Thursday, February 28, 2008

1 in 100 US adults in jail

http://www.cnn.com/2008/CRIME/02/28/prison.population.ap/index.html

Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act (H.R. 5447)

Dear Colleague,

Over the years, NASW has asked you to speak out on behalf of many causes and issues. You have always risen to the occasion. Significant strides have been made in areas such as children's health care, employment nondiscrimination, and fair pay legislation. Your advocacy has resulted in the enhanced mental health, social and psychosocial functioning of clients across the country.

I am calling on you today, however, to ask each of you to take a small action, that when combined, can ensure the future of the profession.

On February 14, 2008 the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act (H.R. 5447) was introduced in the United States House of Representatives by Congressman and fellow social worker Edolphus Towns (D-NY) along with original cosponsors Rep. Christopher Shays (R-CT), Rep. Susan Davis (D-CA), Rep. Ciro Rodriguez (D-TX), Rep. Barbara Lee (D-CA), Rep. Luis Gutierrez (D-IL), and Rep. Stephanie Tubbs Jones (D-OH).

This groundbreaking legislation bears the names of two of the United States' greatest social justice advocates and social workers and serves as an investment in the professionals that will care for the millions of aging baby boomers, wounded veterans, the ever-increasing numbers of people diagnosed with cancer, over six million youth with a serious mental illness, and the millions of people living with HIV/AIDS among others. Yet, insurmountable education debt, insufficient salaries, and serious safety concerns are threatening the profession. The Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act (H.R. 5447)will explore the many successful efforts already undertaken by our nation's social workers, while examining the persistent challenges to these efforts.

Social work has always been at the forefront of ensuring that the most vulnerable in society have a safety net of protection. Our communities are in need, more than ever for vital services provided by over 600,000 social workers across the nation. Passage of this legislation is crucial to ensure an adequate social work workforce. The future of this profession depends on the steps that we take to reinvest in it today. We cannot make this happen without the assistance of every one of our members across the country.

Please help us ensure that the profession of social work will grow and thrive in the coming decades. I am asking you as a leader in the profession, to encourage your Representative to cosponsor H.R. 5447 today by clicking here http://capwiz.com/socialworkers/issues/bills/?bill=11013991.

For more information, contact Elizabeth Franklin at (202) 408-8600 ext. 537 or efranklin@naswdc.org.

Housing Trust Fund Information

Please find key information (below and attached) mentioned during the 2/22/08 foreclosure conference call. Thank you again to Tami Hinton of the NC Office of the Commissioner of Banks, Al Ripley of the NC Justice Center, and Keir Morton of the NC Housing Finance Agency, for facilitating the call and presenting information to the group.



Homeowner’s HOPE Hotline

Hotline established to provide individuals with housing counselor referrals to avoid foreclosures

888-995-HOPE (888-995-4673)



NC Foreclosure Website

http://www.ncforeclosurehelp.org/



Legal Aid of NC

For homeowners with an imminent foreclosure hearing or those with court papers

866-219-5262 (866-219-LANC)



Next meeting of the House Select Committee on Rising Home Foreclosures

Tuesday, February 26th

12:30 pm

General Assembly – Room 421

Note: Additional attendees are welcome


If you want to send a letter:
Housing Trust Fund Letters
Find the names and addresses of your county’s representatives here:

http://www.ncleg.net/GIS/Representation/Who_Represents_Me/Who_Represents_Me.html

Please send the letter in March on letterhead from the chairman of your board, or a prominent member of your board. Feel free to use the sample language, but please add some personal examples from your community. Share a compelling story as an example.


Sample language:

On behalf of the Board of Directors of Anywhere CDC, I am writing to urge you to increase the recurring funding of the North Carolina Housing Trust Fund.

As a first line housing provider for our community, I witness on a daily basis the dramatic impact the Housing Trust Fund makes in our county. This year alone, our grant will enable us to repair or rehabilitate _____ homes and make a meaningful change in the lives of _____ people. The Housing Trust Fund builds stronger communities, allows our seniors and disabled to age in place, and helps provide stable homes for our children. Our work would not be possible without it.

The Housing Trust Fund is a sound investment that the General Assembly cannot afford to miss. Every penny you appropriate goes to bricks and mortar, thus strengthening the fabric of our community. It has created over 8,200 jobs and generated nearly $70 million in tax revenues. Impressively, for every $1 appropriated by the General Assembly, it leverages $4 of housing. That’s a remarkable 300% return on your investment!

Our staff and Board appreciate the support you have given the Trust Fund thus far, but the needs in our state continue to grow. I look forward to your support in the upcoming session, and please do not call on me should you have any questions.


Please send a copy of your letter to:

Will Parry-Hill
3508 Bush Street
Raleigh, NC 27609
919-877-5701 fax

NC Aging

The February 2008 issue of NC*Aging is now available to view at http://www.aging.unc.edu/news/newsletter/2008/2008-2.html

Interested in joining the NC Medical Care Commission?

Are you a social worker interested in being a part of the NC Medical Care Commission?

The purpose of the Commission is:

To adopt, recommend or rescind rules for regulation of most health care facilities. (hospitals, hospices, free standing outpatient surgical facilities, nursing homes, home care agencies, home health agencies, nursing pools, facilities providing mammography/pap smear services, free standing abortion clinics, ambulances, and emergency medical services personnel)
To administer the Health Care Facilities Finance Act; which enables the Commission to issue tax-exempt revenue bonds to finance construction and equipment projects for nonprofit and public hospitals, nursing homes, continuing care facilities for the elderly and facilities related to the foregoing.

See their website for more information.

Please contact Jack Register at 828-9650 if you are interested in being a part.

Wednesday, February 27, 2008

Karen McLeod to fill Vacancy on Child Fatality Task Force

The Speaker of the NC House’s Office contacte the Covenant for North Carolina's children to advise Speaker Joe Hackney on filling a vacancy on the Child Fatality Task Force, a legislative study group that advises the General Assembly on how to reduce child fatalities in NC.

After conferring with Board Chair Mike Rieder and CFTF Director Selena Childs (a Covenant individual member), Karen McLeod was nominated and has accepted. Additionally, Karen is President/CEO of Children & Family Services Association of North Carolina and presides over our Child Welfare Work Group.

NC Saves Week

Hello everyone,
fyi - February 24th-March 2nd is NC Saves Week.

Additional details provided in the email below; please feel free to spread the word.

NC Saves website:
http://www.northcarolinasaves.org/

Even more on Moseley resignation

N.C. mental health director retiring
By Lynn Bonner - McClatchy Newspapers
1/83/8

Michael Moseley, who presided over North Carolina's mental health system in an era of unrest, announced Friday he is retiring.

Moseley, 55, will leave his $131,430 a year post as director of the mental health division on Feb. 29, but will work another three months in the state Department of Health and Human Services in an unspecified job.

A recent overhaul of the mental health system, which cares for 350,000 people, forced most counties to stop treating patients and left seriously mentally ill people without community care. In the last two years, the state has spent too much on a basic mental health service provided by private companies; reviews determined that thousands of people getting the service didn't need it. And in the last year, investigators found problems at all four of the state's mental hospitals.

Moseley "presided over the devastating failures of mental health reform," said Dr. Harold Carmel. Carmel used to work with Moseley and is now an associate consulting professor of psychiatry at Duke University.

Moseley was out of the office Friday and efforts to reach him failed. "I'm proud of what I've done to move things forward for the people who depend on this system for their care," he said in a prepared statement.

His boss, Dempsey Benton, the health and human services chief, was out of the office and efforts to reach him were unsuccessful.

Moseley's retirement surprised those outside the department with an interest in the state mental health.

"Anytime new leadership comes in, there's always an adjustment, said Rep. Verla Insko, a Chapel Hill Democrat who helps lead a legislative committee on mental health. "I didn't anticipate this."

Moseley, a Kinston native, worked for the state more than 30 years. He was promoted to lead the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services in March 2004, after the state had begun widespread privatization of community mental health care. Before he took the state job, Moseley had been in charge of the Caswell Center, a residential state institution.

Moseley was picked to lead the division because of his experience at Caswell creating community care for the disabled. His skill building such networks would be invaluable as the new mental health director, said Carmen Hooker Odom, the former secretary of the Department of Health and Human Services and his boss at the time. The state had begun a reform effort in 2001 aimed at emphasizing community care over treatment in big institutions.

But in the early years of Moseley's tenure, the system of private providers failed to develop in communities. Meanwhile, local mental health offices run by counties had complied with a mandate to stop treating patients. People seeking short-term care overwhelmed state hospitals.

Even those who criticized Moseley's work at the division, including Carmel, described him as a friendly person who devoted his career to developing services for people with disabilities.

Seth Effron, a spokesman for Gov. Mike Easley, said Friday the governor did not have anything to do with Moseley's retirement announcement.

Diane Bauknight offers a cynic's nutshell version of the "MH reform" movement in NC

A cynic's nutshell version of the "MH reform" movement in NC:
by Diane Bauknight

The legislature stumbled across this national movement to reign in state costs for Medicaid by targeting mental health and DD. We had people come in from Michigan (Richard Visingardi) to show us the ropes of reform. He left after the die was cast, but not before double dipping salary both in Michigan and NC (being paid in both places as a full time employee.) We are use to those kinds of shenanigans in NC. It didn't even ripple the water here. Visingardi high-tailed it back to Michigan after his dastardly deed was done, and let us with the framework of our reform, based on the Michigan model. The Michigan model proved to be a colossal failure (in Michigan), but we plodded along with the plan anyway. Why should we learn from other state's mistakes?

Here is the basic idea: Medicaid is one of the fasting growing expense of states. However, the real costs behind Medicaid are end-of-life elder care, but that is too politically risky. The Mental Health "reform" movement was hatched in conservative think tanks and focused on the privatization of health care and cost-cutting measures, much as the privatization movement for prisons and other public institutions evolved.

The focus of the reform is to shifts costs from the state to other funding pools. This includes, for example:

