Select Committee on Mental Health and Substance Abuse Services Minutes for Meeting April 24 & 25, 2008

Committee Meeting Information

April 24 -25, 2008

Teton Mountain Lodge

Teton Village, Wyoming

Committee Members Present

Senator Pat Aullman, Cochairman

Representative Keith Gingery, Cochairman

Senator Ken Decaria

Senator Rae Lynn Job

Senator Ray Peterson

Senator Wayne Johnson

Representative Jack Landon

Committee Members Absent

Senator Bob Fecht

Representative Patrick Goggles

Representative Tim Hallinan

Representative Jerry Iekel

Representative Jane Warren

Legislative Service Office Staff

John H. Rivera, Senior Staff Attorney

Joy N. Hill, Associate Research Analyst

Others Present at Meeting

Please refer to Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.

Executive Summary

The Committee met for two days in Teton Village. The Committee reviewed the results of legislation it has proposed in the last legislative session and heard testimony from the Department of Health on the status of mental health and substance abuse programs that have been created or funded as a result of bills sponsored by the Committee.

The Committee will tentatively meet again in Evanston on June 16-17, 2008 to hear testimony on services provided by the community mental health and substance abuse centers within each of the five regions designated by the Department of Health.

Call To Order (April 24, 2008)

Chairman Gingery called the meeting to order at 8:40 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

Review of Legislation enacted in 2008 Budget Session and Committee Expectations for the 2008 Interim

Chairman Gingery explained that the veteran’s mental health assistance bill (08HB0012) was enacted nearly unchanged. The Title 25 bill restricting costs (08SF0006) also was enacted. The Committee was reauthorized through December, 2009 as a result of 08SF0010. Money for two more regions was put in the budget bill. The Committee had a successful session, with most of the Committee goals accomplished.

Structuring Committee Oversight of Division of Mental Health and Substance Abuse

Chairman Gingery discussed his expectations for the next three meetings and proposed the next meeting to be held in Evanston on June 16 & 17 to discuss regionalization with program directors in each of the 5 regions to identify how regionalization is progressing. A meeting in August may be the final meeting for the Committee this interim. JAC wants the Committee to take a more active role in the oversight of the Mental Health and Substance Abuse Services Division (the Division), including how money is being spent and how services are being provided. Representative Iekel wrote a white paper in which he provided concerns he hoped would be discussed at the meeting (Appendix 3). Chairman Gingery asked members in attendance what they believed the Committee's activities should be this interim.

Senator Johnson said he believed the Committee should have been providing oversight all along. How it will be done should be decided cooperatively.

Representative Landon wants to ensure all affected populations are being served, but asked how can that be best accomplished. The Division needs to explain its short term and long term goals. Many groups are being funded and Representative Landon wants to hear more about the role of each of those groups.

Senator Aullman said it is necessary to get all people involved working toward the same goal, not several people working on different levels. The goal should be to benefit the patient. The Committee needs to educate the rest of the Legislature. Perhaps after the Committee meetings, there should be a short report to explain where money is going, programs funded, etc. to send to all legislators so they have a better understanding of the programs available.

Senator Decaria wants to focus oversight particularly for substance abuse services. He doesn’t believe there is enough accountability for the money and how it is spent. He would like the Committee to be proactive for once and focus on future needs, particularly for the aging population.

Senator Job would like to know there is a comprehensive approach toward services for children. She is not sure this is happening. With respect to oversight, she would like to know more about contracts, money distribution, what the outcomes are, and she would like clear understanding of the Division’s role and philosophy working with community based centers. The Division should have a philosophy of collaboration with community providers and that should be clarified publicly.

Senator Peterson stated that state officials need to educate legislators during the legislative session. He is interested in regionalization and how to best serve the people.

