FINAL DRAFT Meeting #19 Minutes 9:00 a.m. Winter's Tower, … · 2019-01-22 · FINAL DRAFT Meeting...

Joint Committee on Access and Forensic Services • October 31, 2018 • Meeting #19 Minutes • of 7

Joint Committee on Access and Forensic Services

FINAL DRAFT Meeting #19 Minutes

Wednesday, October 31, 2018

9:00 a.m.

Winter's Tower, Public Hearing Room 125

701 West 51st Street, Austin, TX 78751

Agenda Item 1: Opening remarks and introductions

The Joint Committee on Access and Forensic Services (JCAFS) meeting was called to order

at 9:10 a.m. by Mr. Stephen Glazier, Chair. Mr. Glazier welcomed everyone to the meeting

and then asked committee members to introduce themselves, as well as state staff and

members of the public. Mr. Glazier notified members that agenda item #4 regarding

presentation on the preliminary JCAFS data dashboard would be struck from today’s agenda

and taken up during the January 2019 meeting.

Mr. John Chacón, Advisory Committee Coordination Office (ACCO), Health and Human

Services Commission (HHSC), announced that the meeting was being conducted in

accordance with the Texas Open Meetings Act, and noted that a quorum was not present for

the meeting.

Table 1 notes Committee member attendance.

Table 1: JCAFS member attendance at the Wednesday, October 31, 2018 meeting.

MEMBER NAME YES NO MEMBER NAME YES NO

Allison, Jim -

Representing County Judges

and Commissioners

Association of Texas

X Hayes, Aaryce –

Representing Disability

Rights Texas

X

Burkeen, Honorable Daniel -

Representing Texas

Association of Counties

X

Holcomb, Valerie –

Representing the DSHS

Council for Advising and

Planning for the Prevention

and Treatment of Mental

and Substance Use

Disorders

X

Cusumano, Sherry –




and Treatment of Mental and

Substance Use Disorders

(9:27am)

P

Johnson, Windy –

Representing the Texas

Conference of Urban

Counties

X

Davis, Susan JD –

Representing State Supported

Living Center that provides

forensic services designated by

the Texas Department of Aging

and Disability Services

X McLaughlin, Darlene MD –


Municipal League

X

Desai, Tushar MD –


Juvenile Justice Department

X

Oncken, Denise –


District and County

Attorneys Association

X


Echessa, Leonard –


Department of Criminal Justice

X

Smith, Shelley –


Council of Community

Centers

X

Evans, David – Representing

the Texas Council of

Community Centers

X

Smith, James –

Representing DSHS as a

superintendent of a state

hospital with a maximum

security forensic unit (PM

only)

Faubion, Matthew MD –

Representing DSHS as



security forensic unit

X

Taylor, Sally MD –


Hospital Association as a

physician

X

Glazier, Stephen M. –


Hospital Association

X

Vasquez, Amanda –


Correctional Office on

Offenders with Medical or

Mental Impairments

X

Wilson, Sheriff Dennis –

Representing the Sheriffs'

Association of Texas (PM

only)

X

Yes: Indicates attended the meeting No: Indicates did not attend the meeting P: Indicates phone conference call

Agenda Item 2: Approval of minutes from July 25, 2018 committee meeting

Mr. Stephen Glazier noted that a quorum was not present and therefore action could not be

taken and that this agenda item would be tabled until the next quarterly meeting scheduled

in January of 2019.

Agenda Item 3: Review of the preliminary draft committee annual report Part I

Mr. Stephen Glazier asked committee members to review the preliminary draft committee

annual report and referenced handouts entitled “Joint Committee on Access and Forensic

Services (JCAFS): 2018 Annual Report” and “Joint Committee on Access and Forensic

Services: Workgroup Recommendation.” Highlights of the review and committee member

discussion included:

Mr. Glazier, Chair recommended that the committee review the report draft and then

give the authority to the Chair to finalize the report since the committee would not

be meeting again until after the report is due but due to a lack of a quorum there

was no action taken on this recommendation.

Dr. Darlene McLaughlin recommended that the updates on agenda item #7 and the

presentation on agenda item #5 be provided before going any further into this

discussion as it would add more insight into the crafting of draft report and by

consensus members agreed.