Close the state hospitals and get the private hospitals to do the MH care. Why? the private hospitals can pull down federal $$ that the state can not access. The state can also close the buildings, which is a great expense. Problem: Private hospitals do not want to do MH care, as they make little money (or lose money) and it is labor intensive.
Build more prisons to house people with MH, while you close down MH facilities. Entire MH sections are being built in prisons to house mentally ill people. Federal funds can be used to pay for mental health wings in prisons but not in state hospitals. It is also much cheaper to lock people up than to provide long-term treatment in a hospital.
Close (public) area programs. Now the buildings are not costing the state, and the state is no longer in the business of providing care. Indigent people find it harder to receive care with the safety net gone, which (in the short term) saves the state money. Consolidate the area programs, which saves more money. Turn the LME into gate-keepers for community-based services, so they squeeze the providers and consumers even more by denying medically necessary care. Reward the LME by giving them more money if they keep costs down (reduce hospital admissions) and take money from them if they don't.
Hire a big company to deny the more expensive services, like institutional care, groups homes, etc... Pick a friend to pay the big bucks for denying care. Value Options has lots of ties to administrators in our DMH--so they were a great choice. This is a win-win for all! Our friends get to be billionaires and we can still save state $$.
Water-down services. Create new service definitions that provide fewer services, shorter duration and cloak it in the "recovery model" so that they are time-limited. Send out lots of press releases how these reduced services are actually "enhanced services." When services don't exist, confuse the public by saying that "naturally occurring" services will be identified. Don't explain that "naturally occurring" (FREE) services don't exist for most people with serious MH and DD disabilities. Save even more $$.
Dump the professionals where ever you can. They cost too much. Let them supervise a team of para-professionals that will actually work with the person receiving care. Hire high school grads and give them 20 hours of training to teach people with the most challenging mental illnesses "skills" to "recover". Send them out into the community when there is a crisis, at least on paper. You and I know that 24/7 crisis care could mean that the private provider will not respond unless the person already meets criteria for hospitalization (danger to self or others). Heck, it looks good on paper that we provide 24/7 care. If it gets that bad, call the cops. They will sit with the person in the ER for days if they have to and the best part is THE COUNTY pays the cop to supervise the person and the private hospital gets to deal with it!
Turn the psychiatrists into paper-pushers. We don't have that many psychiatrists left in NC. Lets make sure we get the biggest bang for the buck from our psychiatrists. Have the therapist tell the psychiatrist what drug to prescribe and let the psychiatrist write prescriptions! (Yes, there could be some serious side effects from the drugs, but OH WELL.)) On second thought, maybe we can get nurses to do this! Think of the savings.....
Make it really, really hard for people to figure out how to file a legal appeal. Instead, have them think the appeal goes through the LME first. If the grievance does go to court, spare no costs in fighting people who have had medically necessary care denied. We don't want to set any precedents and open the doors for people to think they can truly fight the system when their human rights and entitlements have been violated and actually win.
Understand and accept that there will be some suicides or broken lives. Hell, we can't save everyone and we have have to REIGN in those costs! Consider it collateral damage.
Hire your friends to do lots of studies to support your findings that hospitals should be closed down and community based services developed. Do this every few years so it looks like you are concerned and you are open to hearing new ideas, even if the reports continue to repeat the same "findings." Continue to close state facilities and hospitals, but don't actually develop truly comprehensive community based services, and the ones you have developed-- make sure they are weak and time-limited. For children, pretend like the services are not time-limited (so you don't violate federal law) by calling it a suggested time-frame which can be appealed if more hours are needed. (HA-HA-HA. Aren't we clever?) Make sure it is really hard for any provider to survive that delivers community-based services. That way the services will not be "over-utilized" (mental-health speak for "cost too much.")
Shift costs to the counties. Legislate that the counties provide oversight of the LME, but give them no power to truly manage a system that has no accountability. Lean on the counties to fund more mental health services. Use their police and private hospital ERS instead of creating crisis facilities.
Build a private provider network for those that can pay. Ignore the needs of those that can not (saves lots of state $$.) Keep the focus be on managing the usage (costs) of care by driving providers out of business that insist on providing the true level of care (duration, intensity) the person needs. Make the provider afraid to provide services outside of the established time-frames, regardless of what the person actually needs. Threaten audits if they do. Close down some private providers (you can do this by de-certifying, demanding paybacks, doing audits, or just declaring the provider "too hard to work with"). This will instill fear in the remaining providers. You mean "business. "
Create a wall of paperwork so that it is so difficult to deliver care that few providers can actually survive, and the system morphs into big business private providers. When providers fail, blame them for poor business management. Fewer providers are easier to manage, anyway. When private providers can not keep up with the mountains of ever-changing paperwork and fail to cross all of their T's, accuse them of fraud, or of stealing, or just being plain greedy. Then, drive them out of business by insisting on retro-active paybacks. Now we have them where we want them.
Stonewall consumers until they go away or die. And don't forget that there is plenty of room on the streets and in prisons (even though some bleeding-hearts claim that those with mental illness are flooding shelters, jails and prisons.) Remember our goal: we need to REIGN in costs.
Oh, did I mention we are 43rd in mental health spending in NC, and post-reform costs are causing Medicaid costs for treating mental illness to soar? Could the answer be for the state to recognize that the reform has failed and spend the upfront money needed to create a true continuum of care that actually might result in less need for institutionalization---when the right services are provided at the right time by the right professionals?

Right now we are putting money in a system that can not work. It is like continuing to repair a car that is on its last leg. We are being nickeled and dimed to death with no hope of ever seeing a return on the money we have spent. And, more importantly, people are suffering. Diane Bauknight

More on Moseley's resignation

Moseley to retire from NC division that treats mentally ill

02/22/2008

By GARY D. ROBERTSON / Associated Press

The head of North Carolina's efforts to treat the mentally ill announced his retirement Friday, roughly two months after his boss reduced his level of responsibility.

Mike Moseley said he will retire effective Feb. 29. For the last four years, he was served as the director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services — the agency charged in 2001 with the daunting task of implementing wide-ranging reforms in the state's mental health system.

The division has struggled to shift programs from institutional care to community-based treatment offered by private medical providers.

"I've accomplished a great deal in my three decades of public service to the state of North Carolina," Moseley said in a statement. "There have been a lot of changes in the state system during my tenure, and I'm proud of what I've done to move things forward for the people who depend on this system for their care."

But some advocates believe the system, which treats about 350,000 people annually, is worse off than before the General Assembly set the reforms in motion. Moseley and his deputies have often taken the brunt of criticism from legislators evaluating the reforms.

Last month, Health and Human Services Secretary Dempsey Benton announced several steps to correct problems in the state's mental health care hospitals and with local crisis service programs that serve patients who live at home.

Benton also said the staff responsible for running the state's 14 public mental health institutions would report directly to him, rather than Moseley. He declined to say at the time whether he would also make any leadership changes.

Mark Van Sciver, a spokesman for the state Department of Health and Human Services, said Moseley wasn't in his office Friday afternoon and Benton was unavailable for comment.

Moseley, 55, lived in Kinston while working as director and earned $131,430 a year. He will stay on for another three months to help with the transition, although no replacement was immediately named.

"I think given Mike's 30 years and the drive from Kinston everyday probably played a role in his decision," Van Sciver said.

During his tenure as division chief, Moseley said he helped lead efforts to improve Medicaid coverage for people with substance abuse addictions and developmental disabilities. Moseley previously led a state office that helped provide short-term crisis care to patients and directed the Caswell Center, a state-run home for people with severe developmental disabilities.

Ann Akland, a patient advocate whose son is an adult mental health patient in Wake County, said she hoped Moseley's replacement would bring better management skills to the job.

Akland and other advocates have been encouraged since Benton replaced former department Secretary Carmen Hooker Odom last summer. Hooker Odom often clashed with legislators and mental health professionals over the direction of the reform effort.

"The system obviously needs better leadership. The system is in such crisis," Akland said. "I'm hoping that someone will be hired that will have more experience with the kinds of issues that are needed to move forward."

Mike Moseley resigns

NC Policy Watch
Fitzsimmons

Mental health morass continues
The problems with the state's mental health system continue to mount as the News & Observer prepares to publish a major series on the issue beginning Sunday. Just this week, a major non-profit provider of substance abuse services in the Western Piedmont was dismissed by one of the state's Local Management Entities in a dispute about how data is reported.

There is no standard procedure or even software for all LMEs or providers to use, something that you would think would have been in place long ago. The decision to fire the nonprofit means that four different substance abuse providers have tried to work with the LME in the last 26 months and failed. Something clearly isn't working.

Also this week, news that people in Southeastern North Carolina who need services may end up on a waiting list instead. Officials at the LME in that area say that state funding for services is $2.4 million less than they expected.

State officials say the lower amount simply follows state policy. That ought to go over well with families trying to find services for loved ones, that an LME and state officials disagree on who is following policy and the result is that people don't get the help they need.

And finally, news Friday that Mike Moseley, the head of the state Division of Mental Health, Development Disability, and Substance Abuse Services, is retiring at the end of the month.

It does not come as a complete surprise. Moseley has been under fire for all the problems in the mental health system and hasn't done himself any favors with some of his public statements responding to them.

Secretary of Health and Human Services Dempsey Benton also declined an opportunity to give Moseley a vote of confidence at a news conference a few weeks ago. Benton also recently took oversight of the states troubled mental hospitals away from Moseley.

Maybe Moseley's resignation and this week's troubles are all part of righting the sinking mental health ship, but it's hard to have much confidence that is true, given the history of the reform effort.

N.C.'s mental health 'reform' a recipe for tragedy

Op-Ed from the News & Observer
http://www.newsobserver.com/opinion/columns/story/961899.html
Published: Feb 24, 2008 12:30 AM Modified: Feb 24, 2008 05:20 AM

Mark Sullivan is an MSW and a member of NASW-NC
Our shredded safety net
N.C.'s mental health 'reform' a recipe for tragedy
Mark Sullivan

CARRBORO - Eight years into mental health reform, North Carolina has thus far dodged a bullet. Much of the postmortem on the origins and unfolding of the reform effort has been done. But how much worse can things get, and what will it take to bring about real and meaningful change? If recent developments do not mark a turning point in reform, the turning point will be marked by tragedy on a massive scale.

Consider that after all of this time, just three of 24 Local Management Entities (the organizations charged with ensuring needed services are
available) in North Carolina are meeting minimum standards for routine care.
Just 45 percent are meeting minimum standards for urgent care. How bad must things get before we are willing to rethink the fundamental assumptions that the new system was founded on?

North Carolina ranks near the bottom in the nation in per capita funding for mental health care at $16.80, compared with the national average of $91.12.
Yet our problem is much bigger and more complex than underfunding.

After the first six months of the fiscal year, the Division of Mental Health, Substance Abuse and Developmental Disabilities reported that only 30 percent of mental health funds and 20 percent of substance abuse funds that had been budgeted had been expended.

On the surface it might look like the system is overfunded, but what these numbers signal is that needed services are not being provided because they are unavailable.

A core problem with the new system is that it was built upon a fundamentally flawed assumption; that the private sector will always outperform anything run publicly. It is a wildly popular notion, and a key reason why this particular plan was able to gain support in North Carolina.

The private sector is far superior in many arenas, but not necessarily when it comes to protecting the poorest and most vulnerable members of society.
Private providers pick and choose which services they will provide, based on what will best meet the needs of the agency, as opposed to public entities whose first responsibility is to meet the needs of the citizenry.
Departments of social service, child protective services and health departments are county run -- why not mental health?

In Orange, Person and Chatham counties, Caring Family Network, the agency designated as the Comprehensive Service Agency (CSA) in our area, has determined that it could not financially sustain service provisions and will cease offering services effective March 12. CSAs are designated to provide psychiatry, psychotherapy, crisis services, substance abuse counseling and community support. They are meant to replace our old public "safety net"
clinics to ensure that a basic level of service is available to the community.

l l l

THE NEW SAFETY NET IS THE CRIMINAL JUSTICE SYSTEM.

We know what happens when people who need psychiatric care do not receive it. Most suffer quietly, some lose their jobs, are engulfed by addiction, lose their housing, fill hospital emergency departments, crowd jails and prisons or take their own lives.

But Wendell Williamson, the UNC law student who opened fire on Franklin Street on Jan. 26, 1995 with a military rifle, killing two and injuring two, tells another story. Alvaro Castillo, who allegedly killed his father and fired eight shots at Orange High School in 2006, made a convincing argument for the importance of mental health treatment. Most recently, Steven P.
Kazmierczak made his case at Northern Illinois University.

Calling up these names risks reinforcing some stigmatizing stereotypes about people with mental illnesses. When people hear of mental health disorders, they too frequently conjure up images of the most severe, least common cases. They do not think of someone like me, though I represent a more common picture of someone with a mental disorder.

Only a small fraction of people who experience mental health disorders present a danger to others. But when one considers the scale at which our system is failing, it is clear that a new tragedy is only a matter of time; it's a statistical certainty.

The formula is simple: Take a population of 9,061,032 North Carolinians, of which approximately 356,000 adults have serious mental illnesses and 192,000 children have serious emotional disturbances.
Next, systematically restrict access (either intentionally or
unintentionally) to treatment for those who need it. The result equals tragedy on a massive scale.

We will never be able to prevent every tragedy, even with an excellent mental health system. But by restricting access to care for 550,000 of our most deserving and needy residents, we are stacking the odds against ourselves.

Health and Human Services Secretary Dempsey Benton has been called upon to salvage the system. He is by all accounts a capable administrator, and he has taken steps that show he means business. But with less than a year left in Gov. Mike Easley's administration, Benton will have to be a miracle worker to provide leadership that amounts to something more than too little, too late.

