Task Force on Involuntary Examination of Minors
Meeting Minutes
1317 Winewood Boulevard, Building 6, Conference Room A
October 4, 2017 – 1:00 p.m. – 2:30 p.m.
Conference Call Number: 1-888-670-3525 / Code 9592874884
Topic / Lead Presenter1:00 – 2:00
· Welcome, Opening Remarks
· Review of Key Stakeholder Survey / John N. Bryant, Assistant Secretary
Office of Substance Abuse and Mental Health
Laurie Blades
Office of Substance Abuse and Mental Health
2:00 – 2:30
· Discussion of Survey Results
· Discussion of Next Steps / John N. Bryant, Assistant Secretary
Office of Substance Abuse and Mental Health
Laurie Blades
Office of Substance Abuse and Mental Health
Task Force
Attending:
Task Force Members
John Bryant, Department of Children and Families (DCF) Assistant Secretary Substance Abuse and Mental Health (SAMH), chair
David Wheeler, Florida Department of Education
Christina Wiggins, Florida Public Defenders Association representing The Honorable Bob Dillinger
April Lott, Directions for Living representing Florida Council for Community Mental Health
Melissa Larkin-Skinner, Centerstone of Florida representing Florida Alcohol and Drug Abuse Association
Tammy Tucker, Memorial Healthcare System representing Behavioral Health Care Council of the Florida Hospital Association
Dr. Mariam Rahmani, Florida Psychiatric Society
Dr. Rajiv Tandon, National Alliance on Mental Illness
Nancy Daniels, Florida Public Defender Association, parent representative
Gayla Sumner, Florida Department of Juvenile Justice
Dr. Patty Babcock, Florida State University College of Medicine
April May, DCF Regional Substance Abuse and Mental Health Director, Suncoast Region
Sandy Neidert, Office of State Courts Administrator
Derek McCarron, Gracepoint Wellness and Behavioral Health Center, representing Children’s Crisis Stabilization Units
Kathy Smith, Public Defender, 20th Judicial Circuit representing the Supreme Court Task Force on Mental Health and Substance Abuse
Other attendees:
We didn’t catch all of the name and apologize for any inaccuracies. If you were left off or your name was incomplete or spelled incorrectly, please let us know and we can update the minutes.
Andrea Gates-Gonzalez
Jennifer Shepherd
William Hightower, Florida Osteopathic Medical Association
Margo Adams, Florida Psychiatric Society
Tim Macsuga
Patricia Green with Met? representing Florida Psychiatric Society
Pat Bianca, Jackson Behavioral Health
Stacey Riley, Henderson Behavioral Health
Lourdes Martin, Southern Region SAMH
Andrea ? New Horizons of the Treasure Coast
Norma Wagner Behavioral Health Coalition
Margaret O’Rourke, Behavioral Health Center with Indian River Medical Center
Brandy Cross, Behavioral Health Center with Indian River Medical Center
Margie Menzel, Guardian ad Litum Office
Jeff Harman, Florida State University
Denise Demps, Orange County Sheriff Office
Jill Graham with Florida Alcohol and Drug Abuse Association
Tory Wilson, DCF
Jane Johnson,
Staff:
Heather Allman, DCF SAMH
Laurie Blades, DCF SAMH
Mary Schrenker, DCF SAMH
Key Stakeholder Survey Review
Key Stakeholders Surveyed (250 total respondents as of 10/3/17)
1. Parents/caregivers (15)
2. Substance Abuse Mental Health Regional Directors/DCF (10)
3. Baker Act Receiving Facilities serving children (39)
4. Mobil Crisis Teams (8)
5. School Superintendents (14)
6. School Resource Officers (98)
7. Law Enforcement/Florida Sherriff’s Association and Florida’s Police Chiefs (55)
8. Public Defenders (11)
Overview of Survey
The survey was designed to address the four areas identified by the legislature with questions specific to HB 1121 and questions tailored to the key stakeholder group. Some questions were the same across all surveys, others were specific to the target group. Questions with yes/no answers allowed for entry of an answer when the response was yes. Some started the survey but didn’t finish it.
The responses are still coming in. The draft summary document summarizes the answers to questions including major themes as well as comments that may have been from only one person.
