Orchard Place Blog

Central Iowa Children's Mental Health Crisis Services Planning Initiative

A PDF of the Central Iowa Children's Mental Health Crisis Services Planning Initiative can be found here.

A PDF of the Funding for Services can be found here.

Central Iowa Children’s Mental Health Crisis Services Planning Initiative

 

Lead Organization: Orchard Place

 

Funding Partners:
Mid Iowa Health Foundation
Community Foundation of Greater Des Moines
United Way of Central Iowa

 

January 2017

Background on the Lead Agency:

Orchard Place was founded in 1886 and is accredited by the Joint Commission as a provider of behavioral health services for children, youth and their families. Orchard Place works with children, youth and their families who experience mental health and behavioral challenges. In 2016, Orchard Place provided care to 9,903 Iowa children and youth. By intervening early with appropriate care, we build stronger futures for our young clients. To fulfill this goal, we provide a continuum of services through our four operating divisions.

  • Orchard Place Campus provides a 24-hour psychiatric medial institute for children (PMIC) with a serious emotional disturbance needing intensive residential treatment. The Campus provides an individualized treatment program including individual and family psychotherapy, social skills building, life skills training, psychiatric evaluation/medication management, and educational programing. This division has 88 beds and offers services to youth 10-18 years old from across the state of Iowa.
  • Orchard Place/PACE Juvenile Center (PACE) provides community based services to meet the needs of at-risk youth who have been unable to be successful in school or the community. PACE serves these youth and their families by providing service that develop social, academic, and functional life skills, allowing for positive growth of youth and their families. PACE offers a wide range of services which include substance abuse services, alcohol diversion/education classes, Behavioral Health Intervention Services (BHIS), Latino Outreach services with bilingual workers, and Early Services Prevention Programing (ESP) with Juvenile Court services.
  • Orchard Place/Child Guidance Center promotes community mental health through multiple professional mental health services for children, youth and their families on an outpatient basis and consultation to those persons/organizations influential in the emotional development and well-being of children. Child Guidance Center is an accredited children’s Community Mental Health Center providing outpatient services by a multi-disciplined staff in the fields of child psychiatry, clinical psychology, clinical social work/mental health and child development. Child Guidance Center offers a wide range of services including individual, group and family therapy (utilizing evidenced based therapies), psychiatric evaluation/medication management, psychological evaluation, in-service training on trauma informed care, consultation and trainings from Child Care Resources & Referrals for providers and parents.
  • Orchard Place/Integrated Health Program (IHP) promotes whole child wellness for children facing behavioral and emotional challenges. IHP serves families and youth by listening to needs and providing resources based on these needs, creating a team of support to help children be successful at home, in school and in the community. Each family has a care team consisting of a coordinator, nurse manager and family peer support specialist to ensure services are matched to each child. The care team works alongside families to develop whole-health goals for their children that focus on physical, emotional and social well-being.

Children’s Mental Health and Well-Being Workgroup:

The Children’s Mental Health and Well-Being Workgroup was formed in response to legislative direction to make recommendations regarding the system of services to support children and families in Iowa. A subcommittee of this group identified, defined and prioritized a core set of mental health services for children, one of these focusing on crisis services.

It is important to understand that the research and development of crisis services, does not happen in a vacuum. Many of the services are connected, related and in some instances are provided by the same entities. As defined by the Children’s Mental Health and Well-Being Workgroup, the four broad key categories of necessary service are:

  1. Prevention, early identification and early intervention
  2. Mental health and substance use disorder treatment
  3. Recovery supports
  4. Community based flexible supports

The subcommittee recognized that not all of the identified services identified under these broad categories could be implemented at once, and agreed that children’s mental health crisis services are the highest priority service. Thus, the RFP’s were issued to have at least two sites across the state build out a plan for Children’s Mental Health Crisis Services.

This state RFP was made available, based on the recommendation of the Children’s Mental Health and Wellbeing Workgroup.Seasons Center in Spencer and Youth Emergency Shelter in Ames (Francis Lauer Youth Services division) were the two recipients of the state RFP dollars with a start date of October 3, 2016.

Central Iowa Workgroup:

In July 2016, Orchard Place received funding from three private entities - Mid Iowa Health Foundation, Community Foundation of Greater Des Moines and United Way of Central Iowa - on behalf of a community collaboration, to review current and plan for future needs of children’s mental health crisis services. The goal of the Central Iowa group, led by Orchard Place is to create a plan in early 2017, which can be shared with key legislators during the 2017 session.

Deliverables:

The intent of the central Iowa workgroup, is to line up with the deliverables and the timeline as set forth in the state issued RFP. The deliverables defined below will be captured for Polk, Dallas and Warren counties:

  • Geographically defined area descriptions and characteristics
  • Coalition and stakeholder input in the planning process
  • Data collection
  • Proposed children mental health crisis response system
  • Funding processed and proposed budget

Geographically Defined Area Descriptions and Characteristics:

This plan is focused on the counties of Polk, Dallas and Warren. The population of the three county area is 564,318 and the population under to age of 18 is 145,582 (American Community Survey, 5-year estimate 2010-2014). The population is an urban and rural mix. Specifics of each county are listed below according to the estimates by the Census Bureau's Population Estimates Program (PEP) for July 1, 2015.