County officials have a rare opportunity to step in and do something that is fiscally responsible, morally right and politically popular.
Will they stand by and wait for the state, the Local Management Entities or a private provider to replace the safety net while the system is in free fall? If so we may be in for a very hard landing.

(Mark Sullivan is executive director of the Mental Health Association in Orange County.)

Communication Bulletin #88 regarding the 2nd quarter MH/DD/SAS Community Systems Progress Indicators Report

Communication Bulletin #88 regarding the 2nd quarter MH/DD/SAS Community Systems Progress Indicators Report has been posted to the web. You can find the report here: http://www.ncdhhs.gov/mhddsas/statspublications/reports/index.htm
Please forward this to anyone in your organization who might be interested.

NC Policy Watch: A series of problems

http://app.bronto.com/public/?q=message_preview&fn=Key&type=tracking&id=bbryfryqcrfacxstacltupkjlvcrbog&link=ccslqsknuuulqkuandhpokykhuwgbfc

Letter to the editor and lead article from News and Observer

Letter to the editor and lead article from News and Observer

http://www.newsobserver.com/opinion/letters/story/960544.html

Letter: Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 05:17 AM

Committed to care

Since June 2006, ValueOptions has provided utilization review of mental health, developmental disability and substance abuse services for the Medicaid program in North Carolina. It was with great interest that I read Ruth Sheehan's Feb. 11 column "The greatest theft." I believe the column left readers with an incorrect impression of ValueOptions.

ValueOptions rarely, if ever, denies approval without recommending alternatives for treatment. These alternatives are based on medical necessity and clinical best practice. The alternatives are telephoned to the provider, and many times they include a higher level of care than requested.

ValueOptions relies on requesting providers to substantiate the need for a requested service, which is common medical practice. Accordingly, ValueOptions makes more than 6,000 approvals each week.

Specific to Threshold, the provider referenced by Sheehan, ValueOptions has approved 114 service requests and has made only one denial since June.

The column did note that consumers may appeal. The consumer never has to appear in person. In fact, the consumer is not even required to speak.
Providers and advocates can speak on behalf of consumers, typically via teleconference.

ValueOptions is committed to authorizing care that meets medical necessity and contemporary best practice parameters.

Will Woodell

Vice President, Public Sector, ValueOptions, Inc., Morrisville

Editor's note: The column highlighted the case of a Threshold client whose approved services had been reduced by ValueOptions.

* * * *

http://www.newsobserver.com/news/story/960768.html

Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 03:38 AM

State's mental health leader quits
Michael Moseley led the state system's reforms that left many seriously ill patients without care

By Lynn Bonner, Staff Writer

Michael Moseley, who presided over the state mental health system in an era of unrest, announced Friday he was retiring.

Moseley, 55, will leave his $131,430-a-year post as director of the mental health division Feb. 29, but he will work another three months in the state Department of Health and Human Services in an unspecified job.

The announcement of Moseley's retirement came two days before the start of a News & Observer series on the state's mental health system.

A recent overhaul of the system, which cares for 350,000 people, forced most counties to stop treating patients and left seriously mentally ill people without community care. In the past two years, the state has spent too much on a basic service provided by private companies; reviews determined that thousands of people getting the service didn't need it. And in the past year, investigators found problems at all four of the state's mental hospitals.

Moseley "presided over the devastating failures of mental health reform,"
said Harold Carmel, who used to work with Moseley and is now an associate consulting professor of psychiatry at Duke University and president of the N.C. Psychiatric Association.

Moseley was out of the office Friday, and efforts to reach him failed.
"I'm proud of what I've done to move things forward for the people who depend on this system for their care," he said in a prepared statement.

His boss, Dempsey Benton, the health and human services chief, was out of the office, and efforts to reach him were unsuccessful.

Moseley's retirement surprised those outside the department.

"Anytime new leadership comes in, there's always an adjustment, said Rep.
Verla Insko, a Chapel Hill Democrat who helps lead a legislative committee on mental health. "I didn't anticipate this."

Moseley, a Kinston native, worked for the state more than 30 years. He was promoted to lead the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services in 2004, after the state had begun privatizing community mental-health care. Before he took the job, Moseley had been in charge of the Caswell Center, a state institution for people with developmental disabilities in Kinston.

Moseley was picked to lead the division because of his experience at Caswell creating community care for the disabled. His skill in building such networks would be invaluable as the new mental health director, said Carmen Hooker Odom, the former secretary of the Department of Health and Human Services and his boss at the time. The state had begun a reform effort in
2001 aimed at emphasizing community care over treatment in big institutions.

But during Moseley's tenure, the system of private providers failed to develop in communities. Meanwhile, mental health offices run by counties had complied with a mandate to stop treating patients. People seeking short-term care overwhelmed state hospitals.

'He came in midstream'

Moseley often said he took over after the problems started and tried to put the brakes on the downhill slide by telling local mental-health offices that they did not have to get rid of their psychiatrists, a scarce medical resource.

Even those who criticized Moseley's work at the division, including Carmel, described him as friendly and accessible.

"Mike is a nice guy," said Sen. Martin Nesbitt, an Asheville Democrat who helps lead a legislative committee on mental health. "Obviously there have been problems with the management of the mental health system by anybody's definition." It's hard to know, Nesbitt said, whether Moseley bears responsibility.

"He came in midstream, when the mental health system was at its lowest point," he said.

When the community treatment network started to bloom in 2006, private companies rushed to provide a basic service called community support.
Costs exploded, while people who needed more intensive treatment could not find it.

Last year, all four state mental hospitals were threatened with the loss of federal insurance payments, and one, Broughton Hospital in Morganton, actually lost its money. After constant news of hospital trouble, Benton removed the responsibility from Moseley and took charge himself.

Seth Effron, a spokesman for Gov. Mike Easley, said Friday that the governor did not have anything to do with Moseley's retirement announcement but has told Benton to "do whatever needs to be done to address the mental health administration issues."

Effron did not know whether Moseley's retirement is related to those instructions to Benton.


lynn.bonner@newsobserver.com or (919) 829-4821

Letter to the editor and lead article from News and Observer

Letter to the editor and lead article from News and Observer

http://www.newsobserver.com/opinion/letters/story/960544.html

Letter: Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 05:17 AM

Committed to care

Since June 2006, ValueOptions has provided utilization review of mental health, developmental disability and substance abuse services for the Medicaid program in North Carolina. It was with great interest that I read Ruth Sheehan's Feb. 11 column "The greatest theft." I believe the column left readers with an incorrect impression of ValueOptions.

ValueOptions rarely, if ever, denies approval without recommending alternatives for treatment. These alternatives are based on medical necessity and clinical best practice. The alternatives are telephoned to the provider, and many times they include a higher level of care than requested.

ValueOptions relies on requesting providers to substantiate the need for a requested service, which is common medical practice. Accordingly, ValueOptions makes more than 6,000 approvals each week.

Specific to Threshold, the provider referenced by Sheehan, ValueOptions has approved 114 service requests and has made only one denial since June.

The column did note that consumers may appeal. The consumer never has to appear in person. In fact, the consumer is not even required to speak.
Providers and advocates can speak on behalf of consumers, typically via teleconference.

ValueOptions is committed to authorizing care that meets medical necessity and contemporary best practice parameters.

Will Woodell

Vice President, Public Sector, ValueOptions, Inc., Morrisville

Editor's note: The column highlighted the case of a Threshold client whose approved services had been reduced by ValueOptions.

* * * *

http://www.newsobserver.com/news/story/960768.html

Published: Feb 23, 2008 12:30 AM Modified: Feb 23, 2008 03:38 AM

State's mental health leader quits
Michael Moseley led the state system's reforms that left many seriously ill patients without care

By Lynn Bonner, Staff Writer

Michael Moseley, who presided over the state mental health system in an era of unrest, announced Friday he was retiring.

Moseley, 55, will leave his $131,430-a-year post as director of the mental health division Feb. 29, but he will work another three months in the state Department of Health and Human Services in an unspecified job.

The announcement of Moseley's retirement came two days before the start of a News & Observer series on the state's mental health system.

A recent overhaul of the system, which cares for 350,000 people, forced most counties to stop treating patients and left seriously mentally ill people without community care. In the past two years, the state has spent too much on a basic service provided by private companies; reviews determined that thousands of people getting the service didn't need it. And in the past year, investigators found problems at all four of the state's mental hospitals.

Moseley "presided over the devastating failures of mental health reform,"
said Harold Carmel, who used to work with Moseley and is now an associate consulting professor of psychiatry at Duke University and president of the N.C. Psychiatric Association.

Moseley was out of the office Friday, and efforts to reach him failed.
"I'm proud of what I've done to move things forward for the people who depend on this system for their care," he said in a prepared statement.

His boss, Dempsey Benton, the health and human services chief, was out of the office, and efforts to reach him were unsuccessful.

Moseley's retirement surprised those outside the department.

"Anytime new leadership comes in, there's always an adjustment, said Rep.
Verla Insko, a Chapel Hill Democrat who helps lead a legislative committee on mental health. "I didn't anticipate this."

Moseley, a Kinston native, worked for the state more than 30 years. He was promoted to lead the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services in 2004, after the state had begun privatizing community mental-health care. Before he took the job, Moseley had been in charge of the Caswell Center, a state institution for people with developmental disabilities in Kinston.

Moseley was picked to lead the division because of his experience at Caswell creating community care for the disabled. His skill in building such networks would be invaluable as the new mental health director, said Carmen Hooker Odom, the former secretary of the Department of Health and Human Services and his boss at the time. The state had begun a reform effort in
2001 aimed at emphasizing community care over treatment in big institutions.

But during Moseley's tenure, the system of private providers failed to develop in communities. Meanwhile, mental health offices run by counties had complied with a mandate to stop treating patients. People seeking short-term care overwhelmed state hospitals.

'He came in midstream'

Moseley often said he took over after the problems started and tried to put the brakes on the downhill slide by telling local mental-health offices that they did not have to get rid of their psychiatrists, a scarce medical resource.

Even those who criticized Moseley's work at the division, including Carmel, described him as friendly and accessible.

"Mike is a nice guy," said Sen. Martin Nesbitt, an Asheville Democrat who helps lead a legislative committee on mental health. "Obviously there have been problems with the management of the mental health system by anybody's definition." It's hard to know, Nesbitt said, whether Moseley bears responsibility.

"He came in midstream, when the mental health system was at its lowest point," he said.

When the community treatment network started to bloom in 2006, private companies rushed to provide a basic service called community support.
Costs exploded, while people who needed more intensive treatment could not find it.

Last year, all four state mental hospitals were threatened with the loss of federal insurance payments, and one, Broughton Hospital in Morganton, actually lost its money. After constant news of hospital trouble, Benton removed the responsibility from Moseley and took charge himself.

Seth Effron, a spokesman for Gov. Mike Easley, said Friday that the governor did not have anything to do with Moseley's retirement announcement but has told Benton to "do whatever needs to be done to address the mental health administration issues."

Effron did not know whether Moseley's retirement is related to those instructions to Benton.


lynn.bonner@newsobserver.com or (919) 829-4821

N&O Article on the failure of mental health reform

http://www.newsobserver.com/2789/story/965714.html

Published: Feb 26, 2008 05:01 AM Modified: Feb 26, 2008 05:12 AM

Companies cash in on new service
Community support is lucrative for providers, but reviews say many clients don't need it. Now the state wants money back

Lynn Bonner, Pat Stith and David Raynor, Staff Writers (Second of five
parts)

Joel Hopkins is no longer a basketball coach, but he's still recruiting.
Instead of finding hoops stars, he's looking to sign clients for his mental-health business.

Hopkins, the former Shaw University coach, built Dominion Healthcare Services by having workers go door to door in poor neighborhoods, looking for people to sign up for a mental-health service called community support.

