Mental Health Services

[Marina]

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http://www.al.com/news/birminghamnews/i ... xml&coll=2

Alabama DHR mental health professionals to face rigorous application process, review of work by UAB experts

Monday, March 31, 2008LISA OSBURNNews staff writer

A new partnership between the state's Department of Human Resources and the University of Alabama at Birmingham will bring much-needed oversight to the way DHR contracts with mental health professionals, and will eventually lead to a complete overhaul of the system, said Commissioner Page Walley.

Starting this year, mental health professionals working with DHR clients will face a rigorous application process and review of their work by a panel of university experts, Walley said.

The Alabama Mental Health System Management Program will be one of the first of its kind in the country, said Fred Biasini, associate director of UAB's Sparks Clinics and director of clinical training.

The goal, in addition to accounting for the tens of millions of dollars spent by DHR for mental health services, is to monitor credentials, and create a system to monitor progress of cases, address billing discrepancies, implement standards of care and ensure that appropriate services are available, Walley said.

"We are going to get people every bit of the counseling they need, but we are going to make sure it is the appropriate counseling. We have not tracked that," he said.

Although some mental health professionals have complained that part of the overhaul includes cuts in services, Walley denies that. He said the department has allocated $9.8 million for mental health services this fiscal year alone.

The first phase of the new management program, costing $165,000, will start in Jefferson County and launch in the rest of the state within a year. It will include a new application process that will confirm licenses and educational attainment and will conduct a criminal background check, things that have not consistently happened in the past, Walley said.

There also will be a review of work experience, references and qualifications for certain services.

The result will be a database of qualified professionals that will help DHR send clients to the right mental health professionals for their needs, Biasini said. A panel of university experts, ranging from social workers to psychologists and psychiatrists, will review applicants.

The second phase, which will take place over two years and cost $210,000, will develop standards of care that include policies and procedures for counties and caseworkers, creating workshops to educate workers, court personnel and providers.

At least one group of mental health professionals and foster parents has started a letter-writing campaign to state officials to protest what they see as systematic cuts to mental health services.

Jewel Euto, a licensed professional counselor who works in Cullman, Morgan, Limestone and Marshall counties, said the group's first meeting drew about 12 people.

Euto claims DHR started eliminating counseling throughout the state at the first of the year. Her DHR client base dropped from 30 to 35 people a week down to five. And she said the clients have not been reassigned to other counselors, but were told their services were being stopped.


"I have one mother who is going to be cut off in the next few months," Euto said. "If she doesn't have continuity of service and her medications, the chances of getting her children back are zero."

Donna Harris, a social work educator at Alabama A&M University, said many of her former students work for DHR or are contracted by DHR for services. She said most of them would support more oversight, but not what they see as a decrease in mental health services for DHR clients.

She said she knows of five counties where mental health services have all but stopped, and input from counselors was not considered.

"Sometimes positive change has unintended negative consequences," Harris said. "Something has happened. I have heard from a number of providers who were losing, fairly abruptly, their DHR clients."

Walley said he expected "wailing and gnashing of teeth" from service providers, many who base their entire practice and incomes on DHR clients, he said. But Walley maintains mental health services have not been cut.

He said several red flags over the past year made him realize the department needed to better manage these services.

For instance, UAB alerted DHR that a man contracted by the department for mental health services actually studied law, Walley said.

Then Walley learned after a review of cases by DHR's county directors that many clients were "eternally" in counseling, but without a plan outlining the desired outcome. Contracted counselors would literally repeat the same progress report week after week, he said.

In other cases, Walley was told that DHR was paying hourly rates for licensed counselors for activities that were more along the lines of Big Brother/Big Sister type relationship, such as taking a child to a fast food restaurant.

Chris Monceret, DHR director in Shelby County, said after reviewing cases in her county, changes were implemented. Social workers discovered that some children had been in counseling for three years and had long since stabilized, but services continued week after week.

"It was pretty amazing," she said. "I understand this is hitting some people in the pocketbook, but we wanted to look at each case honestly, and we did.

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