Agenda Item 4: Presentation on the preliminary JCAFS data dashboard

Mr. Glazier notified members during the welcome and opening remarks that agenda item #4

regarding presentation on the preliminary JCAFS data dashboard would be struck from

today’s agenda and taken up during the January 2019 meeting.


Agenda Item 7: Updates Part I

a. Judicial Commission on Mental Health: Judicial Summit on Mental Health

b. The Judge Ed Emmett Mental Health Diversion Center

c. Outpatient Competency Restoration External Stakeholder Rules Workgroup

Dr. Courtney Harvey provided an update on the Judicial Commission on Mental Health:

Judicial Summit on Mental Health. Highlight of update and committee member discussion

included:

The Judicial Commission on Mental Health hosted its Judicial Summit on Mental Health

which preceded the Meadows Mental Health Policy Institute’s Engage and Excel

Conference, October 22-23, 2018 in Houston.

The summit was well attended with over 300 attendees and there were presentations on

specialty courts and the benefits of specialty courts; the sharing of confidential

information between law enforcement, judicial, and mental health providers as

permissible by HIPAA and state statutes such as HSC, Chapter 614; and level setting on

mental illness and IDD.

On the second day of the meeting, attendees were grouped into HHSC health regions

and asked to review the Sequential Intercept Model with a heavy focus on intercepts 1-3

and asked to discuss: o Where they are by way of regional planning; o Gaps in resources at each intercept point; and o A plan for collaborating to address each intercept point.

Dr. Darlene McLaughlin commented that there are many areas where law enforcement and

courts are not yet engaged in alternative justice models. She emphasized that it is

important for local stakeholders to meet with local officials to introduce these ideas and best

practices, identify gaps and strategies for increased diversion from jail.

Ms. Amanda Vasquez commented that the regional breakout sessions were very

informative. She stated that counties are in very different places along the engagement

continuum, and that many areas might benefit from cross-county meetings to share best

practices and strategies. She stated that it might be helpful for JCAFS members to share

ideas when they visit local service areas, and that cost comparisons might increase buy-in

from counties.

Dr. Courtney Harvey stated that the Judicial Mental Health Commission will be creating a

clearinghouse where information about best practices and strategies for jail diversion can be

shared.

Ms. Denise Oncken stated that there are models for local collaboration that might provide a

template for bringing stakeholders from multiple counties together, such as Child Fatality

Review teams and Community Resource Coordination Groups.

Ms. Shelly Smith commented that she represents a very rural area where alternative

partnership models have been created. She stated that collaboration is achievable in rural

areas even though their circumstances differ from urban areas.

Mr. David Evans suggested identifying policy levers that the state could use to support and

facilitate strength-based collaboration at the local level.

Mr. Stephen Glazier, Chair stated the JCAFS will reach out to secure copies of presentations

and consider how the committee can support local processes. He stated that there is an


opportunity for synergy between JCAFS, the Judicial Commission on Mental Health and the

Behavioral Health Advisory Committee.

Public Comment:

Ms. Anna Gray, representing herself as an advocate for people with lived experience of

mental health issues, provided public comment and stated that it was heartening to see the

passion and commitment to make the system work better for people. However, she noted

that strategies such as increased use of guardianship and Assisted Outpatient Treatment

take agency away from people and decrease their engagement and intrinsic motivation.

She encouraged members to focus on strategies that minimize the involvement of law

enforcement and rely on other community supports.

Agenda Item 5: Presentation on State Hospital System and Opportunities for Texas

Deputy Executive Commissioner Mike Maples presented on the State Hospital System and

Opportunities for Texas and referenced a PowerPoint entitled “State Hospital System and

Opportunities for Texas”. Highlights of the presentation and committee member discussion

included: Mr. Mike Maples stated that Health and Specialty Care Services is focused on three key

issues: bed capacity, statutory issues, and efficient use of beds.

The increasing number of forensic patients in state hospitals is resulting in longer

lengths of stay and decreased turnover of available beds.

