The Alleghany Highlands Community Services Board held its regular meeting on January 16, 2014 at 5:30 p.m. at the Administration Office located at 205 E. Hawthorne Street, Covington, VA.

PRESENT: Robert McCallister, Lisa Hicks, Anne Dean, Connie Back and Carla Dobbs.

Also present: Ingrid W. Barber, Executive Director; QuoVadis Washington-Brown, Director of Outpatient and Support Services; Angie Goodbar, Director of Intellectual Disabilities Services, Cara Major, HR Manager, Adam Kenny, IT Manager and Nancy Curry, Quality Improvement Manager.

Absent: Teresa Johnson, Robert H. Johnson, Jr., Charli Laws, Nolan Nicely and Donna Conner.

Bob McCallister called the meeting to order at 5:30 p.m.

Bob McCallister welcomed visitor, Paula Mitchell, Vice President of Behavioral Health Services at Lewis Gale Regional Health System.

Ingrid asked Ms. Mitchell if she would tell the group a little about herself and how she works with the CSB’s and Catawba Regional Partnership.

Paula discussed how the Catawba Regional Partnership came about approximately 12 years ago. The partnership consists of Carillion, Lewis Gale, Alleghany Highlands Community Services, Blue Ridge Behavioral Health and Catawba State Hospital. She stated that over the years they have added other partners such as the Rescue Mission, Community Court Corrections, NAMI, Mental Health America and the Veterans Administration.

They started with a dream of creating a single point of entry. The purpose was to try to make it easier for those with Mental Illness and/or Substance Abuse to be able to access services. Twelve years later they are still working on this ideal purpose. Tearing down the silos was huge. She recognized Nancy Curry as the first project manager when they started to really formalize the partnership. They looked at ways to benefit the patient. They developed community treatment plans because they discovered a patient would leave one facility and go to the next, the patient may have had a medication change and the process would start all over again. This process was not very effective.

They looked at all of the courses of treatment; Nancy did an intensive amount of review of all that data. They looked at what seemed to work the best for the patients. They began to share information with other facilities because under HIPAA this was allowed and in turn the partnership was able to do the right things for the patient. This partnership has been able to reduce the number of hospital stays and have had some patients actually graduate from the treatment plan because they were doing so well.

Paula discussed that when the Partnership originally started there was a State-wide Pharmacy and that the Partnership actually got the first local pharmacy at the Health Department. Because of this the Partnership was able to locally manage this resource. The partnership basically broke down some of the silos to bring together everyone in a forum to discuss the issues and barriers that they were faced with. Specifically with Alleghany they have brought services back to the community. Several years ago the Partnership looked at opening a Geriatric Unit. They evaluated the whole picture for this Geriatric unit. Lewis-Gale ended up transferring 15 beds from their Geriatric unit to Alleghany Hospital so that Alleghany could add a 15 bed Geriatric Unit.

This has been a wonderful year. It is getting more noticed and more awareness across the market. They are receiving patients from all across the state. Even though it is challenging on the discharge side, it is meeting the needs of the patients and we are hearing great things about the services that are being provided.

Paula thanked both Ingrid and QuoVadis for being instrumental in getting this process started. As Paula stated the Special Justice that we have is very committed to the patients and is doing a great service. Initially we were receiving numerous patients from all markets of the state and now, due to more education and promotion of the Geriatric Unit, we are now experiencing a consistent 19% of the patients coming from the Alleghany catchment area. The Partnership just wanted to make sure we were adequately serving the needed population of Alleghany as well as other regions of the state.

The Partnership’s mission is to serve anyone in the Commonwealth, but particularly want to serve those in our region that need services. Paula thanked Alleghany Highlands Community Services for being such a great team in bringing the patients to our community and making sure they are cared for even if they need to go outside of our catchment area for services.

Paula also stated that she serves on the Board for the Department of Behavioral Health and Developmental Services. She is in her second year and is starting to visit different boards in Southwest Virginia. She stated to Ingrid and QuoVadis that if there are any issues or concerns that the Board needs to be paying closer attention to, Paula would be happy to provide her assistance.