Division of Mental Health and Substance Abuse Status and Goals

Rodger McDaniel, Deputy Director, Department of Health (WDH), agreed the work of the Division has to be transparent. The Committee needs to understand that conflict does not mean absence of collaboration. There are many stakeholders involved, including community providers, district courts, clients, the faith community and others who show an interest now more so than in the past. He distributed a packet of handouts that organizes the Division's presentation based upon Chairman Gingery's suggestions. He distributed Appendix 4, containing a description of the role of the Division, an excerpt from a book, Rethinking Substance Abuse‑What We Do and What We Should Do, and materials from the Citizen Review Panel. The Division has a systems approach to programs. Wyoming has gone from denying substance abuse issues to asking why aren’t we fixing the problem. The system is very complicated. The Legislature tried to address the problems through 06HB0091, to develop a comprehensive approach and to facilitate the sharing of data and cooperation. The Departments of Health, Family Services and Corrections have entered creative agreements to address shared populations.

Representative Landon believes community providers are the experts and they should be a partner in structuring a system that has accountability and better outcome measures. Mr. McDaniel believes it is better to allow a holistic approach within a community to develop services, rather than creating a system from the state level that communities must follow. Senator Aullman suggested the state could provide training and guidance for communities to create and implement services and programs. Mr. McDaniel said Ms. Mary Flanderka will address this issue, which will include administering community grants and helping develop a prevention framework federal grant with community involvement. Current Division contracts require that communities work together to develop and provide services. The Division provides technical assistance to communities.

Ms. Flanderka stated there has been some fragmentation and some programs have not been fully funded due to money issues. People want to be involved, but resource issues make it difficult. Many communities want to facilitate themselves and don’t want the state involved, while others do want state involvement for a variety of reasons. People are coming together more and more to collaborate on those issues.

Senator Decaria expressed his frustration because he still doesn't know if the system is working. He is tired of anecdotal evidence and wants some quantitative evidence that the system is improving, including information on how many people are getting through the system without any success vs. those who do succeed and are we spending dollars smartly and getting where we want to be. Mr. McDaniel agrees the best result of this meeting would be an understanding of where the state is with outcome measures. The Wyoming Client Information System (WCIS) has just been implemented since July, 2007, and should provide more meaningful data. Part of the problem has been reaching an understanding of what the "system" should be.

Chairman Gingery asked what the Division's philosophy was toward the Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC). He asked this as a result of Representative Iekel's written questions, expressing concerns that the Division may be moving away from using WAMHSAC facilities and that competition may be diluting the ability of WAMHSAC facilities to provide services. Mr. McDaniel responded the centers were crucial to this system. He is committed to still using WAMHSAC, despite criticisms. While there may be some fundamental disagreements between philosophies, he is aware of the criticism in 02HB0059 that the WDH was serving as a pass-through for providers. He believes the Division needs to provide oversight to ensure public funds are used efficiently. Dr. Brent Sherard, Director, WDH, added that he is responsible for $1.5 billion in public funds and the WDH should not serve as a mere pass-through agency. Mr. McDaniel is not sure what is expected of the Division at this point. These issues are much broader than WAMHSAC; it is a systems issue and people contact the system in more areas than just through WAMHSAC. It is necessary to allow “first responders” such as physicians and clergy to have the ability to help people when they come in contact with them. Referrals need to go to WAMHSAC facilities from these responders. The Division is using the SBERT Program through public health nurses (explained in Appendix 11) to allow system access for persons first seen by the public health nurses.

In response to a Committee question, Mr. McDaniel said there clearly is not a common vision within the state. He is committed to improving communication, but he does not know that it will eliminate conflict between the Division and providers. It is important to recognize that, while legislators are informed of conflicts by WAMHSAC, the legislators may not be equally advised of compromises that are reached between the Division and WAMHSAC.

History of Mental Health and Substance Abuse Expenditures

Mr. Bob Peck, Chief Financial Officer, WDH, distributed Appendix 5, containing fiscal information for expenditures in the 2009-2010 biennium. He explained the funding by program/division. Mental health and substance abuse programs are about 16% of the overall WDH budget.