The state is increasing the number of purchased community beds for short-term

stabilization, but civil patients that are coming to the state hospitals have more

complex needs which require longer lengths of stay.

To be more efficient, the system needs to decrease length of stay and free up

capacity for individuals on the waiting list.

Many patients remain in the state hospital longer than necessary because there isn’t

a suitable place for them to go after they are stabilized. A significant number of

them need a structured, supervised environment for a period of time.

Mr. Dennis Wilson stated that there is a need for courts to more engaged in mental health

issues and possibly for statutory changes to be made.

Mr. Maples noted that the state hospitals do not have control over forensic discharges. He

stated that one possible strategy that might make the courts more comfortable with

discharge would be the creation of an external review board that advises judges on forensic

discharges. He stated that Outpatient Competency Restoration programs could be utilized to

serve patients that have misdemeanor charges instead of sending them to state hospitals

for competency restoration, and that many patients could avoid hospitalization if they were

able to receive appropriate medications while they were waiting in jail. He also emphasized

the importance of continuing to expand the number of purchased community psychiatric

beds.

Ms. Sally Taylor noted that the state must address workforce challenges in order to continue

expanding bed capacity.


Public Comment:

Ms. Anna Gray, representing herself as an advocate for people with lived experience of

mental health issues, provided public comment and stated that longer lengths of stay have

a negative impact on individuals; there is increased skills erosion and loss of community

connections and resources. She said it is important for peers to be at the table as

discussions continue and for the focus to be on pathways to recovery.

Agenda Item 7: Updates Part II

a. Judicial Commission on Mental Health: Judicial Summit on Mental Health

b. The Judge Ed Emmett Mental Health Diversion Center

c. Outpatient Competency Restoration External Stakeholder Rules Workgroup

Ms. Denise Oncken provided an update on The Judge Ed Emmett Mental Health Diversion

Center and referenced PowerPoint entitled “The Judge Ed Emmett Mental Health Diversion

Center – Harris County, Texas.” This is a pre-charge diversion program targeting low-level

offenses.

Dr. Courtney Harvey provided an update on the Outpatient Competency Restoration

External Stakeholder Rules Workgroup. She stated that the workgroup met on five

occasions between July and September 2018 and we will meet again October 12, 2018. The

workgroup has established standards regarding:

Eligibility and ineligibility criteria;

Information that must be provided to criminal courts to support a recommendation

about treatment in OCR;

The services that should encompass competency restoration services;

Requirements for assessment, reassessment, and court reporting;

Discharge planning; and

Outcomes.

The workgroup has also identified several gaps in competency restoration practices that

would require legislative attention to address such as clarifying in the statute academic or

training requirements for individuals making a recommendation on a person’s competency

status post treatment and clarifying who is an eligible provider of OCR services and under

what regulatory authority. The workgroup’s goal is to develop a draft of the rule that is as

ready as it can be prior to the legislative session, as it is likely there will be amendments to

Code of Criminal Procedure, Chapter 46B that may warrant additional revisions to the rule.

The workgroup will resume workgroup meetings after the legislative session, finalize a draft

copy of the rules, and proceed with further external vetting through informal and formal

processes.

Agenda Item 3: Review of the preliminary draft committee annual report Part II

Mr. Stephen Glazier asked committee members to review the preliminary draft committee

annual report and referenced handouts entitled “Joint Committee on Access and Forensic

Services (JCAFS): 2018 Annual Report” and “Joint Committee on Access and Forensic

Services: Workgroup Recommendation”. Highlights of the committee member discussion

included:

Mr. David Evans stated that the committee should consider recommending funding to

maintain existing initiatives. He stated that a number of initiatives do not have funding

security, such the new grant programs. Furthermore, the 1115 waiver program will end in


three years. There are approximately 400 behavioral health projects supported by waiver

funds, which constitute 31 percent of current funding for local mental health authorities.

Loss of these funds would be a tremendous setback for the state’s mental health system.

Dr. Matthew Faubian pointed out that the increasing proportion of forensic patients in the

state hospitals has significantly reduced third party payments, and Ms. Shelley Smith noted

that this trend also threatens the ability of the state hospitals to receive disproportionate

share payments.