Ingrid thanked Paula for taking the time to come speak at the Board Meeting and welcomed her to come back any time. Ingrid stated that Alleghany Highlands Community Services appreciates Lewis-Gale and Lewis-Gale Alleghany Regional when we have patients that need to be served.

Carla Dobbs stated that the Alleghany Community Services Board provides Alleghany Regional Hospital with a wonderful support system. When the hospital has a patient come in AHCS quickly offers the hospital the support needed for the patient. From the Hospital’s perspective Carla stated they greatly appreciate Alleghany Highlands Community Services’ collaborating and helping the patients.

Bob McCallister welcomed AHCS New and Former Board Member Anne Dean. Anne is a valuable asset to AHCS Board. Ingrid stated that Anne had served about 20 years with the CSB.

Anne Dean retired from Alleghany High School after 30 years as a Learning Disabilities Specialist. Chairman of the Special Education Department and retired from that position in 2008. Since 2008, Anne has been teaching part-time at the Boys Home School. Anne is delighted to be back on the Board for Alleghany Highlands.

Bob McCallister welcomed AHCS New and Former HR Manager Cara Major. Bob was delighted that she has come back to ACHS.

APPROVAL OF MINUTES OF November 18, 2013 REGULAR MEETING
MOTION: That the Board approve the minutes of the November 18, 2013 regular meeting.
MOTION: Carla Dobbs
SECOND: Lisa Hicks
VOTE: Unanimous

Ingrid shared with the Board the 2014 AHCSB Strategic Plan in summary. The Leadership Team meets to review and discuss the next year’s Strategic Plan. Mission and Vision statement will stand as is; there were no changes. These correlate with the Department’s vision statement as well. Ingrid discussed that here at Alleghany we look at the Strategic Plan annually. Last year we came up some Core Values: Integrity, Respect, Professionalism, Accountability, Compassion, Innovation and Teamwork. AHCS Motto: Enhancing the quality of life one individual at a time. This will remain unchanged for next year.
AHCS Goals: We set goals for the organization that are attainable. If the Agency does not achieve all the goals during the year due to other barriers, we will make sure to keep that goal on the Strategic Plan for the following year. We have five areas: Organizational Effectiveness, Services, Advocacy, Partnerships and Workforce. Ingrid briefly discussed each bullet item listed within these five areas of Goals for the Agency.

The 2014 Strategic Plan is posted on the website for Alleghany Highlands Community Services.

PROGRAM REPORTS

Mental Health & Substance Abuse
QuoVadis Washington-Brown provided the following report:

• QuoVadis reported that she may need to increase her Access staff due to the increase in clients. AHCS currently has 2 staff that work the hours between 12:30 – 3:30 pm and at one point they had 7 clients at one time. Typically there are about 3 to 4 clients per day on average.

• QuoVadis reported that we have an addition to our Psychiatric Services team, Dr. Jagadamba Pandit, M.D. Dr. Pandit joined out team on January 2, 2014. Dr. Pandit has eagerly begun seeing clients and has a particular interest in working with the substance use disorder population.

• QuoVadis reported that we may begin a medication management group for those individuals that have difficulty with understanding the side effects of medications.

• QuoVadis reported that Dr. Bates, AHCS Child Psychiatrist will be increasing his time for services by 2 hours per week since he retired from being the Medical Director for the Commonwealth.

• QuoVadis reported Dr. Snead, a locum tenum physician will end his tenure with AHCS at the end of February. During this time, we are working on transitioning his patients over to Dr. Pandit and Dr. Bates. We should have this completed by end of February.

• QuoVadis reported that we are continuing to work on collaborative documentation and we will have a pilot to Train the Trainers so that we have the trainers on-site. Then AHCS will be able to provide that to our staff when they are hired.

