Vermont Council
of
Developmental and Mental Health Services

137 Elm Street, Montpelier, Vermont - 05602

Tel: 802.223.1773 Fax: 802.223.5523

Vermont Council

Legislative Agenda 2011

January

Priorities

Sustain the Designated Agency System of Care

Vermont’s designated agency system provides a comprehensive cost-effective system of care.  This was the conclusion of two studies by the Pacific Health Policy Group done for the state in 2004 and 2007.  The DA system is committed to meeting the needs of Vermont’s most vulnerable citizens with a no-reject policy. Each agency maintains core competencies and is required to demonstrate quality standards of care.  DAs respond to the unique needs of our communities with many innovative local and regional initiatives and through partnerships with health care, human services and schools. Charitable donations, city and town contributions, competitive foundation and grant funding and other non-governmental income sources generated by DA’s, complement and leverage federal and state funding saving VT taxpayers millions of dollars every year.

Budget Adjustment for Fiscal Year 2011

The demand for new developmental services (DS) exceeds the appropriation made by state government for the current fiscal year.  Individuals who meet the eligibility criteria for developmental services have significant needs and are often in crisis situations. It is not appropriate to put them on a wait list.  It is appropriate to reassess the expected demand for care in fiscal year 2011 and provide funding accordingly.

Budget for Fiscal Year 2012

Over the last three years developmental, mental health and addiction services have lost $15 million in funding. Waits lists for services have increased, services have been reduced as has staffing. For example, waits for outpatient services can be as long a two months. It is time to put a moratorium on further budget reductions to designated agencies and the populations we serve.  State government initiatives to reform health care, improve education and reduce incarceration all depend on Vermonters’ ability to access quality mental health, developmental services and addiction services.  It’s time to stop the double standard between health care and mental health care. 

Challenges for Change

The goal to redesign government sponsored services to improve outcomes and improve efficiencies is a good one.  Unfortunately, many “challenges,” however well intended, morphed at the local level into a short term budget cutting exercise.  In the community, only designated agencies, not other contractors, were singled out for across the board budget cuts as part of the Challenges for Change legislation. Additionally, many of the innovative ideas for reducing costs were unrealistic and did not materialize. The result was an effective cut of $5.5 million in fall budget for DA community providers.  Some Challenges initiatives, such as Creative Workforce Solutions, should be closely analyzed to determine if the investments are producing cost-effective outcomes.  Early feedback indicates that there is less efficiency in the field as a result. Further work mat result in improved outcomes, but short-term savings targets must be pared down to realistic levels moving forward.

Corrections

Many individuals at risk of incarceration or involved in the criminal justice system have challenges with mental health, developmental disabilities, addictions and severe functional impairments (SFI).  Designated agencies are skilled in meeting complex needs and, with adequate resources could play an important part of the state’s sequential intercept model (SIM) system of care.  DAs are working actively with the Agency of Human Services and Department of Corrections to provide community placements for incarcerated individuals with SFI using flexible funding.  This initiative should be built upon to meet the diverse needs of individuals at-risk or involved in the criminal justice system.  Improving funding for community based substance abuse and mental health intensive outpatient services will be critical to meeting needs of these individuals and reducing incarceration rates and costs.

Health Care Reform

It is vital to include mental health and addiction services as a component of health care reform design and financing.  Sixty percent of visits to primary care physicians are for mental health and substance use disorders. Vermont will not make progress in controlling healthcare expenditures unless we develop more holistic service delivery and financing models. Collaborations among designated agencies, primary care physicians, federally qualified health centers and hospitals are in the best interest of consumers and tax payers. Exciting initiatives have begun throughout the state which lay the foundation for further collaborations in the future. Some individuals prefer to receive comprehensive services through their designated agency.  They should be able to choose DA’s as their healthcare home. 

