Comment and Proposed Revisions to the Illinois Mental Health Code for Mentally III and Developmentally Disabled The Board reviewed a draft memo from Ann Graff on behalf of the Board to the Co -Chairman of the Committee to revise the Mental Health Code. Ms. Henes suggested, per a conversation with Ms. Graff, that an additional comment be included in the memo to convey the Board's strong belief that all communities should share the responsiblity for providing community resi- dential and outpatient services for mentally ill and develop- mentally disabled persons. Art Diers moved and Alderman Gene Feldman seconded a motion that the memo to the Co -Chairman of the Commission to Revise the Mental Health Code as amended be sent on behalf of the Mental Health board. Motion passed unanimously (6-0). VI. Funding Allocations Recommendations Jack Lynch reviewed the amount of new dollars available for purchased services which is $5,374. In addition $1,000 is available to be reallocated from the Alliance of Mentally Ill since this agency is not seeking a grant this year. This is a total allocation of $6,374, which is a 1.5% increase. Ms. Henes then reviewed the Funding Guidelines Committee process for making its allocation recommendations for con- sideration by the Board. The following is the process and summary of the Funding Guidelines Committee recommendations: 1. Utilized results of the Board's assessment of programs based on the Mental Health Board s funding guidelines: i.e., Final Score in Final Score Order, and arbritrarily divided the program scares into thirds, i.e., programs ranking 8.4 - 7.4 were top priority; programs ranking 7.3 - 6.7 were medium priority; programs ranking 6.5 - 5.5 were low priority. 2. Reviewed and discussed programs from the bottom third group to determine reductions. Summary of Committee recommendations: 4C's: Maintained - St. Francis/OATFS Program: Decreased $300 ACORN Drop -In Center: Decreased $105 9 d4ruse.9.11 _3- - PEER Services/Adult Treatment: Decreased $1,000 - St. Francis DD Counseling: Decreased $1,600 - ACORN Volunteer/Case Management: Maintained 3. Reviewed and discussed programs from the top third group to determine increases. Summary of Committee recommendation: - Evanston Hospital Crisis Team: Maintained - Family Counseling Services Child Abuse: Increased $1,953 - Shore Community Services/Day Treatment: Increased $1,860 - Family Counseling Services Senior Counseling: Increased $770 - Evanston Hospital Outpatient Psychotherapy: Maintained - St. Francis Individual and Family Counseling: Increased 51,000 4. Reviewed and discussed programs in the middle ranking group to determine allocations. Summary of Committee recommendations: - Family Counseling Individual/Family: Maintained - Early Childhood Development Center: Maintained - Evanston hsopital Refocus: Maintained - Family Focus/Our Place: Maintained - Evanston Hospital Extended Care: Maintained - Niles Township Sheltered Workshop/First Step: Maintained - St. Francis Hospital Adult Outpatient Psychiatry: Maintained - St. Francis Hospital MI Case Management: Maintained - Evanston Community Defender: Maintained - Mental Health Association/Volunteers: Maintained - ACORN Residential Services: Maintained 5. Reviewed UBP consensus vote taken on 10-27-88 to assess differences between UBP recommendations and Funding Guidelines Committee recommendations. The following differences were noted: Agency/Not Program UBP CG MHB St. Francis Increase Maintain Community Defender Increase Maintain 4 C's Increase mainrain Family Focus Increase uaintain -4-- The following Board comments were made as they discussed allocations to programs: Maintaining at current level should be considered as support of a program; only a small amount of new monies to allocate which makes the allocation decisions very difficult. Final score of Board for programs agreed well with ranking of Mental Health Board Service Area Target Populations Scores. Could give 1.5% increase across the Board to all programs but then no program could get enough money to make difference; hospitals have ability to receive more 3rd party payments and could raise fees in amount of possible increase from the Board. An increase to a program reflects a strong priority of this Board; changing funding within an agency can also reflect our priorities; amount of increase does not necessarily reflect Board's priority. Should consider impact of service on population receiving service and not agency's need for increased monies; small agencies have less flexibility to make adjustments than do larger agencies or programs within large institutions. Residential program