Update on the Choice Resolution

Last May, the Michigan Association of Community Mental Health Boards (MACMHB) Executive Board considered and then tabled for further consideration the Choice Resolution, a statement confirming the right of consumers of Mental Health services to choose from an array of services and supports based on their needs and preferences. Over the summer, the statement was revised and approved by the MACMHB Executive Board. It recognizes differences in philosophy and service needs in this diverse population of mental health consumers. The policy applies to members of the Association - all CMH Boards in Michigan.

The Choice Resolution was a response to issues raised in recent months regarding services for people with developmental disabilities. Administrators from the Michigan Department of Community Health had stated their intent to eventually eliminate specialized programs for people with Developmental Disabilities that are provided in group settings such as day programs, sheltered workshops, and group homes. They claimed they only wanted the best for our family members, but they also recognized that with the state in financial distress, this was an opportune time to begin slashing funding for programs they claimed were discriminatory and isolating. In addition, a draft policy from the Standards Group of the MACMHB, called the Vision for all People with Developmental Disabilities, was being distributed and talked about at meetings between the state and Community Mental Health agencies as if it were already approved policy .

The draft policy statement was especially disturbing because it explicitly stated that the "Vision" should apply to everyone with a developmental disability, regardless of the severity of the person's disabilities, cognitive abilities, or medical or other issues affecting the individual. It was also incredibly silly in its attempt to apply a detailed list of acceptable and unacceptable activities for all people with DD (joining Neighborhood watch is OK, but don't do it with a bunch of other people who are developmentally disabled; a little bit of Special Olympics may be OK, but too much is not acceptable; etc.). Behind the Vision statement is an ideology that some advocacy groups support, but it lacks a basis in law and policy regulating services to people with developmental disabilities.

At the May MACMHB Executive Board meeting there was some backtracking on the Standard's Group "Vision" with promises to take out value judgments on placements and programs that some people need and want in their communities. The Executive Board finally came up with this:

RESOLUTION REGARDING CHOICE
Adopted by the MACMHB Executive Board August 6, 2010

The Michigan Association of Community Mental Health Boards (MACMHB), Prepaid Inpatient Health Plans (PIHPs), and Community Mental Health Services Programs (CMHSPs) recognize there are differences in service preference among the individuals they serve and shall honor Choice for all consumers regardless of the individual’s service delivery site philosophy.

MACMHB, PIHPs, and CMHSPs shall support taking all necessary steps to ensure that individuals with mental Illness, developmental disabilities, or substance use disorders and children with serious emotional disturbances have the opportunity to live in the least restrictive setting that is appropriate to the needs of the individual and is the individual’s personal Choice.

MACMHB, PIHPs AND CMHSPs shall support a person centered planning process that honors the individual’s true Choice.

Our vision embraces programs or services that enable the persons that we serve to be full and participating members in their community.

This can include the continuation of existing services, the improvement of existing services, and the development of new opportunities, all driven by ongoing and informed consumer Choice.

This may do little to squelch the zealots who want to eliminate programs that don't measure up to their views on what our family members should want and need, but it is a beginning. The interest and participation of families and consumers from all over the state were a hopeful sign that the mental health system will respect the differing philosophy's of consumers and continue to take that into account in the programs and services they offer.

Health Care Reform Benefits

Family Voices, an organization devoted to family-centered care for all children and youth with special health care needs, including children with disabilities, has written a statement on the Patient Protection and Affordable Care Act (federal health care reform legislation) summarizing benefits. They give some useful examples of situations in which the benefits will be of particular interest to parents of children with disabilities.

A document on the immediate benefits available is found here. Major portions of the act do not go into effect until 2014, but in the mean time, there are many benefits that are already in place or will be soon:

• Elimination of lifetime benefits caps (beginning September 23, 2010)
• Prohibition against rescinding coverage when someone gets sick (beginning September 23, 2010)
• Prohibition against denying children coverage for pre-existing conditions (July 1, 2010)
• Requirement that young adults be permitted to stay on their parents' insurance policies until age 26 (beginning September 23, 2010)

One section of the law of importance to states is a provision that allows states new options to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP). Effective April 1, 2010, this expansion of Medicaid could help states like Michigan to bring in more money for mental health specialty services. This would be felt especially in the areas of services for mental illness and substance abuse (the vast majority of people with developmental disabilities already qualify for Medicaid). People with these problems who do not now qualify for Medicaid because of their status as single adults or who are just over the poverty line, could qualify in the future and also receive services that are dependent on Medicaid eligibility.

In the long run, this would probably save money for the mental health system by bringing people in early for services and avoiding expensive hospitalizations. Every $1 the state spends on Medicaid will bring in about $3 of federal matching funds and could keep the system from collapsing under the burden of huge state deficits. Not only does money spent on health care expand jobs and improve the economy, but it relieves the pressure on the mental health system and frees up money for other much-needed services.