In 18 months, Dominion charged taxpayers $33.9 million for the service, more than all but one other agency, billing up to $61 an hour for services that included taking clients to school appointments and to charities for free clothes.

Dominion has operated in up to nine North Carolina counties. The company, based in Raleigh, has about 1,000 employees and an aggressive marketing strategy.

"We have community fairs, friends and family days, and we do present our services to the whole entire community," Hopkins said of the company he started in 2001. "It's called community support, and we want the community to be aware. We go to churches, civic groups, Boys & Girls Clubs, all over the community, to let people know where there are services out there for them."

State officials now say that some clients of Hopkins' company -- and others like it -- don't need mental-health services. They're having second thoughts about some of the companies they allowed to bill the government for community support.

The state has demanded repayment of $59 million from companies that broke the rules; it has asked Dominion to repay $1.5 million. The state is trying to stop the company from billing Medicaid, the federal health insurance program for the poor and disabled.

Last year, workers from local mental-health offices reviewed client records on 493 companies and found problems ranging from paperwork errors to the provision of community support to thousands of people who didn't need it.

Community support is a new service, born in 2006 as the state sought to move treatment out of government offices and into people's homes, schools, community centers -- places where they live their lives.
Community support was one of more than a dozen services that the federal government agreed would qualify for Medicaid funding, but it ended up costing far more than everything else combined.

Hundreds of companies flooded the state's new mental-health market to offer the lucrative community support services. In the first three months, through June 2006, 277 companies received taxpayer money to provide community support. At the same time, far fewer companies signed up to provide more intensive treatment.

By the end of last year, the pool of companies offering community support had nearly tripled, to 784. The rules were designed to allow almost anyone who made the right promises into the business.

"When community support got started, the threshold for qualification was pretty low," said Dempsey Benton, secretary of health and human services.

It's the state's responsibility to set the standards for providers, he said.
"We're trying to catch up in that part of the program."

Where the money was

In 2001, a legislative initiative set the state mental-health system on a new course. The old order, in which county mental-health offices provided most of the services, was flawed, nearly everyone agreed.
County offices decided what services they would offer, and clients had limited choices.

Legislators received studies showing that the state relied too much on its psychiatric hospitals. They ordered the county offices to become monitors -- rather than providers -- and opened the way for private companies to dominate community care.

Those companies flocked to provide community support, with the work done largely by workers with high school diplomas. That's where the money was.

Among the entrants was Dominion, selling mental-health services the way some publishers sell magazine subscriptions.

Community support, the most basic of the new services, is supposed to help people with mental illnesses or addictions stay in their homes or in school by focusing on needed skills. The guidelines provided leeway for workers to help meet individuals' needs.

An adult, for example, may be taught how to manage bus schedules or a budget, while a child may be focused on ways to stay out of trouble in school.

Within the first few months, community support was costing taxpayers $50 million a month, 10 times more than state administrators had expected. About a year after the service started, the state cut the $61- an-hour rate it was paying by about $10. By that time, the state had spent $619 million in 12 months.

While money flowed to community support, serious treatment suffered.
From March 2006 through the end of January 2008, community support cost
$1.4 billion, 90 percent of all spending. During that period, the government spent $78 million -- 4.9 percent -- on the seven services that department officials say are more likely to keep people out of hospitals.

Officials had intended to spend more on intensive services than on community support.

In September, 43,579 people received federally funded community support, at a cost of $74.6 million. Assertive community treatment, a more intensive service for severely mentally ill adults, was the second- most costly service that month. Companies were paid $2.2 million to help 1,698 people.

Dominion has one psychiatrist under contract who is the company's medical director, but she does not bill through the company for individual treatment. Dominion makes nearly all its money from community support.

Searching for clients

Traditionally, companies receive referrals from county or regional mental-health offices, social workers, schools or juvenile courts.
Sometimes, a potential client will get a recommendation from a friend or family member.

Local mental-health officials complained about Dominion's practice of searching neighborhoods for clients and sometimes having a minister make follow-up calls.

Wake County's mental-health administrators called Dominion customers in October 2006 to find out how they came to sign up with the company.
One mother said her child's therapist mentioned the company, "but then they were going door to door ... they came to our door handing out flyers," Miki Jaeger, head of the Wake mental-health office's quality management team, wrote in a letter to the state Mental Health Division.

State officials don't like the companies' scouring neighborhoods for clients, but they allow it.

"We do not, to our knowledge, have any authority to stop that from happening at this point," said Tara Larson, an acting deputy director in the state Medicaid office.

In a little more than a year in the community support business, Dominion received more in Medicaid payments than older nonprofit corporations such as Easter Seals UCP.

Notes by a Dominion community support worker detailing activities with a client, a woman, described the same activities day after day. The worker refers to herself by the initials CSSQP, for community support services qualified professional. The worker and client spent 3 1/2 hours together each time, according to the notes on April meetings, allowing a bill of about $180.

For April 23, 2007, the worker wrote she and the client did this:

"CSSQP prompted consumer for a community outing. CSSQP talked to consumer about actions she needed to be successful in fulfilling aspirations. CSSQP discussed with consumer about having a mentor and how she felt about having a female role-model to look up to because she will have someone to help her.
CSSQP discussed [with] consumer how the program will be linking her to programs and other services to help her."

For April 24, 2007, she wrote:

"CSSQP prompted consumer for a community outing. CSSQP talked to consumer about actions she needed to be successful in fulfilling aspirations. CSSQP discussed with consumer about having a mentor and how she felt about having a female role-model to look up to because she will have someone to help her.
CSSQP discussed [with] consumer how the program will be linking her to programs and other services to help her." This section of the note was identical to the previous day's, except for the last sentence: "CSSQP discussed with [consumer] some activities that needed to change in her life."

The state wants Dominion to pay back $1.5 million, and state and local mental-health offices are trying to strip the company of its licenses to bill Medicaid.

An administrative law judge said the state can't act until the company runs through its appeals. Hopkins has hired well-known trial lawyer Willie Gary to sue the state, one of its contractors and several local mental-health offices for $1.3 billion. Dominion claims the counties are discriminating against the company because its owners are African- American.

Hopkins, 39, is best known as NBA star Tracy McGrady's high school coach. He coached at Durham's Mount Zion Christian Academy for eight years and at Shaw University for two years. Dominion is an extension of his long-held desire to help children, Hopkins said.

In the early 1990s, law enforcement agencies around the Southeast investigated a nonprofit organization Hopkins ran with his brother, John.
Triangle Housing/Homeless and its spinoffs used poor children and homeless people to canvass for donations.

Dominion was incorporated by a church that never existed, Hopkins acknowledges. The incorporation papers listed the incorporator as Dominion Christian Church, with the address of a home in Bahama in northern Durham County. Hopkins said he intended to start the church, but he didn't.

Troubled history

Before it found gold in community support, Dominion ran youth group homes in Wake County. The state sanctioned the company for not doing enough to keep children from running away and for failing to conduct criminal background checks of employees.

One of Dominion's state directors, Jerry Wright, was convicted in 2002 of 10 counts of obtaining property under false pretenses after a Medicaid fraud investigation into his work at Lutheran Family Services.
Wright, a former foster parent supervisor there, was ordered to pay
$25,021 in restitution.

Hopkins defended hiring Wright, who he said does not handle money at Dominion.

In the past 14 months, state and local mental-health offices'
investigations and reviews of Dominion's practices and patient records found billing problems, people getting community support who did not need it and the company charging for work it didn't do.

About a year ago, investigators called Dominion patients in the Charlotte area. One of the complaints was that Dominion was offering community support as a mentoring service.

In calls to 11 patients or their guardians, investigators found that eight did not know they were receiving a mental-health service and did not know what their diagnosis was. Ten of 11 did not know that community support is a mental-health service.

Hugh Eighmie II, a lawyer with Gary's firm who is working on the Dominion case, said company workers told clients they were signing up for mentoring so they wouldn't be scared away from mental-health treatment.

Mental illness carries a heavy stigma, especially in minority communities, Eighmie said, and it's important to talk to clients in terms they can understand.

"They do understand terms like 'mentoring,' " he said.

Others questioned, too

Dominion is not the only company with bills attracting attention.

Workers at American Health & Human Services, a community support agency in Elizabeth City, billed Medicaid for picking children up for school, watching them take tests and eat lunch, and watching them play after school, according to company records.

One community support worker spent eight hours with an elementary school student. His goal for the day was to "increase frequency of on task behavior and following directions."

This is the worker's report of what happened from 10:01 a.m. to noon on Jan.
3, 2007:

"1. Client entered gym class quietly. Mentor extended verbal praise to client for his behavior. Client responded by saying thank you.

2. Client participated in the class activities. Mentor complimented client for his class participation. Client responded by saying thank you.

3. Client listened to the gym teacher instructions. Mentor complimented client for being attentive. Client responded by saying thank you.

4. Client lined up quietly to go to lunch. Mentor complimented client for following teachers' directions. Client responded by saying thank you."

The worker made similar notes for the rest of the school day and for two hours after, logging an eight-hour day and allowing American Health & Human Services to charge $488.

Reviewers from the regional mental-health office criticized the services for not building skills or working toward clients' goals.

The state wants the agency to repay about $500,000. American Health & Human Services owner Andrea L. Simpson has repaid some money but said he would appeal the most recent repayment order for $211,957.

Simpson said the company stopped sending workers into schools, though he thinks workers still need to be there.

"You have to teach a child a skill," he said. "If you cannot get their behavior under control first, then you can't teach them a skill."

He blames the state for the confusion about what companies are allowed to do; early on, the state did not require training in community support. Then, when his workers went to training sessions, he said, instructors would not give answers about what's right or wrong.

Wayne Peel of Williamston, who runs an independent company that trains community support workers, said the early lessons the state required did little to help providers new to the mental-health field.

"The training in the beginning was inadequate," Peel said. "I don't think you would find anyone that disagreed with that."

State officials underestimated how many people with little knowledge or training in mental health would start offering community support, he said.
"Didn't have any," Peel said of some of the providers'
experience. "Nada. Zero."


lynn.bonner@newsobserver.com or (919) 829-4821

Thursday: Seeking serious help? Don't count on it.

* * *

http://www.newsobserver.com/2771/story/965581.html

Published: Feb 26, 2008 12:30 AM Modified: Feb 26, 2008 02:41 AM

Community support can help if it's well-focused Lynn Bonner, Staff Writer

Not all private providers of mental-health services are in trouble with the state.
Tim Brooks, a co-owner of Carolina Outreach, a company based in Durham, said the rules on community support haven't been clear, but what's important is that workers make sure time spent with clients connects to treatment goals.
His workers rarely spend their time in classrooms, he said.

The state could do more to help mold a better mental-health system, Brooks said, by taking the reams of information it collects from service reviews and company reports on patient progress to figure out what makes clients better.

Ryan Ort, a community support worker with Carolina Outreach, says he takes an active role in teaching children and teenagers how they can control their behavior and getting them to think about what they want to accomplish.

Ort, 34, doesn't see the boys every day. Usually it's twice a week for two or three hours at a time. The children he works with usually are diagnosed with ADD, ADHD, or oppositional defiant disorder, which can get them in trouble at school and at home.

Ort has been working with 14-year-old Frank Davis of Chatham County to get him to attend school regularly and relate better to his parents.
Frank is repeating seventh grade because he missed so much school last year.
Frank was depressed. His parents were living apart, and his mother was ill.

The job involves working with Frank's parents, too. One recent Tuesday, Ort spent an hour talking to the family about goals met during the week and what steps they could take to prepare for Frank's graduating from community support.

"We're not there just to be a friend," Ort said in an interview.

"The time we spend together, we're talking about their goals and plans and how to reach them."

Community support should be a temporary service, he said, because one of the goals is to show the children and their families how they can go on without it.

From the start, Ort said, he starts talking to children about how the service will end.

