There’s always room for low-tech in a high-tech world

In search of PBH minutes Day 58

While it might concern some that the model agency for delivery of our state’s mental health services doesn’t have ready access to all of its records, I’m not among them, even with my scant knowledge of the complexities of document management.

“Some of the older files were stored offsite, so it took me sometime to access them myself,” PBH Communications Manager Cyndy Brooks wrote in an email last Friday regarding North Carolina Mental Hope’s request for minutes of board meetings since January 2003. This Monday, Brooks called, and when asked the number of minutes stored offsite said she would need to look into it and get back to me. Apparently it’s taking some time to access those older files once again.

Those of a more suspicious nature might think this is agency stonewalling and might even question why any records from 2003 and later would be preserved as paper only. (At least that’s the assumption since Brooks noted the need to scan some of the files.) But think back to 2003, aka the Dark Ages of Computing when Windows XP ruled the land, the iPod was just in its third generation, and Smartphones just weren’t as smart as they are today. [Read more...]

PBH’s latest innovation? Minutes Mecca

For the moment, let’s assume legislators knew what they were doing when they made Piedmont Behavioral Healthcare the model for the state’s mental healthcare service system. And since that assumption pretty much establishes a fairy tale world, let’s go ahead and assume there’s a valid reason PBH has failed to release board meeting minutes more than seven weeks after North Carolina Mental Hope’s request.

So what is it, you ask. I’ve got a theory, I reply.

In an email from PBH Communications Director Cyndy Brooks last Friday, she notes she would “like to make arrangements” for me “to come view” the requested minutes. A less patient man might implode from the frustration of repeatedly telling Brooks that the law doesn’t require in person viewing. But for me, her email was the light bulb moment from which my theory was born. [Read more...]

Waiver LMEs building an IT Tower of Babel?

While legislation passed this year mandates that Local Management Entities operating under Medicaid Waivers maintain fidelity to the Piedmont Behavioral Healthcare model, that hasn’t been the case when it comes to the critical area of information technology.

Glaring IT deficiencies were cited by the August 2010 Mercer Consulting report as one of many reasons the Department of Health & Human Services was not ready to oversee statewide waiver implementation. And while it might have been expected that the fidelity called for in House Bill 916 would include IT standardization through use of PBH’s Cardinal Innovations (CI) software, that hasn’t been the case. In fact, the list of competing software packages available has actually grown, including one from a company founded by two former PBH employees credited with developing Cardinal Innovations. And since DHHS must approve the software system being used, it is apparently choosing to ignore the Mercer call for standardization.

While a number of LMEs have looked at using the CI software, only two of the seven LMEs approved as waiver entities thus far appear to be going with it: PBH, of course, and East Carolina Behavioral Health. According to Smoky Mountain Center’s March 2011 Medicaid Waiver Readiness Report, both it and ECBH had reached an agreement for the software’s lease/purchase from PBH. (For those wondering how a public entity such as PBH can own and license its own software, suffice it to say that’s another story for another day.) [Read more...]

Crossroads revisited: A lesson in doing it the right way

Comments from a small provider following a Wednesday commentary on access to minutes of the Crossroads Behavioral Healthcare board of directors meetings praised Executive Director David Swann for taking time to consider everyone’s concerns and for being something of an anomaly in the state’s fractured mental health system by not just giving lip service to service delivery, but really caring about it.

While I’m not in a position to judge the latter, I can now certainly vouch for his prompt attention to concerns brought to his attention and his willingness to work toward resolution of those concerns. In short, Swann has indeed sent minutes of Crossroads board meetings and from the cover letter accompanying them, he initiated that response the day after my August 24 email questioning the extensive technological resources and labor originally cited as needed to meet my request. [Read more...]

The days are getting shorter, there’s silliness in the air

The calendar may say it’s late summer, but judging by the response from Crossroads Behavioral Healthcare regarding North Carolina Mental Hope’s request for that agency’s board minutes, it’s silly season in Elkin.

Crossroads Executive Director David Swann promptly responded to our late July request for his board’s minutes, detailing the variety of formats with which they could be supplied and the associated costs of each. We agreed to put the request on hold, however, until the Crossroads board considered a policy of posting minutes online at its August meeting.