• QuoVadis reported that we will be working on the daily living assessment tool that will help us to determine how well individuals are functioning. Currently we are using a Global Assessment Functioning scale. We believe this new tool will be understood better than our current system by the client, the clinician and others that work with us. We will get this built into the system as soon as we get the training for everyone.

• QuoVadis mentioned that the remainder of her report will be discussed later by Ingrid dealing with the proposed budget actions and regulations for mental health services, crisis response, and Department of Medical Assistance Services’ information impacting Behavioral Health.

• QuoVadis reported that currently AHCS has 11 consumers that are in State Facilities (1 in Western State Hospital; 10 in Catawba State Hospital)

• QuoVadis reported that AHCS has 2 consumers on the Extraordinary Barriers List. We have 1 close to discharge potentially 1/31/2014. We have 1 ready for discharge in need of Nursing Home Placement. Director scheduling to meet with Hospital Discharge Planner and CM Supervisor to discuss options.

• QuoVadis reported that she and Donna Conner would be meeting with Kate Marshall, Director of Admissions at Catawba State Hospital on January 27, 2014 to discuss if there are additional things AHCS should be doing to help assist in moving individuals out of the hospital in a timely manner.

Intellectual Disabilities
Angie Goodbar provided the following report:

• Angie reported the Infant/Toddler Program had a quality management review by Part C Medicaid that looked at services billed over the past year. The audit went well and the findings were expected in that they were identified during internal auditing procedures. The feedback was positive overall. The evaluators also commended the local system for the QMR process already in place. Holiday cards went out to families and referral sources this season. The current child count compared to the count last year reflects an increase in number served. Last December, there was a total of 30 infants/toddlers receiving services. This December, 47 infants/ toddlers are enrolled in services.

• Angie reported that Support Coordinators will start collecting data quarterly on eight domains including health, safety and community inclusion in order to comply with the DBHDS/DOJ Phase II data collection requirements. The electronic health record forms have been modified to capture the required data elements.

• Angie reported that AHCS has been approached by Logisticare with the proposition to expand the CSB’s current transportation program to include transportation for dialysis patients residing in the community. The CSB is willing to expand services as it falls within the AHCS strategic plan as a way to give back to the community. Two additional van drivers have been hired in an effort to prepare for this expansion. The ID Director and the MH/SA Director are working collaboratively on a grant application to the Department of Rail and Public Transportation to acquire additional handicap accessible vehicles.

• Angie reported that AHCS has invested in renovations at Friendship Residence on Alleghany Street in Clifton Forge. A new central air and heat pump has been installed. Sheetrock is being mounted in the basement area to block off storage areas for the water heaters, boiler, electrical equipment, chemicals and the emergency preparedness items. The old wiring from a previous upgrade is being removed. The facility staff assisted in a “clean up” day in November to help remove unwanted and unused items from the home. Residents and families are very pleased with the renovations and upgrades.

• Angie reported that the Merryfield Residence is in the process of installing a new generator that will power the entire facility in the event of a natural disaster or any power outage. The gas line had to be replaced at the facility in order to increase the gas load to power the generator.

• Angie reported that AHCS is pleased to announce that the Direct Support Professional Staff (DSP’s) in residential services received a pay increase in December. Hopefully this increase will attract qualified staff and also decrease turnover in the residential program area.

• Angie reported that Amanda Webb, Public Guardianship Inc. Program Director currently provides guardianship to 15 individuals. Amanda reports to a multidisciplinary team and Public Guardianship Board. With the assistance of the multidisciplinary team, Amanda has consented to emergent and non-emergent surgeries for individuals. This continues to be a valuable service to the incapacitated individuals in our community and there is a waiting list of approximately 25 individuals. The Public Guardianship Program is scheduled for the annual Department of Aging and Rehab Services Monitoring Review on March 12-14th.

• Angie reported that the holiday months brought about many activities for the individuals served. Merryfield Residents had dinner in Lexington and went to Natural Bridge to enjoy the “Drama on Creation” in November. They also made “no sew” blankets for the Woodlands Nursing Home as a community services project.

