Jessica Cejnar Andrews / Friday, Aug. 11, 2023 @ 5:01 p.m. / Health, Oregon
Curry County Commissioners Discuss Regaining Public, Mental Health Authority Two Years After Ceding Those Powers to the State
Document:
###
Adapt Integrated Health Care began to hit its stride as the community mental health provider in Curry County about six months ago, according to its chief of regional operations.
In the year and a half that it’s been operating in Curry County, the agency has recruited 40 staff members ranging from peer counsellors to psychiatric nurse practitioners. It has invested millions of dollars and aims to get to a “model of that will support Curry County at an even higher staffing level,” Jerry O’Sullivan told county commissioners Wednesday.
But Adapt will rein in that investment if Curry County regains Local Mental Health Authority powers from the state, O’Sullivan warned.
“For us to protect that investment we can’t have things shifting and moving around. We don’t want to get pulled into politics,” he said. “We’re kind of an unusual organization in that we’re willing to take on projects that almost nobody else will and we invest in a way that really does benefit the community. That’s who we are. And our position on this is, not to put too fine a point on it, but if you successfully get the LMHA, we would notice you that we’re not going to continue to be the CMHP anymore.”
O’Sullivan joined representatives from the Oregon Health Authority, AllCare Health and Advanced Health at a Curry County Board of Commissioners workshop. Coming roughly two years after the county ceded its public and mental health authority to the state, Commissioner Jay Trost said he wanted to discuss to taking back that authority would look like.
However, following O’Sullivan’s statement, Trost said he didn’t want to be adversarial and the county isn’t looking to change its community mental health provider. He said he wants Curry County to have a “formal seat at the table to represent our citizens.”
With a handful of participants noting they didn’t receive their invitation to the workshop until the week before and since mental health took up the bulk of the discussion, Trost and his colleagues said they would hold another meeting next month.
“Nobody wants to go ready, fire, aim on a decision,” he said.
Trost, who was appointed to the Board of Commissioners in March, said the discussion surrounding Curry County’s regaining its local public and mental health authority came up at county college — the training he and other new commissioners receive. According to him, OHA representatives were more than pleased with that idea.
“The state has, at least what they have communicated to us, very little desire to manage local public and local mental health programs,” Trost said, adding that he is on the community advisory council for Advanced Health. “And so the discussion began, ‘Well, OK, what do we do to work towards this?’ It’s a little unprecedented because there are a lot of unknowns… they talked about commissioners agreeing in a meeting that that was the desire, and that would be what would prompt next steps with OHA and the state. I thought it would be prudent to first have a workshop with all of our providers and discuss what that potentially could look like.”
Curry County Commissioners ceded its public health authority to the state following a 2-1 vote at an emergency meeting on April 16, 2021. The Oregon Health Authority had sent the county a letter the week prior noting that it lacked the staff to carry out its public health duties under state law, KOBI, the Medford-based NBC affiliate reported.
At the time, Public Health Authority Administrator Sherrie Ward, who attended Wednesday’s workshop, was the only staff member handling public health, KOBI reported.
On May 6, 2021, the Curry County Board of Commissioners again voted 2-1 to relinquish its local mental health authority to the state. At that meeting, Trost’s predecessor, Court Boice, now a member of the Oregon House of Representatives, said transferring authority to OHA was “imperative.”
“We have been working very closely with OHA staff, the coordinated care organizations (CCOs) and Adapt in regards to transitioning the responsibilities of the CMHP (Community Mental Health Provider),” Boice wrote in his May 6 report to his colleagues. “By relinquishing the LMHA, we can then encourage and enable Adapt Health Care of Douglas County, or whomever the state selects, to contract directly with OHA for important Curry County mental health services.”
Then-commissioner Chris Paasch voted against both resolutions relinquishing the county's public and mental health authority to the state.
Adapt began offering substance use disorder programs in Douglas County about 50 years ago, according to O'Sullivan. About 30 years ago it became a federally qualified health center in Douglas County, which allowed the organization to offer primary care services in addition to its substance use disorder programs. Thirty years ago, Adapt expanded to Josephine County and then to Coos County.
In 2012, the Oregon Health Authority established the coordinated care organization model, which serves those who are covered through the Oregon Health Plan, or Medicaid, O'Sullivan said. If counties had an internal program, they still administered it, but the state controlled funding, he said.
“That model had some problems with it,” he said. “You guys have a lot of stuff on your plate. It might be a landslide, it might be a computer hack, there could be a few fires around… All these things are time consuming and public health and mental health are the same way.”
Adapt became the community health provider for Douglas County in 2014 and also has the local mental health authority for Douglas. He pointed out that the LMHA is liable for whatever the community mental health provider does and is named in any lawsuits against the provider.
O’Sullivan argued that while healthcare is a county priority, the Board of Commissioners changes every two years and its members’ attentions are “divided by all the other things that come up.”
“To say that you’re going to be an expert and understand (healthcare) well enough to be able to help add value to the CMHP is unlikely,” he said. “In Douglas County, they figured that out. They said we need to provide a provider who can do this and let them work with the CCO and we’ll go do other stuff ‘cause we don’t want to be involved in all this.”
Bevin Ankrom, Oregon Health Authority innovator agent who works with Adapt, AllCare, Advanced and Umpqua Health Alliance, said she urged Adapt to expand to Curry County because of the “positive changes” they could make.
Ankrom told Trost and his colleagues that there are other ways the county could have some local control over mental health in Curry County.
“I would urge you to talk to commissioners in Douglas County and what they do as part of their oversight working with Adapt in that capacity,” she said. “I’ve been working with Adapt for 10 years. I’m pretty familiar with those guys as well and I just think that would be a good opportunity for you.”
Josh Balloch, AllCare Health’s vice president for government affairs and health policy, pointed out that any changes Curry County makes will have ripple effects. The county’s decision to cede its mental and public health authority to the state is still rippling, he said.
One strength organizations like Adapt and AllCare has is in recruitment and retention of employees, Balloch said. AllCare has some “really good investments” in finding specialists, primary care doctors, dentists and other healthcare providers, Balloch said.
“These are multi-year — like a half-a-decade or longer — investments,” he said. “You really do need to give organizations time. I’m often up in the state saying give Coordinated Care Organizations more surety so we can make these long term investments. I would say the exact same thing for Adapt and our other partners.”
As for public health, Lena Hawthorne, a representative for Coast Community Health, said that the organization has hired a public health nurse from Gold Beach and that the Oregon Health Authority will train both her and Hawthorne in the next two months.
Hawthorne said she learned about the workshop on Tuesday and was attending to gather information.
“I don’t know if we have any strong opinions about where (public health) goes or where it comes rom,” she said. “I believe there was an expectation of the state running public health for four years. The county has to go through a bunch of different programs and processes to get it back. That’s where we are currently with public health and Coast. It’s in transition; we’re working on it.”
Trost referred to a statement that Balloch said about ripple effects and acknowledged that just calling for Wednesday’s workshop was enough to get them started again. He said he wanted to take time to process the feedback he received before holding another workshop.
“I personally have a lot of follow up conversations to (have) to be more knowledgeable about the topic,” he said.
CLICK TO MANAGE