Survey Review: Discussion and Comments
Discussed looking at responses by county to compare to actual data to see if the perception matches the data. Significant was not defined. The responses are the perceptions of the respondent. DCF can provide the number of respondents by county and respondent type for the last meeting on October 11 but there isn’t time for a deeper analysis.
Answers from receiving facilities were probably heavily weighted to the publicly funded facilities who serve a third of the acute care stays. There are private facilities who have higher utilization and this has an impact on perceptions.
A finding for the task force could be that data is insufficient, changing forms to require more details.
The data is deficit on dispositions, not on admissions. No data on hearings, incomplete data on length of stay. University of South Florida (USF) has a great deal of information on admissions, but no data on discharge within 2 hours vs those retained for 72 hours or longer. Plan for next meeting is to have Dr. Christy speak to what data we have, what we don’t have, what we need, and recommendations for changes in data collection.
A participant by phone discussed the following concerns; however, they have not been confirmed by AHCA. The Department will request data from AHCA related to the length of stay and recidivism. Statewide Inpatient Psychiatric Program (SIPP) changes due to managed care was discussed. Prior to managed care, average length of stay was 280 days. With Magellan, stay decreased to 170 days and recidivism almost doubled and we also saw a spike in Baker Acts. Current average length of stay is 90 days. And recidivism has increased. Number of SIPPs has decreased from 16-11. Repeated BAs of specific children could be due to no available SIPP bed or being discharged too soon. May be harder to get at this. The Agency for Health Care Administration probably has some data we may be able to get but we’d probably have to drill down a lot. This could be a recommendation from the task force to look into this. Difficulty with the available data is the forms don’t always have complete information to identify multiple admissions.
Dr. Christy said if she gets DOB and SSN for children receiving SIPP services, she can pull BA data for them. Probably not in time for report.
Discussion on Themes:
· SIPP is a good one, not sure how prevalent, but would be good to gather more information.
· Issues around social media, youth suicide.
· Change in MMA plans requires additional exploration.
· Although not in scope of report, hearings keep coming up and is a substantial area of interest.
· Discussed in first meeting school districts and SEDNET projects having an impact on alternatives.
· Challenge is how do we segment it, develop those kinds of themes to carry forward into final recommendations and findings.
· Due to lack of funding, there is a bend toward using deep end services because the front-end services are lacking. Absence of options, acute care services are what is accessed. Can’t lose sight that we are trying to save lives, last thing we want is a child hurting themselves or others. Need to build out the entire system of care, have prevention in schools. Some things come and go as funding comes when there is a tragedy.
· Local system of care is different in different areas. Some areas have mobile crisis teams and decent access to services, others have neither. Prevention and early intervention needs to be in place.
Preparation for Final Meeting - Homework Assignment:
Themes around capacity of schools, capacity of parents. What are the themes we can identify to answer the four questions we are responsible for reporting on. Please look at the survey, minutes, and meeting materials which are all available on the DCF website. Be thinking about how we can put this in a cohesive report. Don’t lose essential critical stuff in the discussions, but look at the critical themes for the report. Recognizing we have learned a lot of lessons that the state can benefit from regarding data collection.
How do you want to structure the last meeting? We were thinking of structuring around the four questions we need to address in the report. The report comes from the task force. Goal for the final meeting is for DCF to walk away with the information we need to write the report.
Discussion on looking at data with eye on characteristics of the children involved in Florida’s mental health system to help keep in context – meaning information on whether there has been an increase in the number of children receiving mental health services, children living in stressful situations. We have criteria for our target population but the major missing piece is the children served by Medicaid which is a high proportion. It has been a struggle obtain usable data from Medicaid because Baker Acts cannot be isolated in their system. Can look at Florida Kid’s Count to see if there is anything to help put in context.
Task force would like DCF to ask Dr. Noreen Dollard with USF to attend meeting to discuss Kid’s Count data? Annie E Casey has national Kids Count data with a lot of information on the state of the state of our children in general – we will put a link on our website.
A study from CDC on shortage of child psychiatrists was mentioned and will be sent to DCF to put on the website with the other meeting materials.
For next meeting, please review at all materials from meetings, look at our four tasks. Be prepared to discuss how to put in report.