Chairman Gingery stated that, during the last session, in a Senate appropriations Committee meeting, the Division advised it had $7 million extra for prevention that the Legislature apparently didn’t know about. He asked for an explanation of those and tobacco settlement funds.

Senator Peterson asked if enough money is appropriated for prevention, because intervention appears to require significantly more money. Mr. McDaniel replied there is not much appetite left in the Legislature to add any more money for prevention. That was stripped from the funding bill this year. He would like more money for prevention, but funding for treatment is still necessary. Senator Aullman asked for more information on funding and current services to educate legislators on the need for additional funding. Mr. McDaniel said he would provide information on what incentive payments were made to local programs for tobacco prevention.

Senator Job questioned the reason for the high administrative costs for the tobacco prevention program. Mr. McDaniel explained the difficulties in contracting with the numerous community programs where coordinators are hired. Mr. Peck added that, when calculating administrative costs, there are a number of different series through which the state identifies a variety of expenditures. "Administration" generally means everything except the 600 series, which contains funding for the services provided to the client.

Chairman Gingery asked about the chart at the end of Appendix 4 which identifies the Division's organization. He wanted to know how much has the Division grown and whether it was necessary. Mr. McDaniel said that Division staff has actually declined. By merging the mental health and substance abuse divisions into a single division, there has been a reduction in the management team and overall employees. The organizational chart describes the professional credentials of staff in the treatment unit.

Mr. Peck described the process for federal grant applications. Program managers apply for the grants. When awarded, a copy comes to Mr. Peck, who then gets approval from the Governor and Dr. Sherard.

Chairman Gingery observed that the GAP analysis from 2006 demonstrated that Medicaid reimbursement for children was good, but not so good for adults. Mr. Peck replied that late last year, the Centers for Medicare and Medicaid Services (CMS) approved an amendment to allow rehabilitation options to be reimbursable by Medicaid. He suggested adding mental health treatment services to the mandates services under Medicaid to leverage more federal funding, although CMS will have to approve the amended State Plan. A footnote in the budget bill directs WDH to continue pursuing additional reimbursable optional services for adults. Chairman Gingery asked that in the future WDH should let the cochairs know when WDH has extra money.

Mr. Peck discussed how the tobacco settlement fund works. WDH spending has grown about 75% from 2005 to 2008. He explained how the Governor is able to move monies among programs under his flex authority. The practice allows agencies to move any money, earmarked or discretionary, although as a matter of practice they don’t move earmarked money.

Mr. McDaniel advised that funding for SBERT, and the citizen review panel come from discretionary tobacco settlement fund dollars. The citizen review panel money came from other places too. Mr. Peck explained receipt of tobacco settlement funds and how those funds are used. In response to Committee questions about the discretionary use of some of those funds without legislative authorization, Mr. Peck responded that some of the funds are statutorily earmarked, but some are discretionary. The discretionary funds are requested by specific agencies, subject to approval by the Governor through his budget request and the Legislature through enactment of the budget bill. The discretionary funds are not always apparent on the face of the budget document or the budget bill, but are only allocated based on obtaining the necessary approvals. Mr. Peck advised that JAC has asked WDH previously how those discretionary monies will be spent. If asked, an explanation is given, but details of each line item are not always explained unless so requested. The payments the state is receiving under the master settlement agreement are not going into the corpus anymore, but the corpus has grown to over $50 million from $44 million when it was created. Chairman Gingery explained that Representative Simpson had proposed using caution in spending the tobacco settlement funds. Chairman Gingery added that the payments from tobacco manufactures will someday end, and the state could deplete the corpus of the fund pretty fast. Mr. Peck responded that a bill was proposed two years ago to add money to the corpus, but the bill failed. He has heard suggestions to reduce spending and put more in the corpus. Senator Johnson stated agencies do what the Legislature allows them to do. If the Legislature wants more oversight, it should require that it be done.

Senator Aullman asked for information at the next meeting regarding whether past bills the Committee has resulted in a reversion of funds money and why that money was spent as authorized.

