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More on CABHA
Audio of Case Management presentations to the October and November LOC meetings can be listened to or downloaded at: NCMentalHope.org .
Other
linkson the site include: Case Management Steering Committee minutes
and documents, including PowerPoint presentations to the LOC.
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Petition for inclusion
Circumstances
again dictate that North Carolina Mental Hope asks your support in our
efforts for inclusion of citizens with a mental health diagnosis and
their families in decisions affecting them.
Click here or visit our website.
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Helping a
Voice of Hope
Help maintain our efforts toward an empowered and informed citizenry.
NC Mental Hope gratefully ackowledges the contributions of individuals and support from:
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Same old, same old ...
There
are just too many analogies to choose from when it comes to the recent
birth of Critical Access Behavioral Health Agencies (CABHA)
- immaculate conception (certainly no irreverence intended),
"Sherlock Holmes and the Case of The Missing Link," "Poof the Magic
Medicaid Definition."
I'm not knowledgeable enough to speak to
the merit of CABHA. Nor, despite my best efforts, am I able to speak to
its birth. Despite the Division of Medical Assistance's insistence that
the creation of this Medicaid definition was an inclusive process, just
saying so doesn't make it so. (Read Implementation Update 63 here.)
CABHA
was born sometime between the Division of Medical Assistance's reports
to the MH/DD/SAS Legislative Oversight Committee's October and November
meetings. Minutes of the October 20 meeting of the Case Management
Steering Committee, the group logically responsible for the definition,
don't mention it. Instead, broad parameters are outlined and it's noted
that consensus had not been reached on a number of points
But
then, "poof." There it was. Search the DHHS website (which also
searches its Divisions) for "Critical Access Community Behavioral
Agency," with quotes to search for the exact phrase. Four links are
returned, the first dated November 2, the day of implementation.
Tara
Larson, Chief Clinical Operations Officer for the DMA, has noted more
than once the inclusiveness in the decision making process in her
reports to the LOC. Indeed, the DHHS memo announcing CABHA and other
changes starts out: "The Department of Health and Human Services (DHHS)
and system stakeholders have been discussing for some time the concept
of identifying and recognizing provider agencies who deliver a
comprehensive array of services."
A better choice of wording
would have been "certain system stakeholders." And it's apparent I'm
working from a different dictionary when it comes to the word
"inclusion."
In pointing to inclusiveness, Larson mentions a
July stakeholder meeting attended by more than 300. But asking for
input at the beginning of a process doesn't translate to inclusion
unless those with mental health diagnoses are invited along for the
ride.
I Googled all 51 members of those listed as attending
the October 20 Case Management Steering Committee meeting. With the
exception of two or three whose affiliation I couldn't quickly
determine, committee members were almost all from the public and
private health sector, including local health agencies and mental
health providers, or from DHHS, DMA, or the Division. I saw no names of
advocates I recognized nor names of anyone I know to have a mental
health diagnosis. Perhaps, as has been the case before, there was token
representation on these committees.
And while at least two
advocacy organizations are represented in the 50-plus members listed as
attending the last Community Support Steering Committee meeting,
including DHHS Deputy Secretary Michael Watson, at a quick glance the
same exclusion seems to hold true.
Certainly the budget crisis
has meant changes must be made quickly. But the price paid for that
speed should not be exclusion of those most affected. At the November
LOC meeting describing CABHA, Larson said she had given a two-hour
presentation in 15 minutes, apparently to help the committee get back
on schedule. Taking as much time as needed would have been better. She
again mentioned inclusions and noted that agendas, meeting minutes, and
notes from this committee and others were posted on the web. (Perhaps a
less passive approach to communications should be used if trying to
build consensus.)
I hope HHS Secretary Lanier Cansler and Deputy
Secretary Michael Watson understand at a core level the need for
inclusion. I hope they are working to correct the continued exclusion
that is a hallmark of North Carolina's mental health policies. How
distant that exclusion is from a principal finding of NAMI's last
"Grading the States" report: For mental health systems to work, they
must be consumer and family member driven.
I hope they insist
those who serve them share a commitment to inclusion and understand
that posting notices and minutes on a website doesn't constitute
inclusion. Inclusion is something that must be first recognized as
inherently needed and an integral part of progress. Then it must be
sought out and built upon.
"When you start changing the rules
and requirements, you've got to make sure that not only providers know
what's going on, but recipients also need to understand what's going
on." Those are Tara Larson's words at November's LOC meeting.
I couldn't have said it better myself.
David Cornwell
Executive Director
NC Mental Hope
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