"All the while, we have discharge in mind," he said. "The whole purpose is to work yourself out of a job."

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.

* * *

http://www.newsobserver.com/2771/story/965563.html

Published: Feb 26, 2008 12:30 AM Modified: Feb 26, 2008 06:24 AM

At $61 an hour, community support provided a movie buddy and a shopping companion

Government reviews of community support providers produced thousands of instances where the companies billed $61 an hour for services that were inappropriate. Some examples:

Working out at the Y
'Worker assisted with keeping client [58-year-old woman] on task at YMCA and monitored to make sure exercises done right. Worker assisted client with setting up machines (12) with speed, time, mileage, weights, height of seats and calculation of calories "burned." '
-- TWO HOURS

That same entry, almost word for word, was recorded four other times.

Movie, anyone?
'Staff verbally prompted consumer [36-year-old man] to choose an activity to participate in. Consumer chose to go to movies.'
-- THREE HOURS

Out and about
'Staff accompanied consumer [13-year-old boy] to mall and amusement center while discussing stress management and life goals. Staff provided role-modeling, adaptive skills training and encouragement as consumer socialized with others.'
--FOUR HOURS

Applying for a job
'Staff provided verbal & physical prompts to [16-year-old boy] on how to fill out a job application, and how to ask for the application when he goes in the establishment.'
-- ONE HOUR, description given five times one week, for 5 hours total

Celebration
'Asked consumer [11-year-old girl] how her day went today. Rejoiced with consumer about her phone call from her brother. Stated to consumer that I was happy that she was happy. Continued to monitor consumer as she went about her regular scheduled events in a joyous manner.'
-- TWO HOURS

Wal-Mart
'Worker accompanied consumer [8-year-old girl] to Wal-Mart ...
consumer wanted to look at toys. Worker provided feedback to consumer about certain learning toys on shelf. Consumer picked out a toy after worker picked up a couple of items and browsed around.'
-- TWO HOURS

School pickup
Staff went and got [8-year-old girl] from school. Staff watched [child] walk from her classroom to the office. Staff complimented [child] on the way she walked down the hall. Staff talked to [child's] teacher to see how she was doing in class. Staff rewarded and praised [child] on how she was doing in school."
-- ONE HOUR

Homework helper
"The client [14-year-old girl] didn't want to do any homework because client stated it was [boring]. The staff discussed the issues of not doing homework the reason client has work to help client learn. The client wanted to work later but changed [mind] and did it before leaving the center. The intervention was successful."
-- FIVE HOURS

Encouragement
"Worker continues to talk to the child [6-year-old boy] and to help him all she can. Worker will give support and suggestion to the child.
Child has been made aware of just do your best and always try hard in what you do. Worker gave child verbal compliment for his very good behavior and good work today."
-- TWO HOURS

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.

* * *

http://www.newsobserver.com/2771/story/965568.html

Published: Feb 26, 2008 12:30 AM Modified: Feb 26, 2008 06:25 AM

State clamps down on claims
Rules too vague, providers contend

Pat Stith and Lynn Bonner, Staff Writers

It will take more than a year for the N.C. Department of Health and Human Services to resolve disputes with hundreds of community support providers and thousands of their clients afflicted with mental illness or substance abuse.

There is a backlog of more than 5,000 individuals, most of whom are trying to reverse a decision to restrict or deny them a basic skill- building service called community support.

Appeals from more than 300 providers will be more complicated and time consuming. Most of them are fighting decisions by the state to make them repay money or kick them out of the program.

Appeals from individuals soared after the department tightened the screws last fall on ValueOptions Inc., a company paid by the state to look at requests for service and then authorize, amend or reject them.

"We've said to ValueOptions, 'You have got to get more in tune with our expectations of rehabilitative services,' " said Dempsey Benton, the new secretary of health and human services. "They're taking a much more critical look at the requests and, right or wrong, there are fewer requests, percentagewise, getting authorized."

The tougher scrutiny has resulted in a flood of appeals from individuals who want the government to pay for their care.

At first, the department let providers into the program on a "conditional"
basis -- go to work now, qualify later. Now, the department wants to weed out providers it deems unqualified.

"What we're trying to do is change the definition of a provider and require the provider to have more qualifications," Benton said.

Government auditors concluded last year that providers had overbilled by about $59 million, and the department wants the money back. Through mid-January, the state had recovered about $14.8 million.

The most recent batch of letters demanding repayment was mailed in December, and the requests for hearings soon followed. The backlog of provider hearings went from 126 in December to 303 in January.

One reason providers appeal: Some are winning. The 12 completed cases recorded at the department's controller's office so far show that hearing officers have reduced the amount owed by 30 percent.

Keith Green, executive director of the Center for Behavorial & Social Change in Durham, said his company received a letter in July demanding repayment of $116,063. An audit had alleged improper documentation and overbilling.

Green, who said the company has about 25 clients, hopes his repayment will be cut to $30,000 or so.

"If you have to pay back the kind of money they're requiring, you're looking at the possibility of closing your business," he said.

Providers contend they were given vague descriptions of the work they could do and little or no instruction on what was allowed under the rules.

"None of us providers were properly prepared to go into this new mental-health reform," Green said.

Providers and individuals can appeal decisions from the department hearing to the state's Office of Administrative Hearings. Some people go straight to the administrative court.

Renee Montgomery, a Raleigh lawyer, filed appeals for seven community support providers in January, challenging assessments by local mental- health offices that they had provided unnecessary treatment. The companies contend that local reviewers were not qualified to second- guess decisions by doctors and others who ordered community support services.

"Those audits based on alleged lack of medical necessity will be fatally flawed," Montgomery said.


All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.

Providers owe money to state

http://dwb.newsobserver.com/cgi-bin/all/simple_database/list.cgi?input=mental_health/provider.txt&template=mental_health/template.html&sortby=provider&sorttype=a

Mentally ill suffer under faulty system

Letter to the Editor of the Charlotte Observer

http://www.charlotte.com/239/story/507148.html

GUEST COLUMN | SELBERT WOOD JR.

Mentally ill suffer under faulty system
More taxpayer dollars are spent every year, but fewer are helped

I live in the state of North Carolina, but since 2001, I have also lived in the state of mangled care, as our state attempts to manage public-funded mental health care. What began seven years ago as an effort to increase access, choice and effectiveness of services has developed into a quagmire of haste and collapse.

Private providers have started, changed and stopped. Local management entities have merged, changing systems and functions. Service definitions alter frequently, just as reimbursements are reduced and availability of care diminishes. Clinical services that require heavily regulated credentials and expertise are difficult to find, while community support and hospitalizations increased.

Existing and new providers throughout the state, including HopeRidge, Telecare, Mountain Laurel, and New Vista, have closed. Caring Family Network, the largest provider in Chapel Hill, announced recently that it will close in April. Many providers have ceased some services or closed entire service centers.

It is impossible to fly a plane while building it in mid-air.

Services are eroding in our communities while psychiatric hospitalizations have increase 21 percent. In the past three years
49,137 fewer consumers (34 percent) have received clinical therapy.
They have dropped out of services, moved to an inappropriate form of care or faced expensive, disruptive care in institutions.

During the same three years, persons receiving services through state funding and federal block grant dollars have dropped 61 percent (or
32,474 people).

Medicaid expenditures have skyrocketed, with more than $76 million a month getting doled out for community support. A little over half of those cases are deemed medically necessary and only one in ten received the appropriate intensity and duration of services.

Readers would be hard pressed to find any fans of our current system.
Every gubernatorial candidate has a policy statement or platform plank to change it.

We must do better for the families who need our help instead of placing them in expensive hospital or prison beds and outside their own communities.
There is enough money to provide clinical services, but the existing funding and infrastructure should be better utilized.

Reduce the inefficient and overly managed system, which some estimate may spend around 65 percent in administrative oversight instead of care delivery for consumers in our communities.

We have redundancy in our system, with 25 LMEs, Value Options and several divisions in the Department of Health and Human Services performing similar functions in our communities when it comes to authorizing and managing care.

They are often in conflict with each other, to the detriment of care delivery and stability.

We know there are limited resources and finite funding for the care of the populations we serve. Appropriate care should be maximized to the best of our ability. If there is a problem, however, with an overused or inappropriate service, then the answer is not making all care harder to access.

Issues of accountability for this care cannot be addressed merely by increasing bureaucracy.

I am constantly reminded that the process may be complicated, but the impact is simple: enhancing lives.

It is time to focus on service delivery and not turf protection. It is time to invest our existing resources in families instead of sending them to hospitals and building 800 new prison beds each year.

It is the time for politicians, bureaucrats and citizens to step up and untangle this mangled care.

Guest Column | Selbert Wood Jr.

Selbert Wood Jr. is president/CEO of Partnership for a Drug-Free NC Inc., a not-for-profit organization that provides services to reduce the impact of substance abuse and mental illness. The group announced this week that it was closing mental health clinics.

What would we do without emergency room?

Column from the Hendersonville Times-News
http://www.blueridgenow.com/article/20080225/NEWS/802250301
Published Monday, February 25, 2008

What would we do without emergency room?

Life In The Middle
Susan Hanley Lane

What would you do if someone you loved was having a heart attack and there was no emergency room to go to?

Throughout America, hospitals and emergency rooms are having a hard time staying afloat thanks to HMO reimbursement guidelines, government cutbacks and rate freezes on Medicare and Medicaid, and a growing number of uninsured patients.

Like any other business, a hospital must pay its staff if it wants them to keep coming to work. They also have to pay their heating and electric bills, and their taxes.

Most of us take hospitals for granted because whenever we've needed them, they've been there. But an increasing number of Americans are finding out that when hospitals don't get paid, sooner or later they shut down. Go to Google on your computer and type in: emergency room closings. You may be surprised to discover you have about 130,000 entries to choose from. The overwhelming consensus is that emergency rooms, along with everyone else, are feeling the pinch of a tightening economy. But there are only so many things a nation can afford to do without. Emergency rooms are not one of them.

We've been hearing promises about affordable health care for years now. It's becoming a standard election year promise. The unpleasant truth is the solutions to this national health threat will be a tough pill to swallow.

If we ever hope to truly contain the cost of healthcare, we're going to have to change the way we approach 1.) the relationship of lifestyle to disease,
2.) the breakdown of the mental health care safety net, 3.) uninsured populations accessing our health care system, and 4.) the role of large insurance companies in setting reimbursement guidelines.

1.) The relationship of lifestyle to disease: Obesity, diabetes, substance abuse, heart disease, and many cancers are often the result of lifestyle choices. Unless we do the hard work of taking personal responsibility for our own health and the health of our children, these diseases will continue to gobble up a disproportionate share of our health care dollars.

Preventive health care is not just the medicine of the future. It is the fastest way to prevent overuse of the health care system from bankrupting America. What were we thinking when we allowed fast foods to be sold in schools? Do we wonder why obesity is skyrocketing with soda machines in the hallways?

Also, Americans have a right to demand that lobbyists for large corporations, like Monsanto, not be allowed to induce legislators to enact laws that forbid farmers from saving the seeds from their own crops and/or having to buy genetically engineered seeds that do not reproduce themselves.


2.) The breakdown of the mental health care safety net: Quiz question
- What facility has the largest number of mental health care patients in the United States? Answer: The Los Angeles County Jail. This is a national disgrace. A nation that refuses to care for its own mentally ill population is guilty of the basest neglect, no matter how many foreign dollars it borrows to fight the righteous wars of other nations.

Believe it or not, substance abuse comes under the umbrella of mental health care. The lack of a real strategy to eliminate the drug culture that is flourishing across America has resulted in the number of arrests and imprisonments in our large cities doubling within the last decade.

Effective drug treatment, not building new jails, is the most cost effective way to fight the drug war. For every dollar spent on treatment, seven dollars are saved on cleaning up the aftermath of drug abuse in our society.