Check out these important resources to see if you or your family member can benefit from health care reform now.

We're not in Kansas anymore!

We have returned from a 3,000 mile road trip to Colorado and back. Before the trip, I had many second and third thoughts about leaving the boys in their group home, the grandparents in their advanced state of age, and the dog and two cats at the mercy of relatives who agreed to live in our house for a week and watch over the whole mess.

It all turned out OK. The dog Lucy was especially happy to have two young kids at her beck and call who had the energy to take her for walks every day.

Waiting Lists for developmentally disabled

Click here to see a You Tube video called "Disabilities Don't Wait" from Noewait ( National Organization to End the Waitlists). In Michigan we don't have Waiting Lists. We have Priority Lists. Does that make you feel better?

WCHO Town Hall Meeting: June 29th, 2010

Join the Washtenaw Community Health Organization (WCHO) and Community Supports and Treatment Services (CSTS) in a fun and informative evening.

Share your thoughts and ideas on the Community Mental Health System in Washtenaw County and hear what others have to say.

2010 Town Hall Meeting
Tuesday, June 29, 2010
5:00 pm – 8:00 pm
Washtenaw County Human Services
555 Towner, Ypsilanti MI 48197
In the Large Conference Room

Spaghetti Dinner provided by Full Circle Drop In Center and Dessert provided by Fresh Start Clubhouse

All are Welcome! No reservations necessary!

For more information, contact Customer Service at (734) 544-3050 or (877) 779-9707

Large caseloads for Michigan group home monitors

According to the Summer 2010 issue of Exchange, a publication of Michigan Protection and Advocacy Services, there are fewer employees of the state Bureau of Child and Adult Licensing monitoring group homes. Adult Foster Care (AFC) group homes provide housing and services to people with developmental disabilities, mental illness and to people who are elderly.

In the article "Concerns Regarding Bureau of Child and Adult Licensing", Brian Sabourin provides information on cutbacks to licensing that directly affect monitoring of group homes intended to assure safety and appropriate care of residents:

"In 2002, before massive state employee retirements, there were 80 Adult Foster Care (AFC) licensing consultants with an average caseload of 55 facilities per consultant. In 2008, there were only 49 licensing consultants experiencing double the aforementioned caseload. This comprises the division's ability to regulate the almost 4,800 adult foster care homes."

In 2009, with this staff of 49 people, licensing handled over 2,000 complaint investigations, over 2,000 licensing renewals, and 374 inspections for new licenses. This was in addition to monitoring critical components of care such as staff training, qualification, and background checks, administrative capability, resident care, and resident rights.

It is hard to believe that such large caseloads are not affecting resident care or that residents are not being harmed as a result.

(The Summer 2010 issue of Exchange is not yet available on the MPAS Web site under publications, but should be soon.)

Florida parents plan communities for developmentally disabled

In Florida, there are more than 18,000 developmentally disabled people waiting for services and residential placements. That translates to a 10 -15 year wait for most people. Parents have taken this dilemma into their own hands and have begun developing planned communities for their family members. Noah's Ark of Central Florida has plans to create communities modeled on retirement communities that are home to seniors all over the country.

The communities will include families and caregivers of their primary residents, people with developmental disabilities. They will be a blend of apartments, villas, group homes, and single-family homes with spaces for socializing, recreation, and vocational and educational activities. One village, Noah's Nest, has three homes near downtown Lakeland, Florida.

One obstacle the parents faced was a state law that prevented group homes from being established within 1,000 feet of each other, so they lobbied the Florida legislature to change the law. According to an article in the Miami Herald, April 27, 2010, they were opposed by advocates who claimed that the planned communities are institutions that segregate people from the rest of society:

"In our society, we call places like this institutions," said Kingsley Ross, who represents Sunrise community, a nonprofit organization catering to the developmentally disabled and the elderly. "People with developmental disabilities have to be in contact with good models of behavior. If you surround them with people that don't have normal types of behavior, what we are going to see is more people with bad behavior."

[Kingsley Ross, who worries so much about other people's behavior, is a registered lobbyist for the Autism Society of Florida and Sunrise Community, Inc., a non-profit provider of group homes and other services for people with disabilities and seniors.]

The family members, however, have a different view . Many of their loved-ones have already experienced "community living" and have found it to be isolating, not fulfilling, and even dangerous. Families are not trying to compete with options that work well for many people with disabilities, but to offer more options and choice based on the needs and preferences of their loved ones.

The law to rescind the restriction on group homes was passed and signed by Governor Crist on June 3rd, 2010. Well done, Florida parents!

[See also: Michigan group homes for severely disabled]