Monday, August 31, 2009

Cuts to Mental Health Services: Survival of the Fittest?

This letter appeared in on Sunday August 30, 2009:

When I read the article about slashing services to Washtenaw County's Community Support and Treatment Services in the
news, I thought: "Yep, here we go again with the survival of the fittest."

The (relatively young and healthy) people in power (elected to represent us, NOT resent us) could survive a cut in pay or hours, but the seniors and handicapped and mentally ill, WILL surely suffer to varying but great degrees.

Advocates must constantly remind these decision makers that the level of a community is determined by how well we take care of those who cannot take care of themselves (in all the myriad different ways).

Please put your heart before your head or wallet.

Jane Mariouw, Ann Arbor

Monday, August 24, 2009

August 18th WCHO board meeting with public comments on proposed cuts to CSTS

The Washtenaw Community Health Organization (WCHO) Board met on August 18, 2009. Since the WCHO's last Board meeting, the Washtenaw County Board of Commissioners met to discuss the possibility of cutting County services, including mental health programs. This is a summary of parts of the Board meeting that relate to that issue:

Patrick Barrie, the WCHO Executive Director, and Board members reiterated that the WCHO has a responsibility to provide services written into person-centered plans for people with developmental disabilities and that, in any case, those services will be provided whether it is through Community Supports and Treatment Services (CSTS) or through other contracted providers.

Washtenaw County is obligated to fund 10% of the WCHO budget, but it has gone well beyond that in the past in supporting mental health programs. It is the discretionary part (above their 10 % contribution) that can be cut.

The Impact Statement of program cuts from Donna Sabourin, CSTS director, is laid out on pages 11 - 22 of this document .

Public Participation:

During public participation at the beginning of the WCHO Board meeting, I noted that Donna Sabourin had presented Washtenaw County with an impact statement of possible cuts to CSTS and asked if there had been any attempt to consider consumers and family members’ views regarding possible cuts? (Board members agreed that they need to improve communication with families and consumers.) After I became aware of the possibility of cuts from the County, I heard more specifically that this could mean laying off 60 people from CSTS jobs in vocational, training, and day programs.

One of my concerns is that these types of programs (day programs, workshops, PACE programs, and enclaves) are easy targets for elimination by the state with support from advocates who would tell you that everyone can work at a paying job and live in the community like everyone else and that these programs are isolating and discriminatory. For people who need these programs, they are a lifeline for both consumers and their families and are a useful and necessary part of the system of care and services.

Another family member commented that contracting out services (which is a possibility if the County makes severe cuts to CSTS) is not always the best plan for the long term. He works for a car company that did that. They found that workers had a lower level of skills and that they saw a general degradation of services. They went back to hiring their own people rather than outsourcing the work.

More information on the WCHO and County and state budgets:

  • The WCHO has a fiscal year that begins on October 1st. The County' s fiscal year begins on January 1st. The cuts the county is contemplating would go into effect on January 1st, 2010.
  • Everyone is awaiting the State budget. At this time the strongest and most reliable funding will be from Medicaid. The Medicaid match from the federal government will be going up, based on the state’s financial problems. The state will be paid under the old rates until the state files a new agreement with the federal government.
  • The state got an increase of $1 billion in Medicaid stimulus money. With state revenues declining precipitously, the state used up the stimulus funds in three months. The state would have been in even worse shape without it.
  • Barbara Levin Bergman who is a County Commissioner and WCHO Board member said the WCHO needs a better method of explaining budget problems and offered her phone number for anyone who had questions about it. Here is her email address: .

After the meeting, I asked Barbara Levin Bergman which of the Commissioners meetings are the most important to attend. She said all of them. I will try to attend as many as possible and will pass on what I find out. I would love to have company at these meetings if any of you can attend.

Here are the meetings through the month of September:

  • 8/26 Administrative Briefing 5:00 p.m. Administration Conference Room
  • 9/2 Ways & Means Committee 6:30 p.m. Board Room, Administration Building
  • 9/2 Board of Commissioners 6:45 p.m. Board Room, Administration Building
  • 9/3 Board Working Session 6:30 p.m. Board Room, Administration Building
  • 9/9 Administrative Briefing 5:00 p.m. Administration Conference Room
  • 9/16 Ways & Means Committee 6:30 p.m. Board Room, Administration Building
  • 9/16 Board of Commissioners (Annual Meeting) 6:45 p.m. Board Room, Administration Building
  • 9/17 Board Working Session 6:30 p.m. Board Room, Administration Building

The other thing that Barbara Bergman suggested for us to do is for anyone with concerns about these proposed cuts to contact their own County Commissioner.