Additional Legislative Initiatives

Futures Plan

The Vermont Council has been engaged in the development and implementation of the Vermont Futures Plan since its inception in 2003. The “Plan” however has lost momentum if not its way. We are fully committed to the original goal of expanding community–based services to eventually realize the permanent closure of the current state hospital.  However, funding reductions in FY’09 and FY’11 have led to a contraction of community service capacity. Most disconcerting are the significant current and strategic problems in recruiting and retaining qualified personnel.  The sustainability and expansion of comprehensive adult outpatient services are vital to the success of any “Futures Plan” and should be specified as such in the budget of future versions.

Proposed “Futures” Secure Residential Facility:

The current design raises serious questions about its usefulness.  In current form and placement it may be neither cost effective nor therapeutically sound.  In spite of a universal desire for forward progress it would be prudent to first reestablish and affirm a clear strategic system of care vision.  In the wake of scarce financial resources we are strongly opposed to proceeding with the plan as it stands.

Authorization for Advanced Practice Registered Nurses (APRN) to complete Emergency Exams

The goal is to address the shortage of emergency based psychiatry services and to improve preventative crisis psychiatric care in the community. Nurse practitioners with a focus in psychiatric/ mental health care, as defined by the Vermont Board of Nursing, would be able to complete a Physician’s Certificate Emergency Exam. Currently only psychiatrists and residents can do so. The change requires a change in statute. It has support from the Council’s Emergency Services group, the Designated Agency psychiatry group, the Vermont Board of Nursing and the DMH.

Potential benefits to quality of care:

·         Decrease the number of psychiatric emergency exams through increasing community-based psychiatric care

·         Decrease potential for  emergency room visits and hospitalizations through preventative psychiatric intervention

·         Decrease the unnecessary and costly usage of warrants

·         Increase parity of preventative and acute psychiatric care between rural and urban areas

·         Improve measurable individual outcomes

Psychiatric Inpatient Admission for Children under Fourteen

The bill would allow a voluntary psychiatric hospital admission of a child under 14 who refuses consent, as long as a parent or guardian, the medical staff at the receiving facility; and a qualified mental health professional or screener, agree to the placement.  The Council supports the idea that it should not be necessary to write papers for an Emergency Evaluation for a child under 14 who refuses consent to psychiatric hospitalization.

Public Inebriate Program

The Vermont Council supports the recommendation of the Public Inebriate Task Force which was convened in response to Act 179, Sec. 17 of Vermont Statutes in 2009.

• Ensure individuals that are incapacitated are appropriately screened at each stage of the process in all areas of the state, leading to appropriate triage for services and community based diversion resources.

• VDH/ADAP require as a grant deliverable that a uniform screening tool be used.  Communicate with the Vermont Emergency Department of Medical Directors Committee to ensure standard emergency room policies and procedures are observed statewide.

• Provide adequate training to law enforcement, corrections, emergency department personnel, first responders, public inebriate screeners and treatment providers to ensure uniform procedures are observed statewide.

• Provide a screening capacity in Addison County, the only county without screeners.  This will ensure universal inebriate screening coverage statewide.

• Allocate sufficient resources to meet the standard of care by screening, social detox and shelter beds and secure placement beds for the populations as indicated in Domain II.  Regionally appropriate capacity for follow-up treatment could be met by nine two-bed public inebriate bed units at an estimated annualized operational cost of $180,000 each.

• Rescind the previously enacted legislation which would preclude housing a person under the care of the Department of Corrections if they are deemed incapacitated and not charged with a crime.

Potential Issues

1. Background Check requirements for individuals working with vulnerable populations as passed in 2010 in S.297 the Miscellaneous Changes to Education Law

2. Improve funding for mental health eldercare program

3. Public education to raise awareness of mental health and addiction issues, prevent stigma and promote treatment.

4. Address concerns about public safety in relation to services for offenders with developmental disabilities

5. Involuntary treatment of individuals with mental illness

6. Specialized school-based mental health and developmental services

7. Autism Services and Regional Centers

8. State and/or federal loan initiatives for staff who work in the designated agency system.