Programs under Division of Mental Health and Substance Abuse Policy and Planning

Ms. Korin Schmidt, Policy and Planning Administrator, described staffing within the Division that has improved the operations of the Division. She discussed her vision for drug courts, i.e., evolving into problem-solving courts, which would require legislation. She explained some inter-agency coordination that is occurring. The Public Defenders' Treatment Project is near implementation to help divert defendants who might benefit from treatment. Also there is a collaboration with the Department of Family Services and Department of Corrections to help families who have children at risk of being removed from the home, including intensive wrap around program/case plan to help families resolve issues. Medicaid program therapeutic foster care and WAMHSAC providers provide these services. Medicaid staff are now under the Policy and Planning Division. Another Medicaid change is targeted case management intended for adults with serious and persistent mental illness.

Ms. Eydie Trautwein, Inter-agency Coordinator, explained the history of the children’s mental health waiver within the Medicaid program (Appendix 6). The developmentally disabled (DD) waiver has 144 children enrolled. The DD waiver is a long-tem waiver, but the mental health waiver is a short-term program that is currently in the preliminary stages of implementation. Some children may qualify under the child health insurance program, but Ms. Trautwein is not sure. It is the child's, not the parents', income and resource that determine eligibility for the waiver. Ms. Trautwein explained the SAGE Initiative. It is a federal program with a 6 year duration and $9 million grant that was received in 2005. A memorandum of understanding was entered into by DFS, WDH, and Wyoming Department of Education. The program has stringent match requirements. The WDH is moving into the fourth year of this grant. Two pilot sites have been established, in Laramie and Jackson. Interest has been expressed by Buffalo, Sheridan, Gillette, Platte County, Rawlins, Worland, Rock Springs and Cheyenne. The federal program is actually called System of Care Grant. (SAGE – Support, Access, Growth, Empowerment). WDH is currently looking at ways to sustain the program after the federal grant ends. WDH has spent approx $3-4 million of the grant to date. About 27 families were served in Laramie, and 5-6 families in Jackson were served in 2007 under the grant. Chairman Gingery said the program sounds similar to an Multi-Disciplinary Team concept, except the family drives the care and treatment. He added that the advertising aspect of the program has been frustrating, ending up with SAGE mugs, mouse pads, and ads in paper, which advertising is federally required. About $90 thousand has been spent on advertising. The majority of the social marketing money has been spent on the “Photo Voice” program which was explained to the Committee last interim.

Ms. Marla Smith, Research/Data Manger, described advances made with WCIS over the past couple of years (see Appendix 7). The system will identify which clients receive what services, from whom and at what cost. Chairman Gingery advised some of the community providers are noncompliant with the requirement to provide the client's social security number (SSN) to ensure validity of data. He is concerned the providers are intentionally encouraging clients to not provide SSN. Ms. Schmidt said the best way to track a client is with the SSN, but clients have to consent for that data to be available and meaningful. Chairman Gingery suggested that perhaps providers who are encouraging clients not to provide their SSNs shouldn’t be getting money from the state. Mr. McDaniel said WDH is in the early stages of data collection and it may be better to allow time to work through this issue and see where we are at with compliance rates and then decide what happens after that. The most accurate way to track a client is through the SSN, but if that doesn’t work then WDH will have to look at something different then. He hopes clients and providers will become more comfortable with time and experience with the system. In response to a question from Chairman Gingery, Ms. Smith said she will provide an analysis at the next Committee meeting of regional services and what has happened as result of the additional services and programs that have been implemented to fill gaps. In response to a question from Senator Decaria, Ms. Smith replied WCIS will have the capacity to answer questions at next meeting about clients accessing the system for both substance abuse and mental health services.