And the board did OK posting minutes, sort of, with minutes from the August meeting (after they’re approved in September) and subsequent meetings to be posted. Since the Crossroads CFAC minutes are posted online, it would be interesting to know when the board approved posting those minutes and why it didn’t approve posting its own. Of course, that would involve taking a look at past board minutes. One explanation Swann offers in his letter was that the decision had been made “not to archive any of these records in a remote location to ensure that the records would be readily available upon request.” That, whatever it means, certainly explains that. [Read more...]

Up to the minute on the minutes

Request for PBH minutes now at 40,320 minutes and waiting.

It’s been almost a month since North Carolina Mental Hope requested minutes of board meetings from five Local Management Entities – Crossroads, Cumberland County, Johnson County, PBH and Southeastern Regional.

While the commitment of the state’s other 18 LMEs to facilitate the public’s right to know by posting board minutes online ranges from sketchy to comprehensive, these five LMEs are those that had no minutes whatsoever online. And the commitment to the public’s right to know exhibited in responses to the request has ranged from exemplary to virtually nonexistent in the case of Piedmont Behavioral Healthcare.

Within several days of the request, Johnson County Mental Health Center provided easy access to its minutes by simply posting them online. And while it’s hoped Southeastern Regional will follow suit, it did at least quickly provide a copy of the requested minutes on CD. [Read more...]

DOJ: Reform your way is over

When I first read it yesterday, the significance of the Department of Justice’s report on its investigation into North Carolina’s mental health system escaped me. But 16 pages later, the DOJ’s message to the state was clear: “Reform your way is over; reform the right way will begin.”

“The State fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs, in violation of its obligations under the ADA and Olmsted. As a result of the way the State administers its mental health service system, individuals with mental illness are unnecessarily institutionalized in adult care homes throughout the State.”

[Read more...]

LMEs and the public’s right to know

Whether enquiring minds want to know or not, the public has a fundamental right to know how its government works and access to documents compiled by agencies of state and local government.

The state’s public records laws “are critical to operating a fair and open government,” says NC Attorney General Roy Cooper in the preface to the “Guide to Open Government and Public Records” his office distributes. What access means, however, is obviously something upon which the state’s 23 Local Management Entities disagree.

While most of the LMEs maintain at least some of their governing board meeting minutes online, five — Crossroads, Cumberland County, Johnson County, PBH, and Southeastern Regional — apparently do not. I say “apparently” in way of a disclaimer since I only have confirmation from PBH that they do not post their minutes online. And while a fairly exhaustive search on the other LME websites for board minutes has turned up nothing, it’s hard to be absolutely sure they’re not tucked away somewhere on those sites. [Read more...]

NDAs, PBH, and Blossom Rot

In June, the General Assembly officially made the PBH Local Management Entity model the only game in town for delivering public mental health services, with passage of House Bill 916, which mandates all Local Management Entities will maintain fidelity to the PBH model for all public resources related to delivering mental health, developmental disabilities and substance abuse services.

And it hasn’t taken long for PBH to show it deserves the GOP dominated General Assembly’s trust, the LME showing its business acumen by requiring non-disclosure agreements from other LMEs that prohibits sharing all the “know-how, techniques, processes, plans, ideas, documents and all other information” it will provide. [Read more...]

Top 10 reasons House Bill 916 delayed

The House Health & Human Services Committee has delayed consideration of House Bill 916, detailing plans to revamp the state’s MH/DD/SAS system, from today until May 31. Here are North Carolina Mental Hope’s Top 10 reasons why. (Potential spoiler alert: Since audio was unavailable from today’s meeting, who’s to say the committee didn’t change its mind once again and go ahead and consider it.)

10. Legislature votes to funnel proceeds of Dix sale to mental health services and revenue from rich tar sands found there ends mental health crisis.

9. Republican majority concerned that Democrats will mock them as socialists for voting in favor of managed care.

8. Freak rubber band, gum and paper clip shortage renders MH/DD/SAS computer system inoperable. [Read more...]