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Date:            February 23, 2007
To:              CMH Board Members
From:            James M. Elwell, Executive Director
Subject:         Monthly Activity Report
The following summarizes the activity within the agency for the past month:

•     The desk audit documentation form and other materials for the Performance Measurement
      Validation and BBA Compliance Audits for the External Quality Review Organization Staff
      have been completed and submitted.

•     Efforts continue with the various jail diversion groups throughout the affiliation to implement
      the various components of the Plan of Correction for MDCH. The affiliation jail diversion
      policy has been revised.

•     The Muskegon County Homeless Continuum of Care Network completed a point-in-time
      count of homelessness in our community. CMH is assisting in the compilation of the data.
      Three thousand people that met the eligibility requirements applied to be on the waiting list
      for Housing Choice Vouchers on January 31, 2007, which was opened for an eight-hour
      period on January 31, 2007 after having been closed for six years.

•     Staff is assisting the Recipient Rights office in the preparation of their audit materials.

•     Affiliate senior management, with CMH staff, is working on a strategic plan for the
      Lakeshore Behavioral Health Alliance.

•     Training to internal staff and external providers continues as it relates to the requirements of
      the Deficit Reduction Act.

•     CMH Site Safety Officers have been diligent in conducting the new safety drills required by
      C.A.R.F. To date in FY 2007, CMH sites have held fire drills, medical emergency drills,
      weapons and assault drills, chemical spill drills, hazardous transport drills, heating/cooling
      failure drills, electrical failure drills, and bomb threat drills. All sites are up-to-date on
      conducting drills and complete site safety surveys.

•     The computer server room at the John Halmond Center is in need of a new fire suppression
      system. The current water-based sprinkler system is not suitable for the computer
      equipment in the room, and has been temporarily shut down. Staff are working with facilities
      management staff to amend the work order for the back-up generator to include installation
      of a chemical-based suppression system for the computer server room. It is anticipated that
      the new fire suppression system will be installed by the middle of March.
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•   Several CMH staff have retired after many years of county service: Nancy Keur,
    Transcriptionist, 38 years of service; Inez Johnson, Clerical Supervisor, 26 years of service,
    Patricia Holbach, Information Systems Technician III, 13 years of service, and Dennis
    Robison, Supports Coordinator/DD, 11 years of service. Our thanks to these individuals for
    their dedication to public service, and best wishes in their retirement!

•   The Integrated Dual Disorders Treatment grant has given us the opportunity to contract with
    expert Michael Clark, MSW, to train clinical staff on motivational interviewing. This 24-hour
    course will be presented three times between late January and May 2007, training over 100
    affiliation clinical staff in this recognized Evidence Based Practice. This training will result in
    improved staff communication with consumers and more focused treatment planning. The
    possibility of having several clinical staff trained as motivational interviewing trainers is
    currently being explored.

•   Brinks Residence continues to evaluate consumers in ten areas of functioning upon
    discharge. Results for the first quarter of Fiscal Year 06/07 reveal that over 94% of Brinks
    residents have left that facility with increased stability and improved functioning.

•   With the addition of newly trained clinicians, the County Mental Health Center at Southern
    now has two Dialectical Behavior Therapy (DBT) skills groups in operation, serving a total of
    twenty consumers. CMH’s Youth Services program is currently in the final stages of
    implementing a DBT skills group for adolescents who have difficulty regulating their

•   A CMH project team has recently completed a detailed analysis of factors that led up to the
    admission of 24 Muskegon County residents with serious mental illness to Kalamazoo
    Psychiatric Hospital (KPH) during Fiscal Year 05/06. Substance abuse and discontinuing
    their psychotropic medications were found to have played a significant role. Planning will
    take place to address these factors and reduce the need for future admissions to KPH.

•   An agency project team has been convened to draft a detailed plan outlining CMH’s
    response to a flu pandemic striking Muskegon County. This project is in response to the
    State mandated emergency planning initiative for Michigan counties.

