John Constantino, Chair called the meeting of the Missouri Mental Health Commission to order at 9:05 a.m. on Thursday, May 11, 2006. The meeting was held at the Department of Mental Health, 1706 E. Elm Street, Jefferson City, Conference Room B.

John Constantino, Chair made remarks regarding Dorn's retirement announcement. He stated, "There would be no better person to lead the Department of Mental Health than Dorn Schuffman." John expressed that he has a tremendous amount of respect for Don as a leader and although he is disappointe and distressed at his leaving, he respects the decision.

Mary Lou Bussabarger shared that she has known Dorn since the 1970's. She echoed John's remarks, and expressed that it will be hard to imagine DMH without Dorn.

Beth Viviano remarked the vision that Dorn wants to take the Department will be missed. She expressed that it will be hard to imagine someone stepping into his place and she will miss working with him on children's issues.

Ron Dittemore shared remarks from a historic perspective, having had the unique distinction and pleasure of working with every Director of the Department of Mental Health beginning with George A. Ulett, M.D., Ron remarked that every director had something unique to offer the department, but Dorn has shown the best leadership abilities and has done an outstanding job for the agency.

Phillip McClendon remarked, "I'm new to the commission but feel I know your heart. The things that you have accomplished are deeply appreciated throughout our state. It is a joy to know you and the heart that you have for people."

Dr. Constantino outlined the three major tasks that the Commission will devote considerable discussion to as part of open session and closed session:

1. Appointment of an Interim Department Director - review issues related to the designation of an interim director who would begin July 1, Dorn's retirement effective date.
2. Complete the Missouri Mental Health Commission Public Hearings - organize the information of the hearings; and collate the information from the investigations that have been done over the death at St. Louis DDTC.
3. Organize expectation to pursue the search for a new director - review information about the process of the search; historical methods by which the search has been done; develop a process that includes selection of individuals who will sit on various committees to help forward that process.

There were three domains of need identified and shared as it relates to the role of leadership for the interim director and future department director:

1. Things that can be done with modest costs that would have a big pay off in terms of improvement.
2. The Department needs more funding to improve and maintain the scope of its mission; which can not be accomplished at the current budget level. New leadership must be effective in eliciting a share of state revenues and federal revenues towards the department.
3. If more funding is not infused into the system; some difficult decisions will be made around reorganizing to make sure vital services are of high quality.

• St. Louis Psychiatric Rehab Center
• Metropolitan St. Louis Psychiatric Center
• Hawthorn Children's Psychiatric Hospital
• Fulton State Hospital
• Southeast Missouri Mental Health Center

All of the facilties have retained their JCAHO accreditation status. The surveyors will be at Mid-MO Mental Health Center May 11-13, 2006. The remaining facilities on the western side of the state have been going well. Dorn acknowledged Becki Carson, RN, MSN, Office of Facility Operations, and the facility staff for their dedication and hard work to the success of the accrediation outcomes.

• Over 100 cases are back logged
• 1,000+ cases have been assigned with 70-80 percent complete since September 06
• 250+ cases are pending

• Transformation Grants - Alcohol and Drug Abuse; Psychiatric Services; Children Services
• Quality Improvement
• Habilitation Center Plans
• Budget
• A Division Director for Mental Retardation Developmental Disabilities will be named by June 1, 2006.

Linda Roebuck, Interim Division Director, MRDD presented an overview of activities focused on the following:
Quality Assurance/Improvement - the Division of MRDD has been developing an integrated quality assurance system. The model looks at quality assurance findings in several domains: abuse and neglect; certification, licensure; service monitoring; input from surveys; and feedback from consumers and families.

Elements of the quality assurance system are being included in the regional center system review. These include capacity to meet timelines, and availability of resources, staff and services.

Division staff and providers working to develop a partnership that assures quality and effective use of resources. Use of accreditation as a tool to increase quality and accountability is being explored.

Regional Center System Review - This exercise is to look at a range of services across regional centers. There are three teams:
Team A - Poplar Bluff, Sikeston, St. Louis
Team B - Hannibal, Kirksville, Central MO, Rolla
Team C - Albany, Kansas City, Joplin, Springfield

The members of each team include a Lead; Regional Center Administrator; Quality Assurance Staff; Providers and Family advocate. The review process flows as follows:

• Team meeting at Regional Center
• Meet with Regional Center Director and Senior Leadership (entire team)
• Assigned team members conducted discussion with staff
• Assigned pairs conduct on-site visits to six identified providers
• Assigned team members conduct discussions with consumers and family representatives using the "Discussion-Consumer/Family as a guide
• Team meet at end of each day
• Team meet at end of the week
• Exit with Regional Center Director

Reviews are showing that staffing and caseload sizes vary across regional centers. Some regional centers have several quality assurance staff; others have 1 or 2. There are concerns regarding the ability for staff to meet timelines; an inconsistency of practices across regionals; and concerns for clients who make the transition from habilitation centers and need more supports.

John Constantino suggested that at a future Commission meeting a presentation on Regional Centers could be featured and explore what is the make up of a center; the role of a center and why they exist; and how should the regional centers changes.

