Joint Legislative Oversight Committee

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Joint Legislative Oversight Committee

• November 20, 2008
• Hank Debnam, M.P.H. Area Director
• Cumberland County Local Management Entity
• 910-222-6126

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Cumberland County LME
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Joint Legislative Oversight Committee

• Successes.
• Challenges.
• Needs.

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Cumberland County LME

• Single County LME
• County Seat Fayetteville but the county is also
  home to 7 other towns
• Population 306, 518 (7/1/07)
• Approximately 661 square miles

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Cumberland County LME

• Home to military bases
• Fort Bragg
• Home of the 82nd Airborne Division
• Future home of U. S. Army Command and U.S. Army
  Reserve Command
• Pope Air Force Base
• Targeted to become part of Fort Bragg in future

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Cumberland County LME

• Provider Network
• 157 Medicaid Endorsed Providers
• 75 State Standardized Contracted Providers
• 160 Independent Practitioners
• Outpatient treatment for youth

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Cumberland County LMESuccesses

• Co-location of mental health services in two
  primary health care locations Public Health
  Department and Stedman-Wade Medical Clinic
• Developed consultation and referral program with
  Carolina Community Collaborative Care (4Cs) to
  expand access to psychiatrists for 70 primary
  care practices

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Cumberland County LMESuccesses

• Transitional Care Services (TCS) developed in
  partnership with SRAHEC, 4Cs, and Cape Fear
  Valley Health System
• Program offers access to a psychiatrist for up to
  90 days until a community provider is available

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Cumberland County LMESuccesses

• Established Care Coordinator for the Cumberland
  County Adult Detention Center
• Offer consultation/evaluation services to youth
  in Regional Detention Center
• Jail Diversion Committee to address serving
  persons with MHDDSA disabilities who come into
  contact with law enforcement
• Have started training local law enforcement
  personnel in CIT with plans to expand this next
  year

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Cumberland County LMESuccesses

• Crisis services and non-hospital medical
  detoxification services available through Roxie
  Avenue Center
• Opened Child Community Respite Center and have
  contracts for its use by five LMEs in the area
• Available for youth ages 5 - 14

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Cumberland County LMESuccesses

• Successful implementation of System of Care for
  children
• 5th Annual Community Connections Conference
  attended by 340 individuals
• Teens Making A Change T-MAC
• Peer youth leadership initiative - reached over
  250 children last year with average attendance of
  60 youth and 25 adult mentors each week

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Cumberland County LMESuccesses

• Selected as one of six Reclaiming Futures sites
  to expand substance abuse services for youth,
  particularly those in the juvenile justice system
• Member of Cumberland Gang Prevention Partnership
• Co-location of city and county law enforcement
  and social workers specifically dedicated to
  address gang activity in Cumberland County

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Cumberland County LMESuccesses

• Expanded housing resources available to persons
  with disabilities
• Over 110 units currently available with expansion
  by three more developers targeted for this fiscal
  year
• Strengthening Families
• Evidence based parenting program- certified 20
  new trainers this year

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Cumberland County LMESuccesses

• Partnerships with the military
• Child Advocacy Center
• Child Homicide Intervention and Prevention
  Council
• Services to military dependents with disabilities
• Every Child Coalition
• BRAC Planning
• Training and technical assistance

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Cumberland County LMEChallenges

• No community based child or adolescent inpatient
  psychiatric services
• Local hospital has not been able to utilize all
  beds licensed for adults needing inpatient
  psychiatric care leading to over-utilization of
  state operated services

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Cumberland County LMEChallenges

• Recruitment and retention of psychiatrists
  willing to serve Medicaid and state funded
  consumers
• Few private providers willing to offer services
  to military dependents due to reimbursement
  concerns
• Limited number of licensed substance abuse
  providers

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Cumberland County LMEChallenges

• Reimbursement rates not supportive for some
  services
• Highly correlated with increased costs to
  providers to attract licensed experienced staff
  to community based intervention services
• Challenges to provider network in implementing
  changes within required time frames

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Cumberland County LMEChallenges

• Limited community providers to meet needs of high
  risk consumers who have multiple admissions to
  state hospitals
• Dually diagnosed
• Significant involvement with criminal justice
  system
• MI and MR/MI Sex offenders
• High number of out of county children in
  residential care in the County

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Cumberland County LMEChallenges

• Penetration rates for persons served, as noted in
  Division reports, do not reflect services to
  military population
• TriCare recipients are not reflected in State
  data
• Limited providers willing to serve State Funded
  consumers
• Prefer Medicaid consumers due to more units of
  services being authorized

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Cumberland County LMEChallenges

• Significant impact on active duty, reservists and
  retired military and their families due to
  current military conflicts
• Unknown impact from BRAC
• Anticipated that over 40,000 people will be
  locating to Cumberland and surrounding counties
  within the next 5 years
• Need more behavioral health resources to meet
  their needs

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Needs

• Stable funding
• Local inpatient psychiatric care for children and
  adolescents
• Additional housing (short term and permanent
  housing)

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Needs

• Transportation resources for rural parts of the
  county
• Incentives for private providers to serve public
  consumers, especially those who are high risk

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Needs

• Resources in a timely manner to meet needs of
  military families relocated due to BRAC
• Stable funding for the Transitional Care Services
  Program

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Cumberland County LME