Significant mandates arose from an agreement between the U.S. Department of Justice and the State of North Carolina in the latter part of 2012.   This New Year will include a new emphasis on personal agency and choice for individuals using public mental health services in North Carolina!  As a result, our Local Management Entities/Managed Care Organizations (LME/MCOs) are to be ensuring a level of engagement and an emphasis on best service outcomes that we have not seen in our state!  Four state-wide trainings for MCO staff have begun after dozens of people put their heads together to create the training process against at timeline!  Below are some of the training topics.

Diversion of people from inappropriate settings

While the initial target of the DOJ settlement has been the 7,000 or so individuals living in congregate facility settings, the mandates are very far-reaching.  It means focusing more on the potential of people to set goals, grow, and recover rather than assuming dead-end living because people’s deficits are too great to warrant the services they could otherwise have benefited from.

North Carolina, therefore, will be “closing the door” on our overabundance of facilities by carefully screening people for whether they truly need to be in a facility.  Novel idea?  Not so, it has been considered before.  Our state just did not have the political will to implement the actions necessary to ensure people lived more humanely and at least had a choice about where they were placed beyond hospitalizations.  But because of The Department of Justice motivating us, now we do have the will, and this will help our state come forward as a people who desire a humane culture.  So a broader approach to screening people out of facility settings has recently been developed and will be fully operational shortly.

In-reach and Transition Coordination

The next set of functions to be developed per the Settlement and is  the systematic but personal engagement of people living in facilities, finding those who want to live in the community, and making the  arrangements to help that happen for the person’s success.  Our state has decided to use peer specialists for this role because of the natural nature of a relationship between two people who have shared past experiences.  NC CANSO says “BRAVO” to this decision!  The training manual for the MCOs articulates that they are to use peers for the In-reach effort, and if they have no available peers in their areas immediately, they must have them employed for this important effort within twelve months!

The transition staff, who will be trained in options counseling, which includes understanding local housing availability, benefits counseling, and service linkage to the right level of services will be the next important function within the service team.

This team will work closely with the MCO housing specialist so that the transition staff will have housing availability when assisting a person to transition.  This effort will require close coordination and pacing housing and service efforts with the person’s desire to move on out of the facility.

The Department of Health And Human Services Housing Director has been able to determine housing solutions through various programs with rental assistance and other incentives and will also be doing outreach to communities to develop even more housing alternatives.

Person-Centered Services and More Peer Support

Meanwhile, as the transition pieces are developed and trained according to a timeline established by the DOJ, staff in the Best Practices section at the Division of Mental Health, Developmental Disabilities, and Substance abuse services are working with stakeholder groups that include consumers, providers, other agency people to ensure that North Carolina finally has a top-notch serviced definition for ACT (Assertive Community Treatment) teams, for Supported Employment, and for Supported housing/tenancy supports.  Furthermore, the creation of roles for certified peer specialists to enhance the service efforts and results in people’s lives has been another ongoing effort.  The development of these services has required a bit of research, including outcomes studies, and the services will be monitored for fidelity with established and respected tools.

THIS makes people who use services know they are valued—the fact that there will be this level of accountability for service quality now!

NC CANSO wishes to thank Disability Rights North Carolina for its effort in focusing the sights of the Department of Justice on our long-existing problem.  Our members have participated or are participating in many parts of these exciting changes.   We hope our voices make a positive difference for our peers and those who strive to support us in the public system!  Happy, busy New Year!