3.) Uninsured populations accessing our health care system: It is a strain on any emergency room to eat the cost of patient care. But generally, even the uninsured pay income taxes, part of which are funneled back into the health care system by state and local governments. It's not an even trade off, but this system has allowed emergency rooms to survive for many decades.

Unfortunately, in recent years things have changed. The number of undocumented workers who do not contribute to the tax base has soared.
No nation that allows non tax-payers equal access to its emergency rooms can survive when the non tax-payers using those emergency rooms is a significant part of the population. (If you doubt this, type these words into your search engine: emergency room closings in southern
California.)

If we do not solve this dilemma, don't be surprised if someone you love one day has a heart attack (say on a Sunday evening) and there is no emergency room close enough to take him to in time to save him.

4.) Large insurance companies setting reimbursement guidelines for health care providers: When HMO (Health Maintenance Organizations) first came on the scene, we were told they would manage our care.
Instead, they have managed their own health by cost cutting and refusing to pay the kind of fees many health care providers need to charge to stay in business.

Something like the Hill-Burton law of 1946 would place the burden of health care for the uninsured back into the hands of state governments, which could then establish guidelines allotting grants and/or loans to hospitals to sustain reasonable treatment levels based on the most recent census data.

The establishment of free or low fee clinics with emergency rooms, where indigent people could go for care, is another option to solve this problem.
Tax incentives could be granted to physicians, and hospitals who agree to participate.

The answers to our health care dilemma involve tough decisions. But we can do it if we will stop settling for political promises that are nothing more than candy coated lies.

National Healthcare Decisions Day

Dear NASW State Chapters,

The NASW National Office is joining other national organizations in promoting the first National Healthcare Decisions Day (NHDD) on April 16, 2008. The NHDD Initiative is a collaboration of national, state and community organizations to encourage advance care planning for all adults with decision making capacity.

The objectives of National Healthcare Decisions Day are the following:

• To raise awareness through state and community coalitions about the importance of advance healthcare decision making;
• To have adults with decision making capacity to communicate and document their healthcare decisions, and identify a health care agent or proxy to make decisions for them if they cannot make decisions for themselves; and
• To educate related organizations and individuals about access to each state's advance directive documents available for free from Caring Connections at
As a result of NHDD, many more Americans can be expected to have thoughtful conversations about their healthcare decisions and complete advance directives to make their wishes known. NHDD focuses on this issue by drawing attention to advance healthcare planning from a variety of directions simultaneously.

NASW is asking chapters to consider:

1- Reviewing the information on the NHDD website at www.nationalhealthcaredecisionsday.org and to promote the initiative with members and related end-of-life or advance care planning groups that may want to sign on to the state and community campaigns that NHDD is trying to build.

2- Using different events and activities to promote the day, either in accordance with existing education efforts, or with collaborative efforts. The NHDD website provides ideas and outreach materials to organize your community or state efforts at .

3- Signing up at www.nationalhealthcaredecisionsday.orq/maintopics/sign up if your chapter or community group decides to get involved.

4- Using the NHDD email template to educate interested individuals and groups about advance care planning and the NHDD Initiative which can be viewed at: http://www.nationalhealthcaredecisionsday.orq/UserFiles/File/NHDD/Template email for affiliates(1).doc

For additional information or questions about this initiative, please contact: nhdd@nhpco.org or Karyn Walsh, NASW Senior Policy Associate, at kwalsh@naswdc.org or by phone at 202-408-8600, ext. 448. Thank you for trying to make this an important day and initiative

Monday, February 25, 2008

US bishops ask ICE to assist families, communities after immigration raids

Two United States Catholic bishops involved in immigration issues havewritten to the U.S. Department of Homeland Security to express theirconcern about the protocols and the increased law enforcement activityof Immigration and Custom Enforcement (ICE).The bishops asked the agency to adopt policies that would assist thefamilies and communities affected by immigration enforcement actions.They also asked that the agency refrain from conducting enforcementactions at or near churches, hospitals, schools, or charitableorganizations.Bishop of Salt Lake City John Wester, Chairman of the U.S. Conference ofCatholic Bishops' Committee on Migration, and Bishop Jaime Soto,coadjutor bishop of Sacramento and Chairman of the Catholic LegalImmigration Network, wrote the letter requesting policy changes toSecretary of Homeland Security Michael Chertoff and his undersecretaryJulie Meyers."Although ICE has recently issued guidance regarding worksiteenforcement operations, we believe that the guidance falls short of whatis necessary," the bishops wrote. Bishops Wester and Soto urged the release of primary caregivers afterimmigration enforcement actions and the improvement of family members'ease in locating detained relatives. Detained individuals should havebetter access to legal counsel, and ICE should avoid transferringdetainees out of their community.Community outreach and education programs should be developed to followenforcement actions, the bishops said, and enforcement should besuspended during natural and man-made disasters.In an additional statement on February 7, Bishop Wester criticized therecent congressional economic stimulus package that prohibitedundocumented immigrants from receiving tax rebates."The decision to prohibit undocumented immigrants from receiving taxrebates in the stimulus bill highlights the injustice in our immigrationsystem. It proves that these workers pay into the tax system and helpsupport our economy. It also reveals the hypocrisy of our laws. With onehand our government attempts to deport these workers, but with the otherit holds tight the taxes they pay into the system. This perpetuates anunderclass of workers without full rights," Bishop Wester said."We should not accept the fruits of the labor of these workers at thesame time we refuse to provide them the protection of our laws. As ademocratic and free nation protective of human rights, we cannot have itboth ways. Congress must mend a broken system and show the courage toenact comprehensive immigration reform," he continued

Friday, February 22, 2008

Foreclosure assistance

NASW-NC participated in a conference call today sponsored by the members of NC Asset Building Policy Task Force to discuss the foreclosure crisis happening in North Carolina. If you have clients currently facing foreclosure, please visit the following website for information: NC Foreclosure Help

University of Illinois shooter a social work student

Although there have been conflicting stories in the media, it seems as though the shooter in the University of Illinois tradgedy was in fact a social work student. Visit their home page for a statement: University of Illinois School of Social Work

NASW-NC extends our deepest sympathies to everyone involved, particularly in the social work community.

Thursday, February 21, 2008

Jason Bartlett becomes Nation's first black and openly gay legislator

WASHINGTON, DC --History was made earlier today as State Representative Jason Bartlett (2nd District Connecticut) publicly came out as gay. His announcement makes him the highest ranking African American and openly gay politician in the United States. The National Black Justice Coalition proudly congratulates Rep. Bartlett for both his courage and for his political accomplishments.

Please see the National Black Justice Coalition for more information:
http://www.nbjcoalition.org/news/nbjc-exclusive-the-coming.html

2007 NC Youth Risk Behavior Survey

http://www.nchealthyschools.org/data/yrbs/

Wednesday, February 20, 2008

NEW Medicaid Documentation Training

Due to continuing demand, we have scheduled another Medicaid Documentation training west of Raleigh to be held at the Pilot Mountain School Facility in Morganton, NC on March 12, 2008. Please forward this email to providers who would benefit from this training. Thanks!

The training is for providers of Community Support, Developmental Therapy, and/or Intensive In-Home services.

IF YOU PROVIDE ANY OF THESE SERVICES, YOU NEED TO ATTEND THIS TRAINING:

The Three MUST HAVES for Success: Documentation · Medical Necessity · Prioritization
Trainer: Elizabeth Grady, LPC, NCC
March 12, 2008, Pilot Mountain School Facility, Morganton, NC, 9am-4pm

Please see the following flyer and registration form for more information. We look forward to seeing you there.
---------------------------------
Training Registration Form
March 12, 2008 · Pilot Mountain School Facility, Morganton, NC · 9am to 4pm
Designed for Providers of Community Support, Developmental Therapy,
and/or Intensive In-Home Services¾
The Three MUST HAVES for Success: Documentation · Medical Necessity · Prioritization

Participant Information:
Name/Title: _________________________________ Agency: __________________________________

Address: ___________________________________ Phone/Extension: ___________________________

City/State/Zip: _______________________________ Fax: _____________________________________

Email (required): __________________________________________________________________________
_
How to Register:
Cost per participant: Member: $50. Non-Member: $60. Lunch will be served on-site for an additional $5 per participant. Mail this form with payment to:
NC Providers Council, Attention: Diana Mills, 3722 Benson Drive, Suite 102, Raleigh, NC 27609
Fax this form to: 919-850-4593; call 919-850-4592, or email: diana.mills@ncproviderscouncil.org

Method of payment: Check Enclosed_____ Check #__________ Visa____ M/C___ TOTAL: $____________

Name on Card:_________________________________________ Expiration Date:_______________________

Credit Card Billing Address with Zipcode (required):______________________________________________

Credit Card Number:__________________________________________________________________________________

Registrations w/ payment must be received by March 3rd, 2008 to ensure a seat. NO EXCEPTIONS. Please note: 1) You are not registered to attend this event until you receive a confirmation email from the NC Providers Council; and 2) No refunds are allowed, however, substitutions are accepted if notified and confirmed two days prior to the training.

Directions to Pilot Mountain School Facility, 4806 US 64, Morgantown, NC
Traveling West on I-40 (from Raleigh area):Keep RIGHT to take I-40 W/I-85 S via Exit 131 toward US 70/Greensboro/Winston-Salem
Keep RIGHT to take Exit 36A toward Winston-SalemTake the US 64 Exit 103
Turn LEFT onto US 64
Drive 6.7 miles to end at 4806
Traveling East on I-40 (from Asheville area):Take the US 64 Exit 103Turn RIGHT onto US 64
Drive 6.6 miles to end at 4806

Parking:

Parking is free and plentiful.

Teens with Developmental Disabilities Webinar 2/20/08

Dear Colleague:
We are excited to announce our upcoming Web training, Teens with
Developmental Disabilities: Victimization, Risk, and Intervention,
February 20, 2008, at 2:00 p.m. ET. The training is part of our
Web-based series on helping teen victims of crime, moderated by Mitru
Ciarlante, director of our Teen Victim Initiative. Karen Rogers, Ph.
D., a licensed clinical psychologist and expert on the assessment and
treatment of children and families exposed to trauma, will be the
featured presenter.
People with developmental disabilities experience higher rates of
victimization than their typically developing peers. Dr. Rogers will
address these disparities by reviewing the ecological risk factors
faced by youth with developmental disabilities and explaining the connection
between culture, developmental disabilities, and youth victimization.
She will also present a model for intervention.
Dr. Rogers serves as Program Area Leader for Project Heal, the trauma
treatment and training program at Children's Hospital Los Angeles
(CHLA) Mental Health Services at the University of Southern California
University Center for Excellence on Developmental Disabilities (USC
UCEDD). Her clinical specialty is assessment and treatment of children
and families exposed to trauma.
Registration is free, but spots are limited. We ask multiple
participants attending from the same location to register as one
person and view the presentation together.
To register or to access training materials, visit ncvc.webex.com.
For assistance, please contact Mira Krivoshey in the Teen Victim Initiative at 202-467-8747 or
mkrivoshey@ncvc.org.
We encourage you to register early because the response to our previous trainings has been overwhelming. You can
download the materials from past sessions at www.ncvc.org/tvp/main.aspx?dbID=DB_TeenTA151.
Through this Web training series, we explore topics online to help
victim assistance providers and allied professionals provide informed,
culturally competent, and developmentally appropriate responses to
teen victims and their families. We can provide these trainings at no cost
to you with the support of a grant awarded by the Office for Victims of
Crime, Office of Justice Programs, U.S. Department of Justice.
Please forward this e-mail announcement to anyone who may be
interested and include this information in your upcoming publications or on your
Web site.
Thank you.