  • Here is a map of the County so that you can determine who your Commissioner is.
  • Here is a list of all the Commissioners with their contact information.

It is important for the County to understand that these programs, whether or not they are mandatory as far as the County is concerned, are essential for many people with developmental disabilities who have very few options available. Both they and their families are adversely affected by abrupt changes in their lives more than most people.

If you would like more information about the WCHO Board and what it is doing, you may ask to be put on an email list to receive the packet of materials sent out to the Board before every meeting. Email Suzanne Gondek at

Jill Barker

Thursday, August 20, 2009

Healthcare without the shouting

If you are tired of discussions about health care that involve shouting and swastikas, there are a couple of NPR programs on the subject that are both illuminating and civil.

The August 20, 2009 Here and Now (The Uninsured Congressman) features a discussion with
Representative Steve Kagan, a Democrat from Wisconsin, who is also a doctor. He has elected to go without health insurance until his constituents have available something similar to the health insurance offered to members of Congress. This is an interesting discussion of variability in health care costs and how he bargains for the care that he pays for.

On July 28, 2009,
Paul Krugman, Nobel Prize-winning economist, and Stuart Butler, a native of Britain and vice president for domestic and economic policy studies for the conservative think tank the Heritage Foundation, discuss how health care is financed on Fresh Air with Terry Gross. It is interesting how much they agree on.

Tuesday, August 18, 2009

Seeing Red - More on cuts to CSTS

Here is a statement dated August 10, 2009, from Bob Guenzel, the Washtenaw County Administrator on budget reduction options for programs that receive county funds. One thing that is important to understand is that when Guenzel talks about non-mandated services, he means that the county is under no obligation to fund certain programs but has done so in the past because of the benefit to the community. The WCHO does have an obligation to continue providing services written into person-centered plans for people with developmental disabilities, even if they are no longer provided by Community Supports and Treatment Services (CSTS).

Guenzel says:
At last Wednesday's Ways and Means meeting I presented the Phase II 2010/11 budget reduction options to the Board of Commissioners. These options included the reduction or elimination of many worthwhile programs, and undoubtedly will directly impact the community and the organization.

It's important to remember, however, that these are only options at the present time -- not my recommendation. No decisions have been made. There are no easy choices, and over the next few months the Board will deliberate the proposed alternatives and determine where the necessary budget reductions will be necessary.

The largest amount of money to be saved, however, comes from mental health programs provided by Community Supports and Treatment Services (CSTS). According to Sally Amos O'Neal from customer services, up to 60 jobs may be cut from vocational and training programs such as day programs, enclaves, PACE programs, and job coaching.

Important dates in the Washtenaw County Board of Commissioners budget process include:
  • September 11th - 2010/11 Budget Adjustment Recommendations Phase II will be posted to the web
  • September 16th - Guenzel will present his 2010/11 Budget Adjustment Recommendations Phase II to the Board
  • November 18th - The Board is scheduled to adopt a balanced budget
Another document worth looking at if you want the gory details on possible cuts to various programs, how much money will be saved and how many people will be laid off, look here. Those specifically involving mental health are on pages 11 - 22.

Friday, August 14, 2009

Slashing of mental health services begins

AnnArbor.Com reported last week in an article entitled "Washtenaw County Board has tough decisions to make; 181 county jobs on the line", that the Washtenaw County Board of Commissioners is on the brink of cutting 181 county jobs. The County is facing a $30 million deficit.

While many other cuts are being considered, the largest are in Mental Health services:

The county could realize up to $2.4 million in savings through reductions to mental health services, which would eliminate 91.4 full-time jobs.

Employees of Community Supports and Treatment Services, the public agency in Washtenaw County that provides mental health services to people with developmental disabilities, mental illness, and substance abuse problems, work for Washtenaw County. The County's proposal so far is to eliminate over 90 positions at CSTS. ALL vocational programs, including several day programs, PACE groups, job coaches, and enclaves will either be eliminated or contracted out in this proposal.

The exact impact of this is uncertain. The WCHO gets about 10% of its funds from the county. At a Washtenaw Community Health Organization Board meeting earlier this year, it appeared that county cuts would not have much impact because the WCHO relies mostly on state and federal funds and the agency has been successful in obtaining grants that make more funds available.