• Angie reported that a Holiday Luncheon for all individuals receiving services was provided at Fudge Street Café on Dec. 7th. Entertainment was provided by the STARS Performers that sung Christmas Carols. Day Support Participants also rang hand bells to three different Christmas songs. One individual read the poem “Twas the night before Christmas”. Other holiday luncheons were held at Life Skills Day Support Program and Friendship Residence. Families were invited to join their loved ones during these program events.

Quality Improvement
Nancy Curry provided the following report:

UR, Compliance and EHR

• Nancy reported that annually the agency is required to review all AHCS policies and procedures. We start this project in January of each year. A committee has been chosen for this project. In addition, each program/department will be asked to review their specific policy and procedures also.
• Nancy reported that she attended the quarterly Local Human Rights Committee Meeting in Roanoke to present AHCS report.

Credentialing
• Nancy reported that AHCS currently has 6 staff in various stages of the credentialing process. This update is presented for where we currently stand at the time of each Board Meeting.

Staff Development
• Nancy reported that four AHCS RN’s participated in Medication Administrations Instructor Training. This allows them to train and provide oversight to our staff who are required to be medication administration aides. Medication Administration training consists of an initial 32 hr. course with an annual 8 hr. refresher.
• Nancy made presentation to the Alleghany Highlands School Safety Committee on Mental Health First Aid. One of the attendees expressed interest in having us provide the training for the school guidance counselors. We will be scheduling a MHFA training that will be open to anyone in the community.

Other
• Nancy reported that AHCS recruited and hired a new QI position. Welcome Jill Upchurch as our new QI Specialist. Her primary job duties will be providing QI oversight for Merryfield ICF-IID. She will also assist QI Manager in other duties i.e. backup for CHRIS/incident reporting, training, investigations, audits.
• Nancy attended the VA Credible Users’ Meeting in Charlottesville.

IT Manager Report
Adam Kenny provided the following report:

Help Desk
• Complete 26 help desk requests.

EHR
• Completed CCS training for all program areas.
• Completed form changes for MH Supports.
• Completed form changes for MH Block grant requirements.
• Completed form changes for Clubhouse Magellan requirements.
• Completed form changes for ID DOJ Settlement requirements.

Hardware and Networking
• Reconfigured the wireless network at Friendship house to allow for network authentication.
• Installed new computers in Lifeskills, Merryfield, and Admin.
• Setup scanning infrastructure in ID.
• Started installation and configuration of Server 2012.
• Purchased Chromebooks for new ID In-Home pilot program.
• Purchased new computers for MH Front Office
• Planned time clock installations
• Setup server for time keeping software

Other
• Attended monthly DMC meetings in Richmond.
• Completed new System Access form.
• Attended VA Credible User Group Meeting.
• Started researching Office 365.
• Attended agency Jingle Mingle events.
• Completed Medicaid Incentive enrollment for all doctors, 2 have been paid. Attended Open Minds conference in Philadelphia.

Human Resources
Cara Major reported the following:
Turnover
• Reported 35 new hires and 30 terminations for the months of Nov/Dec. (4 Retired)
• Reported the turnover rate of 19.35% for FY14 %.

Loss Report
• Reported 2 Worker’s Comp Claims and No Auto/Property Claims.
• We have received some payments from VACO for the MH roof claim.

Advertising/Recruitment
• Reported that advertising for open positions are published through VEC, Job.Roanoke.com, Indeed, Monster, VA Review, Roanoke, Lewisburg, Southwest Virginia Journal, Lexington.
• Cara reported the following filled positions
Administration
o HR Manager
o HR Coordinator
o Quality Assurance Specialist
Intellectual Disabilities
o DSP
o Home DSP (2), Merryfield (2), Friendship (2)
o RN – Merryfield
Mental Health
o State Hospital Discharge Planner/Case Manager, Recovery Specialist, and NGRI Coordinator
o Psychosocial Technician
o Mental Health Supports-QMHP-E (1)
o Case Manager (1)

