Input provided to the Texas Department of State Health Services
June 14, 2012
Department of State Health Services (DSHS)
Development of 2014-2015 Legislative Appropriations Request
The Texas Council for Developmental Disabilities is a 27-member board appointed by the Governor, 60% of whom are individuals with developmental disabilities or their family members. TCDD is established in federal law to create systems change so that all people with developmental disabilities are fully included in their communities and exercise control over their own lives. Thank you for valuing the input of stakeholders in developing DSHS Legislative Appropriation Request.
TCDD supports expanding community-based health, behavioral and mental health and substance abuse services and housing supports for children and adults that are recovery-oriented, consumer-based and link mental and physical health needs. TCDD also supports prioritizing transition from institutional services to community supportive housing and competency restoration.
Children with Special Health Care Needs (CSHCN): CHSCN provides health care as the payer of last resort for children who are not eligible for CHIP or Medicaid and have significant health care needs and adults with cystic fibrosis. In FY ‘11, 1,872 clients received services that include an array of preventive and acute health care, both outpatient and inpatient as well as dental care and family support services. Funding was reduced last legislative session from $83.4 million to $71.3 million and 824 children are now on a waiting list.
Epilepsy Program: According to DSHS data, an estimated 193,000 Texans have epilepsy with over 8,500 new cases diagnosed each year. Children with developmental disabilities are at four time greater risk of seizure disorders than children without disabilities. The Epilepsy Program, which is administered locally in all 254 Texas counties, is 100% state general revenue funds and is also a “payer of last resort”. In FY ’11, 11,277 clients were provided medication and/or case management at an average cost of just $127 each. Uncontrolled seizures cause death.
Recommendation 1: Ensure funding to the meet the needs of children needing services from the Children with Special Health Care Needs program and the DSHS Epilepsy Program.
Children’s Community Mental Health: Failure to address children’s mental health needs is linked to poor academic performance, behavior problems, school violence, dropping out, substance abuse, suicide, and criminal activity.1 Children’s community mental health services received a $20.6m increase over FY 2010‐11, but even this did not move Texas from ranking last among states in providing assistance for children with serious mental and behavioral health needs, nor does it address the severe shortage of professionals with the skills, knowledge, and training to handle children’s mental health challenges.
Recommendation 2: DSHS should seek necessary funds to serve all children and youth eligible for public mental health services and expand the Youth Empowerment Services Medicaid Waiver project into more communities.
School Health Program: The School Health Program “envisions a Texas where all children are healthy, ready to learn and prepared to make healthy lifelong choices”.2 When school districts are further strapped by budget reductions it becomes more critical for DSHS to continue its school health efforts and to provide leadership in collaborative work through the School Health Programs. These programs function as central resource to communities and increase access to health care for all Texas children with or without disabilities.
Recommendation 3: DSHS should continue to promote the use of certified family partners within the public mental health system, including taking the necessary steps to allow for certified family partners to receive Medicaid reimbursement. Training efforts should include trauma informed practice for those working directly with children across programs.
Recommendation 4: DSHS should continue to support School health specialists, coordinated school health, School Health Advisory Councils, and school health centers. Efforts should be made to expand and strengthen effective school-based strategies and interventions such as school wide positive behavioral interventions and supports (PBIS) approach and school counseling curriculum.
Adult Mental Health: In Texas individuals with serious mental illness cycle through crisis services, hospitals, jails, and prisons and may never get linked to recovery focused treatment. Though the 82nd Texas Legislature restored DSHS mental health General Revenue funding to FY 2010‐11 levels, the All Funds total was actually less than FY 2010-11 levels because federal stimulus funds were not replaced. Current FY 2012-13 funding puts Texas last among states in the provision of mental health services.
State psychiatric hospitals are intended to be used primarily as a short-term stop for patients and defendants in need of intensive temporary treatment before moving on to less restrictive facilities or back into the community. But, many individuals are entering state hospitals and staying longer periods of time. Today one in four beds are used by a patient who has been in that facility more than a year.
Recommendation 5: DSHS should request funding to continue to implement recommendations of the Mental Health Transformation Workgroup and the Continuity of Care Task Force to “enhance innovative, consumer focused, practical, and sustainable infrastructure solutions to systemic problems that hinder mental health service effectiveness.”3
Money Follows the Person: With the Texas Money Follows the Person Behavioral Health Pilot administered by Department of Aging and Disability Services (DADS) Texas has been able to help individuals with severe mental illness leave nursing homes to live successfully in the community. The pilot uses cognitive adaptation training and substance abuse counseling provided by local mental health authorities with long-term care and medical services provided through STAR*PLUS. Over 160 individuals have benefited by the pilot in Bexar and Travis County service areas.
Project Access: The Texas Department of Housing and Community Affairs Project Access program utilizes Section 8 Housing Choice Vouchers to assist low-income persons with disabilities to transition from institutions into the community. In January 2012 ten TDHCA housing vouchers were set aside to pilot transition for individuals in San Antonio State Hospital. DSHS provided $119,000 to the Center for Health Care Services to provide pre-transition services and Cognitive Adaptation Training; however, few individuals have expressed interest in the program thus far. DSHS should analyze the reasons for low utilization of this program and provide training and/or program adjustments as logical.
Recommendation 6: Seeking funding for evidence-based services that enable individuals with serious mental illness to remain in the community and successfully transition back to community living after state hospital services.
Recommendation 7: Ensure all LMHA and state hospital discharge planners have the resources to be trained in and provide pre-transition planning, cognitive adaptation training and other evidence-based services that support an individual with serious mental illness to avoid hospitalization or transition quickly back home to successful community living.
Competency Restoration: DSHS is expected to provide competency restoration of jailed individuals within three weeks of a judge’s order, but with state hospitals at capacity and a waiting list for beds this cannot be done without increasing resources for outpatient competency restoration (OCR) and transitioning individuals back to the community from state hospitals as discussed above. Past experience shows cost savings of $18,258 per person for community OCR compared to competency restoration provided in a state hospital.
Recommendation 8: Continue and expand Outpatient Competency Restoration to more local mental health authorities to reduce the demand for state hospital beds.
Thank you for your time and commitment. If you have any questions, please feel free to contact me.
Belinda Carlton, CPM
Texas Council for Developmental Disabilities