Dr. O’Ann Fredstrom, Wyoming Association of Psychiatric Physicians (WAPP)

Title 25

Dr. Fredstrom expressed concern that many people do not understand what the forms are or the process of involuntary hospitalization under Title 25. She also has concerns about a lack of consistency across the state with the Title 25 process. There are differences in how county attorneys use, and how physicians understand, these laws. Ms. Carol Day advised she is currently working on surveying all the providers to get to some of this information. Dr. Fredstrom encouraged the Committee to review the Colorado law concerning involuntary detention during intoxication. Chairman Gingery said he is not sure Wyoming statutes need that much work, since funding issues between the counties and the state were clarified. The law is intended to address due process rights, not to help people. Representative Landon said the processes to bring clients into the system through Title 25 are not uniform and it may not be all bad because some will need different types of services. Dr. Fredstrom advised that the opening of psychiatric beds in Lander, Cheyenne and Casper has alleviated some of the stress at the Wyoming State Hospital.

Recruitment/Retention

Dr. Fredstrom said there were no big increases, but no decreases, in the number of psychiatrists in the state. The number has held at 55 practicing psychiatrists in the state. She also discussed Medicaid problems, what has been done with grants provided by Legislature for medical marketing, the differences she has seen as a result of the appropriations to WAMHSAC in addressing client needs. She is concerned that physicians are not being used the same way as in other states, rather they are used as medical vending machines. WAPP supports increased funding for WAMHSAC providers, but does not support funding for non-WAMHSAC providers. WAPP also supports increased funding for telepsychiatry and especially for technical support for the system so equipment issues do not hamper access to clients. There are gaps and disjointed aspects to this system.

The Committee recessed at 5:00 p.m.

Call To Order (April 25, 2008)

Chairman Aullman called the meeting to order at 8:30 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

WYPOMS PRESENTATION

Dr. Nancy Callahan, Ph.D., WDH Consultant, stated that outcome measures is a hot topic. Questions raised by a discussion of outcome measures include: are the clients getting what they need; is it making a difference; who is getting what kind of services from whom at what cost with what outcome? She distributed Appendix 8, preliminary results of the Wyoming Performance Outcome Measures (WYPOMS). The study focuses on the population of persons who are persistently mentally ill. In response to a question from Chairman Aullman, Dr. Callahan advised that the general charts in Appendix 8 may look exactly the same, but the populations within the segments of the pie charts may change. It is necessary to look at the populations within the whole chart. She will attempt to provide the Committee with data on populations that had poorer outcomes.

Dr. Brent Sherard, Director, Department of Health

Dr. Sherard stated there were challenges presented by the WYPOMS project, but with collaboration most of the challenges were met. The Committee does not always hear about the positive collaborative efforts that happen. He discussed general principles of the WDH. He heard some comments about single point of entry in earlier testimony and has much appreciation of the community mental health centers (CMHCs), but more people come into the system from a variety of points other than CMHCs. People with mental health needs typically look for other resources for help before going for formal treatment. The SBERT program represents a paradigm shift in the provision of treatment for substance use and abuse. The services are different from, but designed to work in concert with, specialized or traditional treatment. SBERT is an important public health paradigm to provide treatment. The DH has implemented a COMMIT TO YOUR HEALTH program, which is a public awareness campaign. Chairman Aullman requested that more advertising occur in western Wyoming where few Wyoming media outlets are available to promote Wyoming services. Dr. Sherard added that a new Division of Rural and Frontier Health has been created within the WDH to promote rural health in Wyoming.

Update on Use of State Facilities

Dr. Sherard advised that Ms. Carol Day, Community Services/Treatment Manager, has moved to the Director's Office from the Mental Health and Substance Abuse Services Division to do more planning for the WDH.

Ms. Day distributed Appendix 9, a Title 25 Survey Briefing. Within the next few months, she will conduct a survey of Title 25 activities in the state, interview all stakeholders who handle the Title 25 process. She want to know what works and what does not work. All stakeholders will be informed as to feedback and input. By September 15, 2008, she will issue a report of the survey results.