• Reported the following Open positions:
Intellectual Disabilities
o Direct Support Professional (In-Home and Merryfield)

Mental Health
o Support Provider (Full-Time)
o New Beginnings Support Provider (Full-Time)
o Case Manager (Full-Time)
o Licensed Clinical Services Supervisor
o Emergency Services Clinician
General Updates
• December 10 & 11- Jingle Mingle for all employees with door prizes
• FY 13 Annual Report is in progress
• VRS Hybrid Retirement began January 1, 2014 – policies have been drafted to reflect short term disability
• 3% increase for all employees effective January 1, 2014
• W2s and 1099s are being processed for distribution by January 31, 2014
• Employee appreciation day is being planned for March 7, 2014
Participation
Cara plans to register to attend Woods Rogers, SHRM, VACSB, and Sesco trainings in 2014.

Financial Reports
Donna Conner was absent from meeting therefore Ingrid reported the following:

Balance Sheet:
▪Total Cash at the end of December 2013 is $973,175, an increase of approximately $82,000 since November. (Total cash includes $54,658 from the Foundation)
▪Total Assets decreased by $15,172 since November 2013.
▪Total Liabilities decreased by $31,888 since November 2013.
▪Total Stockholders’ Equity is $1,781,292 at the end of December 2013, an increase since November of $16,716. (Current month surplus)

Income Statement:
Total Agency for the month of December closed with a Net Surplus of $16,716 and YTD Net Surplus of $151,257.

EXECUTIVE DIRECTOR’S REPORT AND RECOMMENDATIONS
Ingrid Barber provided the following report:

She talked about the upcoming Alleghany Highlands Chamber of Commerce Annual Dinner to be held on March 22, 2014.

Old Business
• Ingrid talked about the 2014 Biennial Report – The Virginia Public Guardian & Conservator Program/Public Guardianship Update. This report revealed that there are a total of 601 adults across the state of Virginia who are in need of these services.
• Ingrid gave an update on the Catawba Regional Partnership. BRBH has hired a new Executive Director, Debbie Bonniwell.

New Business
• Ingrid reported on the Virginia Association of Community Services Board’s 2012 Building the Future Data.
• Ingrid reported on the Governor’s Proposed Budget Amendments FY 2014-2016 Biennial Report.
• Ingrid reported on the Discharge Assistance Plans, Extraordinary Barriers List, State Hospitals Census Update, and Waiting List for Waiver Services.
• Ingrid reported on the ACA Medicaid Expansion.
• Ingrid reported on the Locality Funding Requests for 2015 for City of Covington and Alleghany County.
• Ingrid reported on the Appointment of Committees for FY 2014 for the vacant seats of Board Members.
• Ingrid reported on the VACSB Budget Update-Public Hearing/Legislative Priorities.

CLOSED SESSION
CODE OF VIRGINIA: PERSONNEL 2.2-3711.A.1
MOTION: That the Board enter closed session to discuss Personnel Matters and Real Estate, as authorized by the Code of Virginia Sections 2.2-3711A.1.
MOTION: Connie Back
SECOND: Lisa Hicks
VOTE: Unanimous
TIME: 7:26 p.m.

CERTIFICATION OF EXECUTIVE SESSION
A signed roll call was taken for each member present who certified that to the best of the member’s knowledge that:
– Only public business matters lawfully exempted from opening meeting requirements by Virginia law were discussed in the closed meeting to which this certification applies; and only such public business matters as were identified in the motion convening the closed meeting were heard, discussed or considered by the Alleghany Highlands Community Services Board.

ADJOURNMENT
MOTION: That the January 16, 2014 regular meeting of the Alleghany Highlands Community Services Board be adjourned.
MOTION: Carla Dobbs
SECOND: Anne Dean
VOTE: Unanimous
TIME: 8:00 p.m.

NEXT MEETING
The next scheduled Board Meeting will be on Thursday, March 27, 2014 at 5:00 pm. at the Moody Center/Lifeskills Building in Clifton Forge, Virginia.