Ms. Amanda Vasquez stated that she would like to see the committee make a targeted

housing recommendation for individuals with criminal histories.

Public Comment:

Ms. Anna H. Gray, representing herself as an advocate for people with lived experience of

mental health issues, provided public comment and asked that the committee include a

statement about the need for better access to community services to avoid the need for

hospitalization. She also suggested recommending revisions to the requirements for Crisis

Stabilization Units so they are less expensive to operate.

Agenda Item 6: Presentation on the proposed JCAFS vision for 2019

Mr. Stephen Glazier, Chair led the discussion on the proposed JCAFS vision for 2019 and

opened the floor to committee members to share their vision for the committee moving

forward in 2019. Members suggested the following topics for consideration:

Developing a best practices clearinghouse for jail diversion initiatives, including

opportunities for partnering with the Judicial Commission on Mental Health;

Assessing the delivery of psychiatric services in county jails towards preventing

defendants from being determined incompetent to stand trial (IST);

Assessing the utility of Community Resource Coordination Groups and other like

models to staff complex cases with variables preventing client transition from

inpatient to outpatient services and vice versa;

Assessing how implementation of best practices may influence rule, contract, or

statutory changes, as well as, utilizing the results of quality improvement and quality

assurance processes to further influence policy;

Non-hospital-based solutions for people determined IST and those requiring civil

care;

Opportunities to build the behavioral health workforce with a focus on peers and

training all professionals in recovery-based paradigms such as trauma-informed

care;

Cross committee coordination and development of joint committee recommendations

(i.e., the Statewide Behavioral Health Coordinating Council, the Behavioral Health

Advisory Committee, the JCAFS, and the Mental Health Conditions and Substance

Use Disorder Parity Workgroup);

A standing agenda item for updates from other HHSC advisory committees (i.e., the

Statewide Behavioral Health Coordinating Council, the Behavioral Health Advisory

Committee, the JCAFS, and the Mental Health Conditions and Substance Use

Disorder Parity Workgroup);

Assessing opportunities to enhance clinical determination about the appropriate care

for persons and appropriate treatment settings; and

Developing evidence-based recommendations for system change.

Agenda Item 8: Public Comment:

No public comment was offered.


Agenda Item 9: Adjourn

Mr. Stephen Glazier adjourned the meeting at 12:56 p.m.

Below is the link to the archived video of the October 31, 2018 Joint Committee on Access

and Forensic Services AC meeting

(To view and listen to the entirety of the meeting and public comment provided click on the

link below)

https://texashhsc.swagit.com/play/10312018-628

https://texashhsc.swagit.com/play/10312018-628

Joint Committee on Access and Forensic Services • July 25, 2018 • Meeting #18 Minutes • Page 1 of 5

Joint Committee on Access and Forensic Services

FINAL DRAFT Meeting #18 Minutes

Wednesday, July 25, 2018

9:00 a.m.

Winter's Tower, Public Hearing Room 125

701 West 51st Street, Austin, TX 78751

Agenda Item 1: Opening remarks and introductions

The Joint Committee on Access and Forensic Services (JCAFS) meeting was called to order

at 9:12 a.m. by Mr. Stephen Glazier, Chair. Mr. Glazier welcomed everyone to the meeting

and then asked committee members to introduce themselves, as well as state staff and

members of the public. Mr. Glazier notified members that agenda item #6 regarding

potential special teleconference meeting to review the draft 2018 legislative report would be

struck out as a teleconference meeting would not be required and another process to obtain

feedback from committee members will be discussed during agenda item #4 regarding

recommendations to consider for the 2018 legislative report.

Mr. John Chacón, Advisory Committee Coordination Office (ACCO), Health and Human

Services Commission (HHSC), announced that the meeting was being conducted in

accordance with the Texas Open Meetings Act, and noted that a quorum was present for the

meeting.

Table 1 notes Committee member attendance.

Table 1: JCAFS member attendance at the Wednesday, July 25, 2018 meeting.