for our target population are high priority. Funding Guidelines Final Score took in opinions and data, both objective and subjective information, and digested this mass of information into one score. Performance objectives with outcomes must continue to be worked on by agencies Board appreciates the hospitals' programs responsiveness to the community; their outreach efforts beyond their walls; their concern for prevention as well as treatment and their high quality sevices. Need to aggressively advocate on a continuing basis for increased State dollars for community services which save the Illinois State Department of Mental Health and Developmental Disabilities significant dollars due to less utilization of State hospital bed days. Then the Board reviewed programs recommended for reduction. By consensus no changes were made in the Funding Guidelines Committee recommendations. The Board reviewed next those agencies which were recommended for maintenance by the Funding Guidelines Committee. Carol Henos moved and Alderman Gene Feldman soconded a motion to increase ACORN's residential services by $700. The motion passed 4-2. (Funding Guidelines Committee recommendation was $2,000. The final recommendation for ACORN'S Residential Services was 52,700). With this increase and a desire by Alderman Feldman to consider an additional increase for Family Counseling Service Child Abuse program, the Board reconsidered the programs for which increases were recommended. By a vote of 4-2 (Lynch and Diers) the following changes for program allocation were made: Agency /Prograw Shore Day Treatment Shore Residential Family Counseling/ Child Abuse Pear/Early Intervention --5- FGC Recoe ondati.ons $1,860 $1,600 $1,953 $1,300 Final MHB Recom. $1,530 $1,300 $1,803 $1,150 A summary of allocations and Board comments have been distributed to the Board and are available upon request. The Board then accepted, by a vote of 6-0, the total roco+mwended allocations as amended. Mr. Greenspan stated that the hospitals need to be aware that although we value their services and outreach beyond their walls to the community, we cannot guarantee them continued funding at this level with our minimal yearly increase of purchased service dollars. The total amount of purchased service allocation is $429,653. This is a 1.2% increase of new dollars over last year's budget. Mr. Lynch stated that representatives of the Board will take the Mental Health Board funding allocation recommendations to the November 5, 1988 Unified Budgeting session. Immediately after Unified Budgeting is completed, the Board will convene to vote on its final allocation and budget. The Mental Health Board's budget needs to be submitted to Human Services Committee by November 10, 1988. The Board then considered issues and recommendations of the Funding Guidelines Committee which they think need to be discussed in other forums. These issues are: 1. If Evanston community programs like ACCESS and First Step are saving the State a substantial amount of monies by reducing days of hospitaliza- tion, why is the Stato (DMHDD) not funding them more? Recommendation: Mental Health Board aggressively advocate on a continued basis for more DMHDD funds from DMHDD with State Representative Woods Bowman and Senator Arthur Berman . The Board voted 6-0 to accept this recommendation. 2. Some agencies are more dependent on local funds than others. Some agencies aggressively seek funds from a variety of sources, while other agencies do very little. Recommendation: It should be required that all 0M. agencies demonstrate and document an aggressive fundraising campaign with the goal of less dependence on local dollars. The Board voted 5-1 {Greenspan} to accept this recommendation recognizing criteria would need to be developed to determine how to measure effort. 3. Performance outcome objectives: Some agencies currently have good performance outcome objectives, e.g., Earn and Learn; however, many agencies are still writing process objectives. Recommendation: A workshop on this issue be jointly sponsored by the Unified Budgeting funders For providers and be held in the spring of 1989 with the goal of improved performance outcome objectives for the UBP process of 1989. The Board voted 6-0 to accept this recommendation. 