•   The affiliation Improving Practices Leadership Team (IPLT) continues to focus on the task of
    incorporating the ten key principles of recovery into the delivery of mental health services by
    the Affiliation. It is also assisting CMH Evidence Based Practice implementation teams to
    identify how each agency will sustain and/or expand Family Psychoeducation,
    WRAP/Recovery, and Integrated Dual Disorders Treatment after the mental health block
    grants have run out at the end of the current fiscal year.

•   In the last month, CMH management and quality improvement staff have undertaken an
    extensive assessment of the agency’s clinical chart review process. Plans are currently
    being implemented to improve the effectiveness and efficiency of this important quality
    monitoring process.
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•   On February 12, 2007, Dave Parnin, Clinical Services Manager, and Paula Kelson, Special
    Project Coordinator, met with the Baker College Human Services Advisory Board to address
    students being placed at CMH in order to receive valuable educational experience. Contract
    language governing these placements is currently being reviewed. The agency hopes to
    utilize Baker College students in the near future to assist in many of our agency programs.

•   Linda Johnson, CMH social worker from Youth Services, currently spends approximately
    sixteen hours a week providing services in several area schools as part of the Department
    of Community Health Children’s Block Grant program and the Governor’s Priority Schools
    Initiative. Working out of the school based family resource centers, Ms. Johnson has
    increased access to appropriate mental health services for children with serious emotional
    disturbance. Many of the students identified in the past by school personnel as needing
    CMH services unfortunately did not follow through with our agency. The current
    arrangement, however, which allows for mental health counseling to be provided in the
    school setting greatly increases the likelihood of follow-through. Students who are in need
    of psychiatric services are still seen by a physician at the Youth Services facility on South

•   CMH has recently received very positive feedback from nursing staff at Muskegon
    Community College. They reported that the student nurses who have taken part in field
    placements at Youth Services and the County Mental Health Center at Southern have been
    greatly impressed with the services that agency nurses provide to children and adults with
    mental illness. It is hoped that because of this experience with CMH, that a number of the
    student nurses will go on to careers in the mental health field.

•   ACT consumers and staff have been doing an outstanding job this winter organizing ACT
    recreation and leisure group activities. Weekly events from 5:30 to 9:30 p.m. have included
    such things as “Learn a Craft and Share a Craft”, “Learn to Tie Dye Night”, and “Double
    Feature Movie Night with Pizza.”

•   New members from the Clubhouse were recently hired for the two Transitional Employment
    (TE) jobs cleaning the lunchrooms at the John Halmond Center and County Mental Health
    Center at the end of each workday. The two individuals with serious mental illness who
    successfully performed these work duties during 2006 were congratulated and recognized
    for their successful completion of their TE work experience by being taken out to lunch and
    receiving a certificate of accomplishment.

•   Three CMH consumers have found jobs during the last month, while only one individual lost
    their job due to poor attendance. Meetings are currently being held with various vocational
    provider staff to facilitate working together to find jobs for individuals presenting with unique
    employment challenges. As a result of these meetings, one person has already been

•   Self Determination efforts continue to move ahead at CMH. With Self Determination, one
    individual has hired a person of his choice to provide support for him two days a week for
    three hours each day in order to participate in more community activities. He was able to do
    this by using the money that had previously been going to skill building services that no
    longer meet his needs. This individual and his support person have gone shopping and
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    bowling, shot pool, and visited the YMCA, as well as taken part in other community
    activities. He has been able to form a personal relationship with his support person,
    improve his eye-hand coordination, increase his understanding of appropriate behavior, and
    have fun at the same time, as a result of Self Determination.

•   Management staff has engaged in a round of discussions concerning strategic and financial
    plans for next fiscal year. A number of areas have been identified both for growth and
    redirection, including management of residential services and a push toward consumer
    employment. On the financial side, it appears we will face some serious challenges in
    maintaining current operations.

•   A letter of support has been given concerning the development of Regional Health
    Information Networks for West Michigan, and staff is participating in work groups. Such a
    network would allow agencies to pull health information about common consumers through
    an exchange. A State of Michigan grant is being requested for the development of this

•   We have staff now available to implement the CMH part of Muskegon’s response to the
    Michigan Prison Re-entry Project. We are developing case management capacity to track
    prisoners with serious mental illness prior to, during, and after their release.

