Community saw gains, losses during session

The 2009 legislative session was one in which Minnesota’s mental health community realized key gains and experienced difficult losses. Cuts to General Assistance Medical Care (GAMC) will have a severe impact, But there were bright spots as well. Led by NAMI Minnesota and the rest of the Mental Health Legislative Network, community members worked hard to protect the gains made during the 2007 session and to advance other key issues.

 
Seclusion and Restraints
There is a new law that governs the use of seclusion and restraints on special education students in the schools. It will go into effect on August 1, 2011. Every school will have to develop a plan that includes the list of procedures that they plan to use, how they will be monitored and reviewed (including an oversight committee and debriefings), and documentation of staff training.

These procedures can only be used by licensed personnel who have received specialized training. The specialized training must include positive behavioral interventions, communicative intent of behaviors, relationship building, alternatives to restrictive procedures, de-escalation procedures, standards for using restrictive procedures, obtaining emergency medical assistance,

physiological and psychological impact of these procedures, monitoring and responding to physical signs of distress and recognizing the symptoms of and interventions that may cause positional asphyxia.

The new law defines restrictive procedures as seclusion and physical holding. Seclusion is defined as confining a child alone in a room from which egress is barred. Physical holding and seclusion can only be used in an emergency. An emergency means a situation where immediate intervention is necessary to protect a child or other individual from physical injury or to prevent serious property damage. Restrictive procedures must be the least intrusive intervention to respond to the emergency, and must end when the threat of harm ends. A child must always be directly observed during their use. Parental notification is required.

Schools must document each time seclusion and restraints are used and include what led to their use, why less intrusive methods failed, the time use began and ended, and the child’s behavioral and physical status. There are standards for the room that is used for seclusion that address safety issues.

The Individualized Education Program (IEP) can plan for an emergency and thus put the procedures in the IEP, however, the bill also requires the IEP team to meet if the procedures are not included in the IEP and are used twice in 30 days or when a pattern emerges. There is a list of prohibited procedures that are very similar to prohibitions contained in other laws and rules covering other types of programs. It includes things such as withholding food, not allowing a child to use the bathroom, physical holding that restricts a child’s ability to breathe, or assuming a position that would be painful. Finally, all districts are encouraged to establish effective school-wide systems of positive behavior interventions and supports. This was a major victory!

 
GAMC
Funding for General Assistance Medical Care (GAMC) was vetoed for the second year of the biennium. This program provides health insurance for more than 30,000 low income Minnesotans, a majority of whom have a mental illness, chemical dependency or both. Loss of this funding is devastating for both the people who depend on the program and for the hospitals, mental health centers and other health care providers who serve many of them.
 
Mental Health
911 operators will now be able to refer to mental health crisis teams and children’s crisis teams will be afforded greater flexibility in rural areas by not being required to provide services 24/7. The Willmar Community Adolescent Behavioral Health Services will be changed to provide a safety net for children with mental illnesses who need intensive care and the Anoka Regional Treatment Center will be redesigned to provide services in 16 bed facilities.

Youth aging out of the foster care system will have access to MinnesotaCare and will be able to access support and advice from the county after they turn 18.

The Extended Employment Program for people with a serious mental illness took a small cut—$80,000 but the BRIDGES housing program was funded at the same level. Mental health providers, including inpatient mental health care, did not receive cuts to their payment rates.

 
Redesign and Maintenance of Effort (MOE)
There was a lot of discussion this session about how to redesign human services and how to allow counties out of the laws that require them to spend the same amount of money as in previous years. Unfortunately, most of the focus of these efforts was on mental health. In the end there were three different pieces of legislation to address this issue.

For the mental health MOE the state will make it easier for counties to know how much they have spent and will allow some dollars to be decreased due to other budget cuts experienced by the county and population decreases.

On a larger scale, the commissioner of human services must recommend a new program that consolidates county property tax contributions across all mandated health and human services programs and that has an easy funding mechanism, maintains current services, and ensures equal access to mandated services.

Another effort to reform human services is the State-County Results, Accountability, and Service Delivery Redesign Council which would review and certify the formation of service delivery authorities (SDA) either in a large county or a group of counties. These SDAs would be able to come together to provide specific services and use performance measures and outcome goals. They could obtain waivers from current laws in order to carry out this “new” way of providing human services. There would be an accountability process and penalties for not making progress. The council does have to have a process to take public input.

There would be a steering committee on performance and outcome reforms that will review performance and outcome standards for all essential human services and will develop appropriate reporting measures and uniform accountability process for counties that don’t make adequate progress. The steering committee can form work groups that includes people who provide, receive or advocate for essential services. Members of the steering committee include county representatives, clients or client advocates and state agency staff.

 

-Sue Abderholden is Executive Director of NAMI Minnesota. Visit the organization’s Website at www.namihelps.org  to learn more about 2009 legislation.

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