Representative Gingery asked what the feedback was from district court judges at the meeting Ms. Day and Dr. Sherard attended the previous day. Ms. Day said she heard many concerns expressed about inpatient services for kids and adolescents and patient convalescent leave issues, including liability that may exist for the Wyoming State Hospital (WSH). The WDH will next meet with the county attorneys on Title 25 issues.

Representative Gingery recapped the lack of uniformity across the state in the implementation of Title 25 proceedings. Part of the problem is most county attorneys do not keep data to help understand what problems may exist. He believes the WDH needs to designate hospitals for voluntary commitments of minors. Either rules need to be adopted by WDH, or it should adopt Joint Commission on Accreditation of Health Care Organizations rules. Chairman Aullman suggested the WDH go to the next meeting of the Joint Judiciary Interim Committee and inform that committee of what the WDH is doing in this area.

Ms. Day distributed Appendix 10, Identified Issues and Recommendations on Psychiatric Inpatient Services and Mental Health and Substance Abuse Services for Older Adults, containing the recommendations of two working groups. She advised that a working group has been formed between WSH and CMHCs related to client flow issues in and out of the WSH. The group will review inpatient beds and services for older adults, based on statements from the Committee. Senator Job supports the project because Title 25 has been an issue for a very long time because patient care and civil rights are important.

Representative Gingery asked if it would be worthwhile to consider sponsorship of a mental health insurance parity bill again. Senator Decaria voiced support for such effort. Representative Landon expressed concern with ERISA rules, because only small private insurers would fall within any mandate and such a mandate could raise rates which may result in people dropping their insurance coverage. Representative Landon believes it would be better to consider a different strategy, i.e., should the state consider mental health insurance coverage that would allow treatment of a certain number of people. Chairman Aullman suggested the Committee should think about this more and discuss it later, perhaps at next meeting.

Ms. Day stated that Wyoming does not have enough inpatient beds for mental health patients. Based on national data, the state needs 30 more beds. Wyoming Behavioral Institute will be adding another 20 beds and the WDH believes the state should have another 20 beds, in addition to those new beds. The pilot project with Cheyenne regional medical is a model that could be used more extensively.

Representative Gingery reminded the Committee of discussions four years ago about building a geriatric facility at the WSH. Seventy thousand dollars was appropriated to study that proposal. He asked if the idea is still on the table. After several Committee members expressed frustration with the results of the authorized study of the WSH, Ms. Day replied that it is still an option, but may not be the best option. It may be more efficient to look at regional options so people can receive services closer to their families. A comprehensive effort is needed to fully address these issues. Representative Landon advised the Joint Labor, Health and Social Services Interim Committee attempted to do this with a bill authorizing a master facilities study, but the bill failed on introduction in the Senate. He suggested perhaps this Committee could rewrite the bill. It is necessary to forecast populations and then plan for them.

Dr. Sherard said the state built a wing on the Retirement Center in Basin, which was never opened because of staffing issues. Senator Job asked what the staffing issue was. Dr. Sherard replied that salaries of certified nurse assistants was certainly part of the problem. Ms. Day added that the Retirement Center is reinstituting a certified nurses assistants training program.

Chairman Aullman asked if the recommended national standard of 30 beds is intended just for adults, whether the beds would be used to serve youth and if there is a waiting list. Ms. Day said she doesn’t know if there is a waiting list for children. There are so many players in children's system, she is not sure of the answer. Appendix 10 has a list of recommendations, but no funding is attached to the recommendations. Ms. Day explained the recommendations in the document.

Programs under Division of Mental Health and Substance Abuse Community Services and Prevention

Ms. Mary Flanderka, Community Services and Prevention Administrator, distributed Appendix 11, a Brief Review of Regionalization, and related documents. She commented that all the groups that have worked together, public, private and non-profits, have provided valuable input. She explained because of the turnover of staff in the Division, few people in the Division understand what the original vision was. She also commented on where the Division is in terms of the system of care document in Appendix 11.