•   Work continues in identifying areas of much closer collaboration between Muskegon and
    Ottawa CMHs. A number of areas have been ranked for value to consumers, ease of
    implementation, and likelihood of financial savings.

•   Discussions are continuing with Hartford Terrace towards a clustered supported housing
    program for people we serve. The proposal would allocate several apartments for CMH
    consumers, and provide for a live-in staff capacity in one apartment to provide ongoing
    Community Living Supports.

•   Staff is loading the users and courses into the Netsmart University application. We expect to
    have the tracking system operational within a few weeks and the first online courses
    available within 60 days.

•   We are rolling out the new approach to respite. Although this will give families greater
    control over their respite providers and ensure a better trained workforce, the primary goal is
    to have the service become Medicaid billable. This will ease pressure on our General Fund

•   Staff has prepared the Cost Allocation Plan being required by the State in response to
    legislative requests for information about costs in administration. We will be sending the
    plan to MDCH at the end of February and participating in a panel presentation to all CMH
    Finance officers at a statewide meeting in March.

•   Together with Ottawa, we have developed eligibility guidelines for people with
    Developmental Disabilities. We presented this for review to advocacy and stakeholder
    agencies in February and received feedback. We expect to finalize the guidelines within the
    next 30 days.
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•   We have turned over caseload tracking, demographic data entry, and discharge completion
    to clinical staff. In the past, this was all done by clerical staff using a paper process and
    manually produced reports. Clinical staff can now enter changes in demographics and
    caseloads directly into the Avatar application.

•   We are starting to see substantial benefits from the Avatar system. We are holding two staff
    positions vacant as a result of reducing the amount of data entry done by clerical and
    finance staff. However, the most significant benefit is in having timely data and a robust
    reporting system. We are able to track services within a day of their being performed, and
    are able to link pieces of data to obtain a much clearer picture of trends.

•   We have completed our encounter and year end reporting for FY05. Our Information
    Systems and Finance staff have made significant improvements in the accuracy and
    completeness of our reports, and we are confident that we have provided high quality data
    for the actuarial review of 2008 rates.

•   We have moved our DD contracted residential services to the new rate-setting process
    using the Service Intensity Scale scores. We are still working with some providers about
    how the change is affecting them. Several providers have received substantial increases as
    a result of the new system.

•   A Medicaid Fair Hearing will occur in March that could have significant impact on services
    for people with mild forms of developmental disabilities. Our understanding of the Medicaid
    contract is that such persons are eligible for services from other community organizations,
    such as Michigan Rehabilitation Services, Housing Organizations, and the Department of
    Human Services but not from CMH. The hearing will be on the definitions used by
    Muskegon concerning eligibility for its services.

•   Staff honored individuals throughout the agency who deliver training to staff who work at
    CMH and in our network of providers. More than 50 people participate as trainers in one
    area or another. The staff spoke of their experiences, shared humorous stories, and heard
    information about future training events.

•   Our first electronic chart item is now in production through Avatar. This is the assessment
    that is used during a crisis to establish a course of action appropriate for the crisis situation.
    The system will automatically notify a set of staff that the assessment has been completed.
    This replaces a system of making copies and distributing information through the mail.

•   We are working on a tracking system for Alternative Treatment Orders. These are orders
    from Probate Court that require consumers to participate in treatment. They are very
    important to maintaining consumers who do not take medications, keep appointments, or
    otherwise follow through on treatment plans. These orders expire periodically and must be

•   Our architects have presented the first drafts of program summaries that will be used to
    develop plans for office space development for CMH. Early ideas are to attempt to bring the
Page 6 of 6

       array of core CMH services closer together in physical space in order to create more
       efficient use of staff and other resources.

•      Staff met with Mike Barkey, who has completed the Network Capacity study for the
       affiliation. There are a number of conclusions and recommendations that have been worked
       on, and a summary will be provided in the March Board meetings.

cc: James Borushko, County Administrator

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