4. Many agencies/programs are dependent on local funds because they do not charge fees. Recommendation: UBP staff work with agencies to consider the possibility of charging fees for rograms not now collecting fees. It is our belief that some feu payment, whether 50 cents or $5.00, is an indication of commitment and connection to the service/program. The Board voted 4-2 (Greenspan and Jones) to accept this recommendation. Mr. Greenspan also recommended that the Board consider in its next funding cycle an incentive for agencies to fund raise, perhaps with a match for money raised; need to consider what criteria we will use to determine "aggressive" funaraising. Ms. Fox shared two other concerns to be addressed by the Unified Budgeting Panel on Saturday: 1. To consider a different allotment of time for agencies requesting small amounts of monies vs those asking for a large amount of monies from Unified Budgeting funders. 2. Assess community funding for target or population groups and the impact on services, e.g., homeless, youth employment, mentally ill, and substance abusers. There being no further business, the meeting was adjourned. Respectfully submitted, Jeanne It. Fn Y EVANSTON MENTAL HEALTH BOARD DECISIONS OF MEETING NOVEMBER 1, 1988 1. The Board unanimously approved the corrected `.Mental Health Board FY 89--90 objectives and their priority rankings. 2. The Board unanimously agreed to send recommendations to the Co -Chairman of the Commission to Revise the Mental Wealth Code. 3. The Board unanimously approved the recommenced allocations for purchased services. A summary of allocations and Board comments have been distributed to the Board and are available upon request. T'le Mental Health Board recommended the following: - dental Health Board aggressively advocate on a continued basis for more ONIHOD funds from DMHOD with State Representative 'Hoods Bowman and Senator Arthur Berman. Vote: 6-0. - It should be required that all agencies demonstrate and document an aggressive fundraising camoaign with the goal of less dependence on local dollars. Vote: 5-1 {Greenspan). Criteria would need to be developed to determine how to measure effort. - A workshop on this issue oe ;ointly sponsored by the Unified Budgeting funders for providers and oe ^eld in the spring of 1969 with the goal of imDroved pp^- `ortnance outcome objectives `or the UBp process o` .989. Vote: 6-0. - UBP staff work with agencies to consider -^e oossiolity of charging fees for programs not now ccllecting `ees. Vote: 4-2 +Greenspan and Jones). }i 11 1 !Ili 111 ' n 9 1 i "II II ip '. 1 I1 i I I ' TI I ^ 11! . 111 I 11 n l ill lip 1 n 1111 " I It' II 1 1 1 � 1 1 ' II EVANSTON MENTAL HEALTH BOARD MEETING MINUTES NOVEMBER 5, 1988 (MINUTES APPROVED) Members Present: Ann Graff, Carol Hones, Art Diers, Ellen Browne, Janice Jones, Bonn Greenspan Presiding: Ann Graff, Chairperson Staff: Jeanne Fox, Harvey Saver, Joy Workman, Nicole Romano Community Representatives: None I. Call To Order Ms. Graff called the meeting to order at 12:40 p.m. in the Council Chambers of the Evanston Civic Center, immediately following the end of the Unified Budgeting Panel meeting. II. Mental Health Board Budget Ms. Graff stated that the only agenda item for this meeting is the final vote on recommended allocations for each part of the Mental Health Board's budget. Therefore, Ms. Hones moved with a second by Art Diers to accept the Unified Budgeting Panel's agency/program recorended allocations, which are the same allocations which were recommended by the Board at its 11-1-88 meeting, for a total of $373,153. The motion passed unanimously by a vote of 6-0. Janice Jones moved with a second by Benn Greenspan to allocate a total of $429,653 for purchased services. (This amount includes Early Childhood Development Center ($45,000) and Mental Health Association ($11,500) which do not go through the Unified Budgeting Proces.) The motion passed unanimously by a vote of 6-0. Bonn Greenspan moved with a second by Ellen Browne to allocate $121,379 for the Mental Health Center Budget. The motion passed unanimously by a vote of 6-0. Art Diers moved with a second by Carol Hones to submit to the Human Services Committee and the City manager a total Mental Health Board budget of $551,032. The motion passed unanimously by a vote of 6-0. Art Diers and members of the Board recognized staff for their excellent work during the budgeting process. Ms. Graff thanked Board members for their commitment of time and thorough study of all the issues during the budgeting process. Ms. Graff reminded everyone of the Board's budget hearing before Human Services Committee on November 14 at 7:30 p.m. and asked all to attend. (The itemized budget of the Mental Health Board and its objectives for FY 89-90 are availalbe upon request from the office - 866-2919) . Janice Jones roved with a second by Ellen Browne for adjournment of the Board meeting at 12:50 p.m. The notion passed unanimously. Respectfully submitted, f J sane M. Fox