Mary Lou Leary
Executive Director
National Center for Victims of Crime

Monday, February 18, 2008

Fred Smith on Mental Health

MENTAL HEALTH:North Carolina should not reduce the number of beds in its psychiatric hospitals until progress is made in improving local treatment options for the mentally ill, Republican gubernatorial candidate Fred Smith said Thursday. The state senator from Johnston County released a policy paper Thursday on the state's mental health care system. Smith argues that "improperly timed, poorly planned and failed implementation" of mental health reforms has hurt patients. In 2001, the state began implementing a plan to shift care of the mentally ill from large hospitals to community-based treatment centers run by private caregivers. But the level of local care has been uneven, and hospital admissions remain high.
Smith said the state should be responsible for providing long-term care. But the state needs more short-term psychiatric care in community hospitals and other crisis services to reduce demand on the state institutions, he said. "Building a strong system of community based mental health services is not going to happen as a result of increased and constantly changing state rules and regulations coupled with poorly developed and sometimes inadequate provider reimbursement policies," Smith said in the statement. (THE ASSOCIATED PRESS; THE NEWS & OBSERVER, 2/14/08).

Action for NC Children Updates

Greetings,
Below are summaries of articles related to child well-being in North Carolina. Also provided are links to each article's full text.
HEALTH
SAFETY
EARLY CARE
EDUCATION
ECONOMIC SECURITY
HEALTH
The Daily Southernerhttp://www.dailysoutherner.com/statenews/local_story_039094557.html
"Candidates for governor focus on insurance"
By The Associated PressRESEARCH TRIANGLE PARK-—
Four Republican candidates for governor preached personal responsibility and private insurance solutions Thursday night to reduce health care costs and put more North Carolina citizens on insurance rolls."We've got to move from a culture of unhealthy lifestyles to a culture of healthy lifestyles," state Sen. Fred Smith of Johnston County said at a gubernatorial forum at the University of North Carolina Television studios. “We’ve got to have market-driven consumer decisions to where are patients make good prudent decisions about our health care costs."Earlier in the 90-minute forum, leading Democratic candidates Lt. Gov. Beverly Perdue and State Treasurer Richard Moore also talked up preventive care to reduce the costs of chronic diseases like diabetes and high blood pressure to cover the 1.4 million North Carolinians who are uninsured.Perdue and Moore also again traded barbs in the second of the candidates’ three scheduled statewide television forums, with Moore questioning Perdue’s work on a state health panel and Perdue citing a 1994 candidate’s newspaper questionnaire that he was willing to consider trimming federal health programs for the elderly and poor.All six candidates, who are vying for their parties’ nominations in the May 6 primary, also lamented about the lack of physical education in the public schools and shared their challenges to their own personal health, with Moore saying he was an overweight child."I've literally lived this," Moore said. "I grew my way out of it, exercised my way out of it and really saw the link that there is between academic success and being physically fit."The other GOP candidates, Charlotte Mayor Pat McCrory, former Supreme Court Justice Bob Orr and Salisbury attorney Bill Graham, joined Smith in encouraging state involvement to provide incentives for small businesses and individuals to provide private insurance to the uninsured.--------------

The Independent Tribunehttp://www.independenttribune.com/servlet/Satellite?pagename=CIT%2FMGArticle%2FCIT_BasicArticle&c=MGArticle&cid=1173354549682"
"Leaders: Strides are being made in dental care"By Josh McCannHARRISBURG -
Local leaders have consistently identified access to dental care as a need for more than a decade, but dentists and health officials say Cabarrus County children still do not have enough.As part of an ongoing push to remedy that disparity, 17 local dentists opened their offices to provide free screening, education and treatment Friday to more than 200 children.Cabarrus dental professionals also participated in the "Give Kids a Smile!" program each of the past five years as part of National Children’s Dental Access Day.The issue was one of the first charged to Healthy Cabarrus as a result of a 1997 needs assessment, executive director Gina Goff said."It's a need that's not yet gone away," Goff said. "But I do know we've made a lot of progress."Since 1997, the Cabarrus Health Alliance has opened a dental clinic in Kannapolis that has expanded to 12 chairs at The Village in Concord.The overall number of dentists in the community has also increased as more for-profit practices have started, and an increasing percentage of Medicaid recipients are accessing dental care, Goff said.Even so, Cabarrus has fewer dentists per capita than either the state or national averages.Goff said there were 3.0 dentists per 10,000 residents in the county in 2005, up from 2.7 in 2001.The state has 4.4, up from 4.0.The nation has 6.0, up from 5.9.--------------

WECT-TV Wilmingtonhttp://www.wect.com/Global/story.asp?S=7852932&nav=menu157_11
"Health Tip: Baby Teeth Need Attention"(HealthDay News) -
Even though baby teeth eventually fall out and are replaced by permanent teeth, they still need proper care.Here are suggestions to keep baby's teeth healthy, courtesy of the American Academy of Family Physicians: * It's never too early to start brushing. As soon as the infant's first tooth erupts, start brushing twice a day with a damp washcloth. * Once your baby is a year old, start brushing teeth with a toothbrush and toothpaste (without fluoride) that are designed for babies. * Make sure your baby sees the dentist by the first birthday. Make sure the child has regular, twice yearly checkups every year. * Avoid too much juice, which may contain lots of sugar that can lead to decay. * Don't give your baby a bottle once the infant has reached 1 year of age.--------------

WSOC-TVhttp://www.wsoctv.com/food/15301276/detail.html
"Diet Can Make For Healthy Smile"
February is Children's Dental Health Month, a good time to review basics of healthy teeth.Nutrition for healthy teeth starts with the MyPyramid food guidance system. Although calcium helps build strong teeth and bones, many foods in MyPyramid contain nutrients that help kids maintain a healthy smile, snacks such as fresh vegetables, fruits, yogurt and cheese.Encourage your children to keep their teeth and gums healthy by brushing with fluoride toothpaste twice a day and flossing daily. Go easy on between-meal snacks. When they do snack, have them eat the snack at one sitting, rather than nibbling on it over a long period.When possible, have your children brush right after eating. If brushing is not an option, at least remind them to rinse their mouth well.--------------

The Times-Newshttp://www.thetimesnews.com/articles/physical_10165___article.html/school_most.html
"Nutrition is just as important as education"
Commentary by Gabriella Gallo, Times-News correspondent
If you asked any kid what their favorite period in school is, their likely answer is lunch.Yes, they get to socialize and gossip about all the latest news, but that’s not the only reason they jump out of their seats at the sound of the bell. It’s their senses telling them that yogurt, salads, cheeses, fruit and more is waiting for them. At least ideally, that’s what it should be. In reality, school cafeterias are packed with unhealthy food like fries, burgers, cookies and chili hot dogs. It’s not that these foods should never be eaten, just not every day.Recent studies have shown that children in the U.S. are most at risk of becoming overweight or obese. Physicians believe the cause for obesity is, first and for most, the lack of physical activity.Now, most schools only demand one semester of physical education for high school students and one hour a week of physical education for elementary school children.But, is this really enough to help children stay in shape? According to the Trust for Americas Health (TFAH), it’s not. In addition, a survey conducted in 2003-04 by the U.S. Department of Health and Human Services showed that more and more children ages 10-17 are becoming overweight.A state-by-state study of overweight children ages 10 to 17conducted in 2003-04 showed that the top 10 states with an obesity problem are as follows: (1) Washington, D.C; (2) West Virginia; (3) Kentucky; (4) Tennessee; (5) North Carolina; (6) Texas; (7) South Carolina; (8) Mississippi; (9) Louisiana; (10) New Mexico.Sadly, all this does have consequences on one’s physical, mental and emotional well-being. Research has shown in the past that being overweight can cause numerous health issues such as heart disease and diabetes.--------------

Rocky Mount Telegramhttp://www.rockymounttelegram.com/health/content/shared-auto/healthnews/hear/611912.html
"Campaign Targets Noise-Induced Hearing Loss in Kids"
(HealthDay News) -- About one in eight -- or about 5 million -- American youngsters have noise-induced hearing loss, something that's entirely preventable, says the American Academy of Audiology.The academy has launched a public education campaign, called Turn it to the Left, to boost awareness of the problem and explain how it can be prevented simply by turning down the volume of personal music players."The hearing loss kids experience now will accelerate the hearing loss normally associated with aging when these kids are in their 60s and 70s," Alison Grimes, academy president and head of the Audiology Clinic at UCLA Medical Center, said in a prepared statement."Hearing loss is the third most common health problem in the United States and affects more than 31 million Americans. With the Turn if to the Left campaign, we hope to educate kids to turn down the volume and prevent hearing loss before it begins."Grimes said it's a simple thing to turn down the volume, avoid areas with excessive noise, or use earplugs, but many children aren't doing it."Parents and teachers need to help educate kids at home and at school," she said.Because children seldom complain about symptoms of noise-induced hearing loss, it can be difficult to diagnose. Symptoms may include distorted or muffled sound, difficulty understanding speech, or ringing in the ears, which is a sign of imminent damage. Youngsters may not even be aware of hearing loss, but it can be detected during a hearing evaluation."Kids need to have their hearing checked regularly by an audiologist, but more often than not, children don't see an audiologist until there is a problem," Grimes said. "Hearing is critical to children's safety and to the development of speech, listening, learning and social skills. With a little education, a commitment to turning down the volume, and regular visits to an audiologist, hearing loss can be prevented."-------------------------------

SAFETYWinston-Salem Journalhttp://www.journalnow.com/servlet/Satellite?pagename=WSJ/MGArticle/WSJ_BasicArticle&c=MGArticle&cid=1173354618138
"2006 death toll from ATVs at least 555: Number includes more than 100 children but is incomplete, agency says"
By The Associated PressWASHINGTON--
At least 555 people - more than 100 children among them - died in all-terrain vehicle accidents in 2006. Government safety officials expect the number to go much higher as they continue to gather information.The Consumer Product Safety Commission estimated that an additional 146,600 people were treated in emergency rooms for ATV-related injuries - more than a quarter of them children.Consumer groups and parents who have lost children in wrecks have complained for years about the safety of the popular off-road vehicles.The industry says that it is not the ATV but the driver that is the problem."ATVs have never been shown to be an unsafe product, but there have been bad decisions made by people sitting on the seat," said Mike Mount, a spokesman for Specialty Vehicle Institute of America, based in California.In its annual report released yesterday, the CPSC said that Pennsylvania, with 420 deaths, has had the highest number of reported ATV deaths since 1982, followed by California, West Virginia, Texas and Kentucky. North Carolina, with 297 deaths, is ninth."The signs are pointing to a very dangerous trend into more than 800 deaths per year," CPSC spokesman Scott Wolfson said. The agency is still gathering data as far back as 2003. The report updates CPSC data with numbers from 2006, the latest year that agency staff have analyzed.--------------

Raleigh News & Observerhttp://www.newsobserver.com/2188/story/938703.html
"Ban sought on novelty lighters"
By Amy Lorentzen, Associated Press WriterDES MOINES, Iowa -
The cartoonish plastic frog with bulging eyes could be a children's toy - but for the torch-like flame that bursts from the novelty lighter's head."They look like something you would get in a McDonald's Happy Meal," said John Dean, president of the National Association of State Fire Marshals, who often shows off the device. "They're cute, they're little" - but they can be deadly.Dean's group is backing an effort to ban novelty lighters across the country, and a handful of states are considering it. In California, Washington and Arkansas, local ordinances have been passed to keep the lighters off store shelves.Novelty lighters can look like anything from tiny skateboards and cell phones to farm animals and butterflies. Some light up or make noises, including the tiny green frog that elicits a "ribbit" when its flame is ignited."They look like toys so kids play with them, and that's caused a number of injuries and ... deaths," said Iowa state Sen. Keith Kreiman, who called the devices "an attractive nuisance." The Iowa Legislature considered a measure last year seeking a study of the lighters, and the matter will likely come up again this session, Kreiman said.The European Union has moved to ban novelty lighters, which are generally manufactured in China. Fire officials worry that manufacturers will try to unload the lighters in the U.S."What I think is happening now is we're really getting dumped on, we're seeing more," said Judith Okulitch with the Oregon State Fire Marshal's Office.Okulitch's agency was among the first to raise concern about the novelty lighters.-------------------------------