MEMBER NAME YES NO MEMBER NAME YES NO

Allison, Jim -

Representing County Judges

and Commissioners

Association of Texas

P McLaughlin, Darlene MD –


Municipal League

X

Burkeen, Honorable Daniel -

Representing Texas

Association of Counties

X

Oncken, Denise –


District and County

Attorneys Association

X

Cusumano, Sherry –






(9:27am)

X

Smith, Shelley –


Council of Community

Centers

X

Davis, Susan JD –

Representing State Supported

Living Center that provides

forensic services designated by

the Texas Department of Aging

and Disability Services

X

Smith, James –

Representing DSHS as a



security forensic unit (PM

only)

P

Desai, Tushar MD –


Juvenile Justice Department

X

Taylor, Sally MD –


Hospital Association as a

physician

X


Echessa, Leonard –


Department of Criminal Justice

X

Vasquez, Amanda –


Correctional Office on

Offenders with Medical or

Mental Impairments

X

Evans, David – Representing

the Texas Council of

Community Centers

X

Wilson, Sheriff Dennis –

Representing the Sheriffs'

Association of Texas (PM

only)

P

Faubion, Matthew MD –

Representing DSHS as



security forensic unit

X

Glazier, Stephen M. –


Hospital Association

X

Harvey, Courtney PhD –

Representing HHSC Forensic

Director

X

Hayes, Aaryce – Representing

Disability Rights Texas X

Holcomb, Valerie –






P

Johnson, Windy –


Conference of Urban Counties

X

Yes: Indicates attended the meeting No: Indicates did not attend the meeting P: Indicates phone conference call

Agenda Item 2: Approval of minutes from April 25, 2018 committee meeting

Mr. Stephen Glazier noted that a quorum was present and asked for a motion to approve

minutes from the previous meeting.

MOTION 1:

Ms. Sherry Cusumano moved to approve the minutes from the April 25, 2018 Joint

Committee meeting. Mr. Jim Allison seconded the motion. The Committee members

unanimously approved meeting minutes by voice vote with thirteen yeas, no nays and no

abstentions.

Agenda Item 3: Report from the Access Subcommittee on the 2018 Utilization

Review

Ms. Tamara Allen reviewed the report from the Access Subcommittee on the 2018 Utilization

Review and referred to PowerPoint/handout entitled “Joint Committee on Access and

Forensic Services Report of the Access Subcommittee: Review of Admissions 2018 –

Summary of Findings.” Highlights of committee member discussion included:

It would be helpful to better understand the use of state hospital beds versus contracted

beds and the interaction between them.


Factors influencing readmission include social determinants, services and supports,

homelessness and the availability of transitional residential options, and substance use

involvement.

Mr. David Evans reported that Integral Care has moved from a bed day rate to an

episode rate with a penalty for readmissions, which is designed to provide an incentive

for efficient and effective use of its contracted beds.

The committee emphasized the need to provide better care so readmission is not

needed.

Agenda Item 4: Recommendations to consider for the 2018 legislative report

Dr. Courtney Harvey presented the recommendations to consider for the 2018 legislative

report and referenced handout entitled “Joint Committee on Access and Forensic Services

Workgroup Recommendations”. Highlights of the committee member discussion included:

Mr. Stephen Glazier, Chair, stated that the report should be boiled down to some

prioritized key points. He stated that JCAFS workgroups reported on their

recommendations and this format would make it more readable for the Legislature.

He noted that it is a staff report and does not require approval from this committee

but the staff would like input from the JCAFS committee.

Dr. Courtney Harvey stated that many work group recommendations can be

combined and streamlined.

With regard to workforce issues, the committee highlighted the following strategies:

o Robust loan repayment programs across the professions, to include

individuals with lived experience with mental illness.

o Competitive pay, particularly for staff at the lower end of the pay scale,

including peer providers.

With regard to housing, the committee recommended:

o Expanding resources for a range of housing options for independent living and

structured facility residences, both on the grounds of state hospitals and in

the community.

o Statutory authority to provide appropriate regulation and oversight of a range

of residential settings.

Members advised adding language to indicate that step-down programs can also be

used as “step up” programs for individuals at risk of hospitalization.

It was noted there are long wait lists for programs for adolescents with intellectual

and developmental disabilities (IDD) as well as for IDD waiver programs.