The WCHO has sent out a letter to consumers with the following paragraph:
At the request of the County, Donna Sabourin, Executive Director of CSTS, submitted an impact statement to the Washtenaw Board of Commissioners showing the possible impact of cuts in county funding. The proposal listed possible position reductions, and potential outsourcing, cutbacks and/or elimination of various CSTS operated programs. While it is necessary for CSTS to clearly identify reduction options and scenarios for the Board of Commissioners, the WCHO has an obligation - under state law and federal waiver requirements - to make available certain services to particular priority groups and eligible beneficiaries, within the constraints of the funds appropriated by the Legislature for these purposes and populations. To meet these obligations, the WCHO’s contract with CSTS for the budget year that begins October 1st may stipulate provision of programs/services that are different from those currently prioritized by CSTS for retention, reduction or elimination.

No final decisions have been made with regard to program, provider, or service changes.

At this point, questions about the letter to consumers should be directed to Sally Amos O'Neal from WCHO Customer Service: Phone: (734) 544-6807 Email:

In the meantime, most of the groups that are being affected by the cuts have raised Holy Hell at recent meetings of the County Commissioners. I think it's time to make the concerns of people with developmental disabilities heard, but we need more information. The next Board meeting of the WCHO is on Tuesday, August 18, 2009 from 6:00 pm to 8:00 pm at the Learning Resource Center at 4135 Washtenaw, Ann Arbor, MI (enter from Hogback Road, near the Washtenaw Ave. Interstate 23 overpass).

There is time for audience participation at the beginning and end of the meeting.

Other meetings coming up are the County Ways and Means committee on 9/2/09 6:30 to 6:45 followed by the Board of Commissioners from 6:45 - 8:00 pm. Check the calendar here for information on the location of these meetings and contact information.

I am not sure yet which are the most important meetings to attend, but let's begin with the WCHO Board meeting on Tuesday August 18, 2009 so that we can ask some pertinent questions about what is happening. Even if all the services are outsourced, these kinds of cuts will gut the CSTS of experienced employees, which can't help but have a huge impact on our family members.

I will send updates when they are available. If any of you have any information or questions about this, let me know.

This and further information will be posted on my blog at

Jill Barker
Friends of the Developmentally Disabled

Thursday, August 13, 2009

Michigan Conference on Medicaid Waivers

Home and Community Based Waivers are available to provide a wide array of services to people living at home or in other community settings including group homes. Your developmentally disabled family member may already have a waiver - if that is the case, you were asked to give consent to use waiver services instead of placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

Families usually don't receive much information about the waivers, the services they pay for, and how your local Community Mental Health agency is spending the money from the waiver. But access to HCBS waivers is often vitally important to getting all the services your family member needs to live safely and comfortably in whatever setting is appropriate.

This conference may help you to fill in the gaps in your knowledge about Medicaid waivers and how it might help your family. I'm hoping that's the case. As always, these mental health people are in love with acronyms and funny language ("wrap-around facilitators"???) Here is the the text of the flyer sent out by the MACMHB and the Michigan Department of Community Health:

MI Association of Community Mental Health Boards, in partnership with the MI Department of Community Health presents:

Annual Home & Community Based Waiver Conference
September 9 & 10, 2009

Kellogg Hotel & Conference Center
MSU, East Lansing, Michigan

3 Featured Waivers:
  • Children's Waiver Program (CWP)
  • Habilitation Supports Waiver (HSW)
  • Serious Emotional Disturbance Waiver (SEDW)

Workshop Goals and Objectives: Learning objectives for each educational activity are identified within the body of the brochure.

Who Should Attend: Case managers, supports coordinators, wrap-around facilitators, clinicians, administrative staff, providers, consumers, and family members.

Consumers & Family Members: A special rate is available for consumers and family members. [The special rate is $50 for the whole 2-day conference.]

Continuing Education Credits: The Michigan Association of Community Mental Health Boards (MACMHB), provider #1140, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) through the Approved Continuing Education (ACE) program. MACMHB maintains responsibility for the program. Social workers participating in this conference (9/9/09-9/10/09) may receive a maximum of 10.5 continuing education clock hours.

Evaluation: There will be an opportunity for each participant to complete an evaluation of the conference and the instructor. If you have any issues with the way in which this conference was conducted or other problems, you may note that on your evaluation of the conference or you may contact MACMHB at 517-374-6848 or through our webpage at for resolution.

Includes Plenary Sessions such as:
  • “Asperger’s and the Five Senses”and Concurrent Workshops such as:
  • "Medication and the Child and Teenage Brain: What do Psychiatrists do? What do Medications do? Can we all Work as a Team?"
  • "Getting Started in Self-Determination"
  • "Benefits and Community Supports for Persons with Developmental Disabilities and Mental "Illnesses
  • "Increasing Independence for Children with Autism through Visual Supports"
  • "Project ImPACT: Teaching Parents of Children with ASD Strategies to Enhance Their Child’s Social Communication"
  • and much more

Other MACMHB Trainings here.