Linda Roebuck reported on staffing changes: John Long will serve as a Designated Principle Assistant to the Interim Division Director; Kelly McDonald will serve as the Administrative Assistant to the Division of MRDD.

Dr. Joe Parks shared that in part the current difficulties at the habilitation centers are a result of the success of the habilitation model. The model was originally conceptualized and introduced when the majoirty of habilitation center residents were mildly to moderately retarded persons who were overly independent and had marked deficits of self-care skills. Overall the success of the habilitation model has changed a population that reside and the habilitation center so the current staff mix is no longer able to meet the remaining residents more complicated needs. The staff mix are able to meet the needs of the current residents will be substantially more expensive.

Linda Roebuck commented on the following:

• Support for a 7% cost of living increase across the board proposed in for the 07 budget
• Encouraged comment on utlization review rule
• Need to develop strategies to get current with investigations

Kay Green, MRDD reported on the 2005 Deficit Reduction Act: Select Provisions to Assist Individuals Who Have Disabilities. In a handout the provisions are:

To assist individuals with disabilities and seniors in need of long term care services and supports, a State can:

1. Expand coverage for individuals with disabilities
2. Increase access to community supports so that disabled and elderly indviduals have true choice of a range of quality options.
3. Promote personal responsibility, independence and choice by helping individuals to take control of their long-term support needs, including planning for the future; and to make rational, informed choices about all types of health care needs.

To expand coverage for individuals with disabilities, a State can:

• Expand coverage to allow families with disabled children to pursue Medicaid coverage
• Create a new health coverage option for working individuals with disabilities
• Help individuals with disabilities reteurn to the workforce and remain independent

To increase access to community supports, States can:

• Offer core home and community-based services without waivers
• Apply for grants to "rebalance" their long-term support system
• Apply for demonstration projects to offer home
• Apply for demonstration projects to offer home and community-based alternatives to psychiatric residential treatment facilities for children
• Apply for funding under Title V of the Social Security Act to support the development of family to family health centers

To promote personal responsibility, independence and choice, State can:

• Offer State plan self-directed personal care services without a waiver
• Opt to participate in the State lon-term Care Partnership Program

Dorn shared an update on the Facility Quality Improvement.

• Ken Miller and Blake Shaw, Change & Innovation Agency, lead the Workplace Improvement initiative and have been asked to lead the Facility Operations Team in achiveing the following outcomes:
  • A clear understanding of what occurs in the work environment/climate that leads to abuse
  • Creation of a climate where reporting of abuse is encouraged
  • Increased level of employee satisfaction during the abuse investigation process - a more endourable process
• A Literature Review of abuse and neglect in mental health facilities is underway.
• All employees received an email from Dorn on April 21st encouraging them to report issues or problems across facilities to the Director's Office email address. Mark Stringer, ADA was asked to supervise the process.

4 - Agreed to meet and share additional information
1 - Dorn will meet with one-on-one
1 - Agreed to meet with an investigation staff person
6 - Raised issues that will receive serious review
3 - Are personnel issues

• The Facility Operations Team is doing an assessment at each facility to look at where additional resources may be phased in; also to determine what technical assistance is needed at facilities. The assessment schedule includes:
  • Southeast MO Habilitation Center - May 3-5
  • Nevada Habilitation Center - May 23-26
  • Marshall Habilitation Center - June 13-16
  • Higginsville Habilitation Center - June 19-21
  • Bellefontaine Habilitation Center - July 11-13
• An RFP has been put out for bid for a consultant to put together technical assistance and training across all facilities. The award should be announced in a few weeks.
• Review of Supervisors - Quality Improvement, Facility Operations staff, and a representative from Human Resources will develop a protocol to review supervisors who provided instructions to an individual who is found to have committed abuse and neglect. Once finalized, the protocol will be shared with the Commission.
• Death Review Task Force - Criminal Investigations - met with the Department of Social Services' State Technical Assistance Team. Agreed to utilize the team whenever there is a death in a DMH facility; DSS will automatically investigate and report to the DMH Director. DMH will provide support to the DSS Technical Assistance Team during an investigation of a child's death in their custody with mental health issues. Both departments have reached A Memorandum of Understanding.
• Team of Policy and Prosecutors - Mary Tansey and Felix Vincenz identified and met with police and prosecutors to get their advice and recommendations on how to best assure their involvement around abuse and neglect investigation activities.
• Camera surveillance - Felix Vincenz continues to research other state where surveillance cameras are used in habilitation centers.
• The state of New Mexico's Department of Developmental Disabilities' website details an Annual Report - Management System; Developmental Disabilities on abuse and neglect. Research is underway to develop a format that can appropriately share DMH abuse and neglect data on a regular basis.

• Search Committee
• Recruitment period
• Selection of applicants
• Stakeholders interviews
• Finalist
• Reference checks
• Commission interview
• Senate confirmation

• Increase the number of stakeholders involved
• Inquire of an executive search agency to advertise the positon
• Contact NASMHPD for recruitment
• The Commission will clarify expectation of a department director
• The Commission will select an interim director

Ron Dittemore made a motion that the Mental Health Commission go into Closed Executive Session in accordance with Section 610.021, RSMo, (3) Personnel. Mary Lou Bussabarger seconded the motion. The motion passed.