Mr. David Evans pointed out that funding from the Money Follows the Person

demonstration project has been used to develop hubs to support families and

providers in caring for individuals with IDD so they can continue living in the

community. Funding is running out, and it is important to maintain these regional

hubs.

Agenda Item 5: Review of the preliminary draft 2018 legislative report

Ms. Tamara Allen reviewed the preliminary draft of the 2018 legislative report and

referenced handout entitled “Report on State Hospital Bed Day Allocation Methodology and

Utilization Review Protocol for Fiscal Year 2018”. Highlights of the committee member

discussion included:

The report should clearly differentiate statements informed by qualitative information

and those resulting from data analysis.

Mr. Mike Maples, Deputy Executive Commissioner for the Health and Specialty Care

System, asked the committee to consider the evolving role of the state hospitals. The

state is moving toward a system of care where state hospitals focus on the forensic


population and individuals with medical comorbidity and other complex needs. It is

important for communities to have appropriate resources to treat patients requiring

short-term acute stabilization close to home.

Mr. Jim Allison stated that action can be taken to affect current trends, and that it is the

state’s responsibility to provide individuals with their constitutional right to appropriate

care.

The committee noted the need for more permanent supported housing and preventive

interventions, including peer respite.

Ms. Denise Oncken noted that many urban areas are taking action to divert two groups

from criminal justice system: individuals with mental illness who have not committed an

offense and those that have committed low-level crimes. These people should not be in

jail if there is another alternative.

Members also discussed the staffing shortage and recommended better resource sharing

across system, particularly through telemedicine.

Agenda Item 6: Potential special teleconference meeting to review the draft 2018

legislative report

As previously noted during agenda item #1, Mr. Stephen Glazier, Chair notified members

that agenda item #6 regarding potential special teleconference meeting to review the draft

2018 legislative report would be struck out as a teleconference meeting would not be

required.

Agenda Item 7: Presentation from the Behavioral Health Advisory Committee

(BHAC) Housing Subcommittee

Mr. Jason Howell, Chair for the BHAC Housing Subcommittee provided a presentation from

the BHAC Housing Subcommittee and referenced PowerPoint/handout entitled “Housing: A

Vital Resource for Persons with IDD, MH and/or SUD.” Highlight of the discussion included:

Mr. Howell described unintended negative consequences of boarding home regulations.

In eliminating bad actors, regulation has also decreased the availability of these

services. He recommended policies that support good actors, voluntary

accreditation/adherence to standards, and incentives for funders to refer only to

accredited providers. He suggested members consider successful models from around

the nation.

Mr. Howell also noted that many programs are only available for people who have fallen

to a low level of functioning, and that it would be preferable to provide services early so

that individuals do not reach that point.

Aaryce Hayes stated that the Texas Department of Housing and Community Affairs can

share responsibility with HHSC to support and promote meaningful programs. The

Department of Family and Protective Services also needs to be involved, particularly

with respect to youth aging out of foster care.

The committee discussed the need for coordination on housing issues among the Office

of Mental Health Coordination, the Behavioral Health Advisory Committee, the

Behavioral Health Coordinating Council, and the JCAFS.

Agenda Item 8: Public Comment:

Ms. Anna H. Gray representing herself as an advocate for people with lived experience of

mental health issues provided public comment on various issues on agenda items #3, #4,

#5, and #7 and provided input as well.


Ms. Lynda Frost representing herself as a consultant provided public comment on agenda

item #4 regarding the workgroup recommendations specifically around forensic nursing

homes.

Mr. Lee Johnson, Deputy Director representing the Texas Council of Community Centers

provided public comment on agenda item #4 regarding recommendations to consider for

the 2018 legislative report.

Mr. Jim Allison, committee member made a request that metrics should be presented at

every meeting moving forward specifically on the status of the backlog of the waiting list.

Agenda Item 9: Adjourn

Mr. Stephen Glazier adjourned the meeting at 12:27 p.m.

FINAL DRAFT Meeting #19 Minutes 9:00 a.m. Winter's Tower, … · 2019-01-22 · FINAL DRAFT Meeting...

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