Mr. Chuck Hayes, WDH Consultant, provided a history of the regionalization initiative for mental health and substance abuse services. It started on 2004, when Representative Simpson approached Mr. Hayes to discuss the creation of this Select Committee. In response to a question from Representative Gingery, Mr. Hayes said there has been no discussion of combining CMHCs. The WDH initially looked at the proposal, but it never went anywhere.

In response to questions about funding appropriated as a result of the Committee's sponsorship of legislation, Ms. Flanderka said the Division will examine how to address unspent funds that were directed to specific providers. Perhaps reversions or redirection can be addressed through the contracts with the providers. Mr. Hayes added that both 06HB0091 and 07SF0076 were very prescriptive in the appropriations to providers. Some provisions would not allow the option to move the money and it would, therefore, revert if not used.

Mr. David Harrington, Mental Health Planning Council, described the composition and duties of the Council which oversees the federal mental health block grant. The state only receives about $500K under the block grant. He stated Wyoming is receiving national acclaim for its regionalization efforts begun by this Committee. Some key issues he sees include crisis stabilization to keep people out of jails, training for primary care physicians to treat mental health issues, and more funding for bricks and mortar to ensure appropriate facilities to serve persons with mental illness problems. He would like to see the crisis intervention team (CIT) program expanded around the state.

Ms. Anna Edwards, Executive Director of the Wyoming Alliance for the Mentally Ill (WYAMI), described the advocacy group and its mission. WYAMI has been receiving more positive calls from consumers since the Committee's legislative proposals have been enacted into law. Many people want regionalization to happen faster. She has also heard frustrating concerns about Title 25 issues, including that citizens do not understand the process. She provided information about CIT, which is based on a Memphis model.

Ms. Flanderka introduced Ms. Jay Otto, SPF-SIG coordinator, who discussed the "Where Do You Draw the Line" advertising campaign. He explained the WDH wanted to have a positive social marketing and social norming campaign. He also distributed Appendix 12, outlining the WDH's substance abuse prevention initiatives.

Representative Gingery asked for more information about SBERT. Ms. Flanderka explained that SBERT is a screening tool for hazardous consumption, not for addiction or mental health issues. It is supported by the World Health Organization. SBERT is used by public health nurses who identify a patient who may be in need of a substance abuse assessment. The patient is given a telephone number, which the patient is not required to call, to receive more information about substance abuse. The telephone number provided is to a Colorado organization that provides the information on substance abuse.

Representative Gingery also wanted to know more about the status of citizen review panels and the rate study. Mr. McDaniel said the WDH is moving forward with citizen review panels and has set aside $15 thousand for this purpose in communities that wish to participate. The result of those efforts will be provided to other communities, that may subsequently want to participate. With respect to the rate study, the WDH needs to have a longer conversation about this. Mr. McDaniel referred to an LSO study a couple of years ago concerning rates to providers. The WDH now has the ability to measure outcomes and has developed a proposed RFP, formed a review committee, received three proposals and awarded the rate study to Signal Behavior. A contract is being developed to proceed with the study.

Wyoming Association of Mental Health and Substance Abuse Centers

Mr. Mark Russler gave update on WAMHSAC and its relationship with WDH. He expressed concern with the duplication of efforts from WAMHSAC and WDH, citing the SBERT program as a prime example. WAMHSAC wants a locally driven system of care, which still needs additional legislative funding to develop an appropriate level of services for clients. Mr. Russler advised WAMHSAC's relation with WDH is improving, but still is not great. WDH is still being prescriptive with WAMHSAC and is not really including them in collaboration efforts. He is concerned that WAMHSAC providers are not really recognized as the treatment experts, even though they are the providers who are actually seeing and treating persons with mental illness and substance abuse problems. Recent legislation relaxing licensing requirements has been helpful in recruitment of staff.