EARLY CAREKinston Free Presshttp://www.kinston.com/articles/care_44286___article.html/quality_child.html
"More Lenoir and Greene county children in quality child care"
The New Year starts with good news for parents in Lenoir and Greene counties. According to data released by The North Carolina Partnership for Children Inc., more families with young children have access to and are participating in high quality child care programs in Lenoir and Greene counties.NCPC leads the state Smart Start program and evaluates local and statewide progress annually. The latest data shows that Smart Start continues to improve the quality of child care in both counties, thanks to the efforts of the Partnership for Children of Lenoir and Greene counties.Keith Sylvester, executive director, shared the good news at the organization’s board of director’s meeting Jan. 31. The number of children enrolled in high quality child care (programs with four or five stars) has increased 87 percent in Lenoir County and 29 percent in Greene County since 2001, reflecting an improvement in child care quality and an increase in the number of children enrolled in high quality programs.Of child care enrolees, 43 percent in Lenoir County and 60 percent in Greene County are enrolled in the highest quality programs."This is really great news for the children of Lenoir and Greene counties," said NCPC President Stephanie Fanjul."Not only are young children experiencing improved care, but families seeking child care are better able to find high quality programs."The Lenoir/Greene program assesses child care center quality, recommends changes where needed and helps child care teachers continue their education.-------------------------------

EDUCATION
NCSU Technician Onlinehttp://media.www.technicianonline.com/media/storage/paper848/news/2008/02/08/News/Alternatives.Programs.Begin.Bridging.Gap.In.Teacher.Numbers-3197735.shtml
Alternatives, programs begin bridging gap in teacher numbers: Several new and expanding programs aim to place more highly qualified educators in N.C. classrooms"
By Megan Peters
Almost a month into the third quarter for public schools, newly graduated teachers and soon-to-graduate student-teachers settle into their classroom tasks.But it's not enough.Twelve thousand teaching positions open up annually in North Carolina public schools. But the state's colleges and universities produce fewer than 6,000 licensed teachers in that same time, according to Director of Professional Education Michael Maher."The state of North Carolina operates on a deficit every year," he said. "Education is very cyclical. It has to do with the [student population] growth in the state from outside."Educating educatorsThe University has had a hand in lessening this void, Maher said."There's been tremendous growth," he said. "Our enrollments are growing. If you look in terms of sheer numbers, the college itself is growing."Last May, the college certified 185 undergraduates and 153 alternative licensure students, a growth of more than 200 percent from 2002 statistics.And Maher said these numbers will continue to increase due in part to initiatives, such as STEM grants, and new programs, like the elementary education and master's of art and teaching majors. The first class of elementary education majors, totaling approximately 30, will graduate in May with rates projected to double by next spring.Jeffrey Reaser, professor of English and coordinator for the English secondary education alternative licensure program, said he accredits much of the University's contribution of certified educators to alternative licensuring programs."N.C. State has been really leading the way with alternative licensures," he said. "[It was] the only institution last year to increase alternative licensure plans."Through N.C. Teach, an alternative licensure program that allows teachers to take distance-education classes toward their licenses while teaching at their schools, educators are getting into the classrooms sooner, Reaser said."In two years, we've effectively increased our number of licensed people through [N.C. Teach] six-fold," he said.And Maher said more teachers are graduating from the University in other ways as well."For at least the last five years, N.C. State has produced almost half of the licensed teachers in math [in the state]," he said.--------------

Asheville Citizen-Timeshttp://www.citizen-times.com/apps/pbcs.dll/article?AID=/20080208/NEWS01/80207167/1250
"WNC dropouts up; city bucks trend"
By Ashley Wilson
ASHEVILLE--More Western North Carolina students dropped out of high school in 2006-07 than the year before, according to a state report released Thursday.The report, released by the N.C. Department of Public Instruction, showed at least nine WNC school districts with year-to-year increases in their dropout rates.The trend extended across the state, where 5.24 percent of students dropped out, up from 5.04 percent the previous school year."Are we happy with the numbers? Absolutely not," said Stan Alleyne, spokesman for Buncombe County Schools, which had a 5.38 percent dropout rate, nearly identical to the year before. "I do think with all these initiatives we have put in place over the years it does take time. We’ve invested a lot of energy the last couple of years."Instead of focusing solely on high schools, the school district’s Graduation Initiative, launched in 2006-07, is taking a kindergarten through 12th grade approach to keeping students in school.Using attendance and discipline records and family history, Buncombe officials are identifying students in elementary schools who may be disengaging from school, launching interventions to reach them and hoping to prevent them from dropping out years later. --------------
Greenville Daily Reflectorhttp://www.reflector.com/opin/content/news/opinion/stories/2008/02/10/ED_dropouts.html
"Start young - Dropout problem, hopefulness persist"
Editorial
Pitt County schools' dropout numbers reported Friday make an easy target for those bent on finding fault and assigning blame. But a better approach will be calmer and more thoughtful — and directed toward the young. Some of these are out there already.The numbers reported last week were not good. Dropout rates for Pitt County for the 2006-2007 year went from 5.89 percent to 6.89. The actual numbers: 509 dropped out in grades 9-12 in 2006-2007 compared to 417 in those grades in 2005-2006. That's a 22 percent increase year to year. The state dropout average reported for the same period was 5.24 percent, up from about 5 percent last year.However, Pitt County's numbers are up more dramatically this year since last year's figures were significantly lower. For example, the county percentages for the five years prior to this one are fairly consistent: 6.64 percent, 6.82 percent, 6.95 percent, 6.56 percent and 5.89 percent in 2005-2006. These are high compared to many other of the state's counties, but it is nonetheless clear that the problem here is not suddenly that much greater. But it remains persistent and troubling.At the state level there were no "answers" forthcoming following the report, although the political minds are and have been bending toward the subject for some time. Many educators believe, for example, that the bad numbers again underscore the need for raising from 16 to 18 the age that young North Carolinians must attend school. Now they can drop out at 16, which many do, according to statistics.New committees have been formed in the General Assembly to help in the fight, mainly by awarding grants designed to stem the dropout tide and then evaluating those efforts.--------------

Raleigh News & Observerhttp://www.newsobserver.com/front/story/931995.html
"Durham, Orange dropouts fewer, bucking N.C. trend"
By Samiha Khanna, Staff Writer
Although the number of high school dropouts statewide climbed 6 percent last year, dropout rates for schools in Durham and Orange counties decreased, according to a report released Thursday.In Durham, 508 high school students dropped out in the 2006-07 school year, compared with 520 the previous year, according to the report. The district-wide dropout rate for students in grades 9 through 12 fell from 5.15 percent to 4.90 percent. Dropout rates in the Orange and Chapel Hill-Carrboro City Schools systems also fell slightly.School administrators in Durham credit several initiatives for the decrease, particularly the creation of smaller, nontraditional high schools, said Debbie Pitman, assistant superintendent of student support services."One of the things we're hearing from students who are disconnected, or have dropped out, is that the traditional high school is not a setting where they've been successful, and they don't want to return," she said.In the past year, Durham has opened three new small high schools to give students more focused attention. One such program, the Performance Learning Center, focuses on recapturing dropouts and pushing them to finish up, get their diplomas and qualify for better jobs. Durham also received funding last month to start a night school at Southern High School this spring to aid about 30 dropouts or students at risk for doing so.Statewide, the number of dropouts increased. A total of 23,550 students dropped out in 2006-07, representing 5.24 percent of the state's high school population, according to Thursday's report. That is the biggest number in seven years.Educators couldn't explain why the numbers are getting worse, but they said it reinforces the need for the General Assembly to raise the minimum dropout age.-------------------------------

ECONOMIC SECURITY
Congress Dailyhttp://nationaljournal.com/about/congressdaily/
"Bush Signs Stimulus Bill As Paulson Predicts Growth"
By Elaine S. Povich
Treasury Secretary Paulson said today that economic stimulus rebate checks should be in the mail starting in May and that he expects the money and the rest of the package to increase economic growth. "It has a real impact," he told the House Budget Committee. "I think it will be quantifiable." Paulson added that "payments will be largely completed this summer, putting cash in the hands of millions of Americans at a time when our economy is experiencing slower growth," he said. "Together, the payments to individuals and the incentives for businesses will help create more than half a million jobs by the end of this year."The bill, which President Bush signed this afternoon, will provide $600 payments for most individuals -- $1,200 for couples -- plus $300 for each child younger than 17. Eligibility phases out after $75,000 in adjusted gross income for individuals and $150,000 for couples. Workers who can show $3,000 in earned income last year -- too little on which to pay income taxes -- and Social Security recipients and disabled veterans would be eligible for payments of $300. Businesses also get incentives to invest in new plants and equipment, and federal mortgage backers are allowed to insure larger home mortgages.Several Budget Committee members pressed Paulson to say the economy was slipping into recession, but he described it as a period of "slow growth." Paulson said the housing market was his main concern. He dismissed the idea -- also rejected by Congress in the economic stimulus package compromise -- of extending unemployment benefits. He said the current unemployment rate is 4.9 percent, not high enough to justify an extension. The lowest unemployment rate that has ever seen an extension of benefits was 5.7 percent.Paulson also was chastised for Bush's FY09 budget, which House Budget Chairman Spratt said includes many cuts rejected by Congress in the past "and aren't going anywhere now." Last year, Bush proposed cutting or eliminating 141 programs, but the Democratic-controlled Congress agreed with only 44 -- 23 terminations and 21 reductions. His proposed cuts in education and Medicare also were rejected. Paulson gave no ground on Bush's budget and said overhauling the alternative minimum tax should be done as a part of a look at the overall entitlement picture, along with whether Bush's tax cuts should be extended. --------------

Raleigh News & Observerhttp://www.newsobserver.com/politics/story/943693.html
"Bush's budget threats often lack teeth"
By Elizabeth Williamson, The Washington Post
WASHINGTON - It has happened for the past two years: President Bush, in a play to fiscal conservatives, draws up a budget request that sends a long list of domestic programs to the slaughter.Food for infants, toddlers and breast-feeding mothers -- gone. Innovation and technology grants for entrepreneurs -- history. Early-childhood education, job training -- poof.Then Congress weighs in, condemning Bush for ignoring the needs of the disadvantaged Americans who will suffer most from the cuts. The shouting dies down, Congress keeps most of the programs alive, both sides claim victory, and they walk away for another year.For fiscal 2008, which began in October, Bush proposed trimming or eliminating 141 programs in the current budget. Sixteen were eliminated and 13 were trimmed, according to the White House budget office.For fiscal 2009, Bush wants to cut even more, and, as always, he says he means it."I proposed a budget that terminates or substantially reduces 151 wasteful or bloated programs," he told a cheering crowd at the Conservative Political Action Conference last week. "Those programs total more than $18 billion. And if Congress sends me appropriations bills that exceed the reasonable limits I have set, I will veto the bills."Bush fared better when Republicans were in control of Congress. For fiscal 2006, he proposed 154 program terminations and reductions, and 89 (52 terminations and 37 reductions) were accepted either fully or in part, saving almost $6.5 billion, according to the Office of Management and Budget. In 2007, he proposed 141, but the Democratic-controlled Congress went along with only 44 (23 terminations and 21 reductions), saving slightly more than $2 billion.In a statement issued Tuesday titled "Spending Taxpayer Dollars Wisely," the White House budget office said the proposed cuts for 2009 "will result in savings to taxpayers and improved government services by eliminating or restructuring low-priority and duplicative programs as well as programs that are not producing results."Most of the proposed cuts target the same programs that Bush has tried to slash before.

Thank you,
Action for Children North Carolina