  • Polk County: Population is 467,711; under the age of 18 is 25.2%; persons in poverty 11.9%; population per square mile in 2010 was 750.5
  • Warren County: Population is 48,626; under the age of 18 is 25%; persons in poverty 7.8%; population per square mile in 2010 was 81.1
  • Dallas County:Population is 80,133; under the age of 18 is 28.4%; persons in poverty 5.3%; population per square mile in 2010 was 112.4

School Enrollment Data:

The three county area has become very diverse in the student population within each school districts. Below are the school districts which make up the three county area, as identified by the Department of Education.

 

In the Polk County School districts, 62.2% of the students are White, 15.4% are Hispanic, 0.3% are Native American, 6.0% are Asian, 10.8% are Black, 0.2% are Pacific Islander and 5.2% are Multi-Race. The chart above shows the percentage of variance within each school district. Overall, the percentage of non-white students in Polk County School districts is 37.8%. The largest percentage of non-white student population is in the Des Moines Independent School system at 40.3%. Many of these students represent immigrant and refugee communities and bring with them a variety of challenging issues including language barriers and trauma.

 

 

In the Warren County School districts, 90.6% of the students are White, 4.0% are Hispanic, 0.1% are Native American, 1.4% are Asian, 1.2% are Black, 0.1% are Pacific Islander and 2.6% are Multi-Race. The chart above shows that within each school district the percentage varies. In Warren County, 9.4% of the county school population PreK to 12th grade is non-white.

 

 

In the Dallas County School districts, 80.5% of the students are White, 9.1% are Hispanic, 0.2% are Native American, 4.2% are Asian, 2.9% are Black, 0.1% are Pacific Islander and 3.0% are Multi-Race. The chart above shows that within each school district the percentage varies. Overall, the percentage of non-white students in Dallas County School districts is 19.5%. The largest percentage of non-white student population is in the Perry School system at 57.0% with 50.9% of the student population being Hispanic. Many of these students represent immigrant and refugee communities and bring with them a variety of challenging issues including language barriers and trauma

Free and Reduced Price Lunch Data:

The Department of Education has provided the number of students in Polk, Warren and Dallas counties who are eligible for Free and Reduced Price Lunch. As with the above statistics on student enrollment within each of the three counties, the data regarding free and reduced price lunches demonstrates a wide variance in food insecurity within the counties,with some school districtshaving a very high percentage of children eligible. Two of these school districts (highlighted in yellow), Des Moines Independent and Perry, have over 75% of the student population eligible for free and reduced lunch, indicating high food insecurity. Below are the breakdowns for each county.

We know from the Adverse Childhood Experience (ACE) study, the impact of childhood adversity can be substantial on the long term mental health and well-being of children and adults without appropriate intervention or a supportive community environment. Poverty is a stressor for families and food insecurity can create many behavioral issues in students, which impacts their ability to learn, develop and succeed in school and the community.

Coalition and Stakeholder Input in the Planning Process:

In July 2016, Orchard Place staff began the process of reaching out to community partners inviting them to the table for a conversation regarding Mental Health Crisis Planning for Children. Participants were drawn from the Trauma Informed Care Stakeholders group, children’s service organizations, Juvenile Court, Police, Iowa’s MCO’s, and other community partners. The original group had 16 agencies and 20 individuals (plus Orchard Place) represented. However, some important entities were missing, such as representation from Dallas and Warren counties as well as consumer/parent representation. These groups are now represented in the Stakeholder’s group. The current list of the Mental Health Crisis Planning group is listed below

Mental Health Crisis Planning Initiative Group Members:

1. 5th Judicial District - Judge Colin Witt

2. Amerigroup Iowa Inc - Kelly Pennington, Emma Badgley, David Klinkenborg, Kristi Younis, Leslie Cardoza

3. AmeriHealth Caritas - Dr. Steven Sehr

4. BroadlawnsHospital - Dr. Janice Landy, Jeffrey Scott

5. Central Iowa Community Services - Jess Van DeVoort

6. ChildServe - Carrie VanQuathem, Misti Johnson

7. Dallas County - Lisa Anderson, Darci Alt

8. DSM Police - Officer Drane

9. Grandview University - Cathy Beck-Cross

10. HCI Services & Visiting Nurse Services - Trey Wade, Jen Stout

11. Iowa Department of Human Services - Mike McInroy, Kristin Walker

12. Mercy Hospital - Mary Thompson

13. Mosaic Haven - Ruth Mwangangi, Lisa Shaw

14. National Alliance of the Mentally Ill (NAMI) - Teresa Bomhoff

15. Orchard Place - Gladys Noll Alvarez, Kerby Hanson, Nicole Beaman, Anne Starr, Mandy Harris, Lisa Clement

16. Polk County Attorney - Andrea Vitzthum, Stephanie Brown

17. Polk County Health Services - Annie Uetz

18. Polk County Juvenile Court -Chad Jensen, KathyMcDonnell

19. United Health Care - Cheryl Chophard, Diane Johnson, Brenda Lechner, Tya Fisher

20. Unity Point - Lana Herteen, Jennifer Early, Kevin Carrol, Dana Cheek, Brenda Downey, Chaney Yeast

21. Warren County - Betsy Stursma

22. Youth Emergency Shelter & Services - Steve Quirk

23. Youth Justice Initiative - Ashlee Swinton

24. Iowa Department of Education - Angela Van Polen

In addition, Orchard Place has had a working committee at its residential campus looking at what a crisis stabilization unit might look like. This committee has made an onsite visit to Jackson Recovery’s Crisis Unit to gather information. The committee also did research on various other crisis programs in Iowa such as Foundation 2 in Cedar Rapids and The Network in SW Iowa. This information was shared with the Community Stakeholder’s Mental Health Crisis Planning Group.

As the Community Stakeholder’s Mental Health Crisis Planning workgroup has gathered for meetings, participants have varied. We have had 24 organizations and 49 individuals participate in the planning meetings. The group has met July, August, October, December 2016, and January 2017. To maintain consistent communication, minutes have been sent after each meeting to allow those who were unable to attend to stay up to speed and offer input on the work.


Funding For PMIC’s

Voluntary, CINA and Delinquent Placements<p>

Funding for children who are placed at Orchard Place, a Psychiatric Medical Institute for Children, can be accessed in one of the following ways but please note that we apply for Medicaid for every client.


Private insurance

Private insurance is always primary and these benefits must be used before Medicaid. Please note that it is rare for insurance policies to have benefits which cover the entire stay. Some policies have no benefits and others are limited to 1-30 days. Any policies covering the child must be reported to us prior to admission and a copy of both sides of the card supplied. Any changes in coverage during treatment should be reported to your child’s therapist and copies of the new card submitted. This allows us to obtain any authorizations necessary. Failure to obtain authorizations could jeopardize payment by both private insurance and Medicaid.

It is important to know whether referrals and/or pre-certifications are needed prior to admission. Orchard Place is a PMIC (Psychiatric Medical Institute for Children) in the state of Iowa. We provide mental health residential treatment for children and adolescents.  We are Joint Commission accredited and provide 24 hour on call nursing care under the supervision of a medical director. Our daily rate does not include psychiatric or physician fees. It also does not cover medications and educational costs.

Medicaid:

Clients may be eligible for Medicaid at the time of admission by virtue of a subsidized adoption, Supplemental Security Income (SSI,) Social Security, or due to parent’s income. We ask that you complete the attached Health Services application even though your child may already have Medicaid. The application must be processed for facility based Medicaid. The application also can be used to apply for the Children’s Mental Health Waiver upon admission.

Private Pay:

Parents/guardians pay privately for child’s treatment.

Children who have private insurance which will not cover the entire stay or who do not have Medicaid at admission can become Medicaid eligible the first of the following month. Medicaid may retroactive to the first of the month of admission depending on some circumstances. There may be costs to parents during the first month based on family income.

What will treatment cost?

During the month of admission parental deeming is based on parental income. This is determined by the centralized PMIC processing department of DHS who will notify you of your expenses. Our full private pay rate is $425 per day; however, if Medicaid deems your child ineligible for the first month of treatment, we will reduce the rate you are required to pay for that month to $209 per day. During the first month, you will also be responsible to pay co-pays, co-insurance and deductible fees based on your private insurance policy benefits. If you have concerns about payment, you may contact our accounting office at 515-246-3515 to discuss options.

You must submit your pay stubs for the month of admission. Please plan accordingly to allow time for this.

We suggest that you make copies of your application and the attached forms for your records.

If you receive income on your child’s behalf (child support, adoption subsidy, social security or supplemental security,) DHS will determine and notify you of the amount you will need to pay Orchard Place as part of your client participation costs.

Clinical Authorization for Admission:

The Admissions Office will contact the appropriate Medicaid authorization agency to obtain clinical authorization for your child’s admission. Please note that the Medicaid agency can deny admission if they do not agree that your child meets clinical criteria. If denied, Medicaid will not provide funding. There is an appeal process for denials. Please note that this could delay your child’s admission.

The Admissions Office will also contact your private insurance company to obtain clinical authorization for funding on or prior to the day of admission. It is rare for private policies to have benefits that will cover the entire stay. If private insurance does not cover your child’s treatment, Medicaid is billed as secondary coverage.

If both private insurance and Medicaid deny authorization for admission, the cost of treatment would be your responsibility. The daily per diem rate is $425.00.

For further information regarding Medicaid, Client Participation and Parental Liability, please contact:

DHS PMIC UNIT PHONE: 1-877-344-9628
DHS PMIC FAX: 1-515-564-4040
PMIC UNIT EMAIL ADDRESS: csapmic@dhs.state.is.us

Orchard Place is a nationally recognized leader in children's mental health and juvenile justice services.