Mr. Mike Huston, Executive Director, Central Wyoming Counseling Center, provided a brief update on the substance abuse residential facility being built in Casper. Completion should be by the end of July, 2008. He invited the Committee to have its next meeting in new facility with a formal dedication ceremony, in early August. The existing adult facility would be converted to a transitional facility after new one is opened up.

OTHER BUSINESS

Representative Gingery reminded the Committee of the proposed meeting dates of June 16 & 17 in Evanston. As the Cochairs develop the agenda, he would like people to begin focusing on a discussion of regional issues, including spending some time considering services in each of the regions. He would like Committee members to let him and Cochairman Aullman know if the proposed meeting dates would work for them.

Representative Landon presented ideas he had jotted down during this meeting for further consideration, including:

Exploring the relationship between WAMHSAC & WDH. He encourages a meeting about common vision and roles of the parties;
Conducting a facilities/people (demographics) study through this Committee to examine what the populations are that will be needing state services, inventorying facilities we have to serve those people, and determining how to modify existing and build new facilities to serve those people;
Determining how funds appropriated in 06HB0091 and 07SF0076 are prescribed and examining the use of the funds to make sure the funds are actually accomplishing what was intended;
Addressing the need for more geropsychiatric expertise in the state.

Senator Job reiterated that the geriatric problem will grow and the state should get better grip on it.

Senator Decaria asked for a list of what tobacco settlement monies are being used for and which of those uses are considered discretionary.

Meeting Adjournment

There being no further business, Chairman Aullman adjourned the meeting at 12:30 p.m.

Respectfully submitted,

Senator Pat Aullman, Cochairman Representative Keith Gingery, Cochairman

Appendix	Appendix Topic	Appendix Description	Appendix Provider
1	Committee Sign-In Sheet	Lists meeting attendees	Legislative Service Office
2	Committee Meeting Agenda	Provides an outline of the topics the Committee planned to address at meeting	Legislative Service Office
3	Brief on Wyoming's Mental Health Delivery System	Provides questions and issues developed by Representative Jerry Iekel for Committee consideration	Representative Jerry Iekel
4	Various materials for consideration of the Role of the Mental Health and Substance Abuse Services Division (MHSASD), Wyoming Department of Health (WDH)	Contains information on the role of the MHSASD, principles and the science of serving substance abuse issues, an explanation of the role of the Citizen Review Panel and related documents	Mr. Rodger McDaniel, WDH
5	Facts on WDH 2009-2010 budget appropriations for mental health and substance abuse	Provides facts on how the WDH will expend funds appropriated for mental health and substance abuse services in the biennium beginning July 1, 2008	Mr. Bob Peck, WDH
6	Children's Mental Health Waiver	Provides a history of the Children's Mental Health Waiver and an LSO research memo analyzing funding trends for mental health services in Wyoming	Ms. Korin Schmidt, WDH
7	Wyoming Client Information System (WCIS)	Provides a status report on the WCIS developed by the WHD	Ms. Marla Smith, WDH
8	Wyoming Performance Outcome Measures (WYPOMS)	Provides preliminary data developed as a result of the WCIS implementation and analysis	Ms. Marla Smith, WDH
9	Title 25 Survey Briefing	Describes a survey the WDH will be conducting to determine how Title 25, involuntary hospitalizations are occurring throughout the state	Ms. Carol Day, WDH
10	Identified Issues and Recommendations on Psychiatric Inpatient Services and Mental Health and Substance Abuse Services for Older Adults	Summarizes the results of a study by the MHSASD and multiple stakeholders on the issues of psychiatric inpatient needs at the Wyoming State Hospital and the growing problems of mental health and substance services for older adults	Ms. Carol Day, WDH
11	A Brief Review of Regionalization	Provides a history of efforts at regionalization of mental health and substance abuse services in Wyoming, what the results have been, and what remains to be done	Ms. Mary Flanderka, WDH
12	Wyoming Substance Abuse Prevention Initiatives	Describes the WDH's substance abuse prevention initiatives.	Mr. Jay Otto, SPF-SIG coordinator, WDH