Wednesday, August 12, 2009

WCHO Oversight of Provider Agencies

In May 2009, the WCHO Board asked for a report from the Organization Operation Committee (that is an awkward name, but that really is what they call it) to give the Board a better understanding of how the WCHO carries out its oversight and monitoring responsibilities of the provider agencies that are contracted to provide services to WCHO consumers.

This request was motivated in part by problems with Community Residence Corporation, an agency that provides community living supports to consumers in unlicensed settings as well as staffing for licensed group homes. According to a report to the OOC on Provider Oversight & Monitoring (June 2009), since Michigan was granted the Medicaid 1115 Waiver, Community Mental Health agencies have created opportunities for more consumer choice, resulting in the growth of the contractor provider network. Many consumers have moved out of licensed settings into smaller supported living sites. Currently there are over 220 individual service delivery sites that must be monitored. This rapid growth in the number of sites has strained the capacity of the WCHO to assess the services being provided and to oversee and monitor contracted providers.

The June 2009 report goes on to discuss "risk management" and the current "monitoring framework".

I did not attend the July WCHO Board meeting, but at the August 5th, 2009 OOC meeting there was further discussion of
continuing problems with oversight of provider agencies. Community Residence Corporation has been given provisional status to continue to provide services. Although there has been staff training, there was a question as to whether training included a "competency component" - did the training make the staff more competent at handling situations that have caused problems in the past?

There was also a discussion of two contracts that WCHO was recommending be approved:

One was to add residential services for a consumer with predatory sexual behaviors who is leaving Mount Pleasant Center to a contract with Spectrum Community Services. Spectrum has experience with this population and has a licensed home in Wayne County that will cost the WCHO $188,106 per year. (There are three other residents who live in the home at the same cost per person.)

Leila Bauer, a WCHO Board member and OOC member, had questions about the ability of Spectrum to provide the services. She has been in contact with families whose family members live in a supported living situation managed by Spectrum. Even though staff are there 24 hours per day, the police have had to be called several times, and there have been some serious incidents. Families do not know what their rights are or who to complain to and Spectrum has not been responsive.

decided to recommend the contract for additional services by Spectrum. In addition, a recommendation was made by the committee for the WCHO Board to file a recipient rights complaint on behalf of the consumers at the supported living site and for recipient rights to begin an investigation into the quality of services being provided.

The second contract was for the CHC Group, LLC that currently provides services in Monroe County. The proposal is to add CHC to the community living supports panel to provide Supported Employment services in Washtenaw County. The OOC has been discussing the problem of having too many providers to oversee, and the question came up as to why they should add another provider? The OOC recommended approval of the contract, but was not entirely comfortable with the decision.

These particular items on the OOC agenda were the ones I paid attention to because they affected people with developmental disabilities. There were other items involving other WCHO consumers, but those groups will have to get their own blog.

The Committee had many thorny issues to deal with and I had the impression that they lacked all the information necessary to feel comfortable with their decisions, but they are expecting to recieve more information and to be kept informed by WCHO staff.

Tuesday, August 4, 2009

Detroit Researcher to Discuss OCD on ABC's Primetime

A Children's Hospital of Michigan psychiatrist and researcher at Wayne State University in Detroit, Dr. David Rosenberg, will appear tonight on ABC's "Primetime" at 10 p.m. to discuss the role of glutamate in Obsessive Compulsive Disorder (OCD). According to an article in the Detroit Free Press, "WSU prof ties chemical to obsessive compulsive disorder", 8/4/09, an imbalance of glutamate might explain OCD.

The discovery in Dearborn, Michigan, that a man with OCD was keeping more than 100 Chihuahuas in filthy and inhumane conditions, has brought the issue to light recently. The behavior the man exhibited was probably an extreme form of the disorder called hoarding.

The article also refers to another extreme case in a local nursing student whose fear of choking prevented her from eating since the age of 10. She has since been successfully treated for her OCD.

According to the Free Press article:
Rosenberg said glutamate keeps the fear center of the brain on high alert, even when there is nothing to be afraid of. “When you check the door to make sure it’s locked,” the fear center “gives you the all clear, the door is locked, and you go to sleep. In children with OCD, you never get that signal, and in fact the fear cen­ter warns the danger is worse than before,” Rosenberg said. OCD sufferers are haunted by anxieties that never go away...

Treatments are available for the disorder.