Commission - Regular Meeting

All right. All right. Uh start our meeting with the pledge of allegiance. I pledge algiance to the flag of the United States of America and to the republic for which it stands. One nation under God, indivisible, with liberty and justice for all.

Well, everyone, welcome to the Shauny County Board of County Commissioners work session. And uh today we have a presentation uh Kathy Moer and uh it'll be from Astro Mental Health and Recovery. It's a new day. It's a new day. It's a new name and a new day, but we're still here. Oh, sorry.

Commissioners, thank you for having me today. And um I want to recognize the great support that we have for our agency and our community. And we have this wonderful board of directors. Uh would my board members please stand and be recognized? And so we have Dick Klene and Ashley Gil Gilen

and Matt Kad and Linda Oaks. And then we have uh my chief deputy officer uh Jackie Feathers. Um, I wanted to update you on our merger and on what's been going on and um what the changes are uh and what we're accomplishing for the community uh over 2025 and then into the new days of Astro where we are a combined unified uh community certified community behavioral health center and community mental health center, both licensed and certified, and uh in addition to that, the uh designated mental health authority and safety net for Shauny County. So, the first uh handout that I gave you was our new strategic plan. So, I thought that might just give you an idea of what we're working on for this year. We're still uh bringing our two cultures together and continuing to streamline uh find efficiencies and to deliver very um strong quality of care that will make an impact for the community. But what I'm going to focus on today is the 2025 annual report. This is the last report you'll get from Valleo and Family Service and Guidance Center prior to the merger. So, the merger stayed on track first of all and we did become Astra Mental Health and Recovery on January 1. A couple things to talk about why the merger and how the merger. after

um about a year and a half of planning and due diligence and um examining the needs of our community per pro uh participating in a community needs assessment. We looked at we we put all agendas aside and we said how can we best serve the community going forward? What makes the most sense? So 2025 ended up being a year of preparation for the merger and both agencies and boards came to the table with one thing in mind. How do we serve our community better? What's the best way to do that? And we brought the best of both centers forward when we decided that merger was the best way. Um brought the both the best of both forward and then we embraced opportunities to improve along the way. So, I hope that's what you get a a a taste of what we've been working on and where we're going. The merger was guided by these principles that are listed in your on the front page. No, first of all, no disruption to patient care. We wanted that to be seamless for them and them not to not see a merger happening in the background. We wanted them to keep their same treatment plans and be able to continue as always. And then we improved access to services. We wanted to also focus on fiscal discipline and how we could be sustainable long term and then expanding crisis capacity and our crisis response for the community. So what those outcomes and services that we provided in 2025, some things were already starting to come together uh from our two agencies and some things were still being planned that couldn't start until January 1,

but overall we had a 9% increase in the services that we delivered together over 2024. In fact, we increased therapy services by 44%. Which means we found more workforce. We have licensed um licensed social worker, psychologist types of u mental health providers that are so in demand. And we're we were able to better meet that need. And you'll see in a minute how that increased our um our access standards which always has good outcomes. So we deliver 258,000 plus services to 11,000 people and we were we are prepared to meet the needs of all of Sha Shauny County residents when they're ready to get help. So the increase in um the wait time, the average wait time, the state requires it to be within 10 days of a person identifying they need help that they are able to get that help. And we over the past year uh 2025 were able to get that down to four days on average. Why why does that matter? That matters because when you serve someone at the time they need it, then what you know is they're not going to get worse waiting for it and you can treat it more quickly and then you have capacity in the system to serve more people. So there's all kinds of good that comes from meeting them where they're at and getting the service to them when they need it.

We also uh by providing timely services uh the clients and families had a reaction to that as well I think um and along with the continuum of care that's more smooth and coordinated between us but we had an over a 98% satisfaction rate from both children adults uh and family members. When you have your the people that you're serving more engaged and feeling like services are benefited, they show up. Uh they are engaged, they work, and uh you have you get better outcomes. So the the foundational work that we're doing through the merger is starting to affect those outcomes in a very positive way. We also accomplished these outcomes uh by addressing our workforce shortage. Of course, healthc care has a huge shortage. Mental health care is no different. and we've created a workforce pipeline that we worked very hard on. We had over 30 interns last year and we attracted seasoned professionals and with without increasing administrative costs. So, we're very proud of that as we work to be the best provider or the preferred provider for people whether you're you have coverage or not coverage because it's that balanced mix of payers that makes it sustainable. Um then you also uh we also work on the other side which

is to become a preferred employer and you have to get out of that deficit of not paying your people or paying them you know up to 50% below market doesn't work and um so with CCBHC one of the one of their goals is to uh address workforce so some of the funding has been able to go towards wards that from the CCBHC side of things not from the county and that has helped us but along with that we have to provide we have much more stringent standards uh tighter access standards we have evidence-based practices we have to follow uh across all of our services and uh we have a lot of oversight and audits to pass which we've done successfully. So let's talk about the impact to public safety. CCBHC's have been working together with our community partners across all the public systems, emergency rooms and hospitals, law enforcement, court and jails, child welfare systems, school and many other community resources. We also impacted the quality of our services. Uh, one, we added mobile crisis services. That is a requirement of CCBHC. That's a new service to our community. Mobile crisis services are now available for both youth and adult. And we expanded that by 206% from beginning of 2025 to the end of 2025. We also get data from the state on that. They contract with Carolon and we learned that we have the in Shauny County uh Valleo and family service together had the fastest response time in the state.

Out of the calls for mental health crisis that come in, we received at our agencies 79% of those calls. That means that reduced pressure on 911. It reduced pressure on 988 and it reduced pressure on ERS and jails because if we can get to them first, a lot of times they don't end up there. A couple partnerships are resulting in some life-changing care and system savings. So, I thought I would uh call those out. The services that we provided in the schools resulted in uh improved attendance, improved behavior and those are based on the schools behavioral writeups. All of this data we don't collect, the schools collect and tell us how we're doing and improved grades. And then we we added one an outcome that's called internal behavior. And what that is is self harm, internal depression. The child that's quiet, he's not disrupting, he's just chronically failing. Um so we added that as a separate category and that is getting in the 80s in terms of your outcomes to 80% improvement. Those are some of the best outcomes you'll ever see in any evidence-based practice. Then we um continued to work with um and this is more on the Valo legacy Valo side I we say now uh adult law enforcement partnerships they were successful and 83% of our co-responders um contacts were diverted from jail and this prevents individuals from incarceration when treatment's more appropriate and effective.

that cost savings is significant. And then we added a partnership with juvenile justice and that has a 98% diversion uh the and you can see the things that that reduces in terms of the the juvenile partnership. So how is our financial stewardship? Both organizations operated within their budgets in 2025. We had a 50% uh of our services that we delivered were to the were to uninsured were uninsured services that we provided. And then 50% were covered. So when when it says they're covered, those we collect fee for service on and

spend no government um no government safety nets are or funding is needed. The charitable care

it grew. A lot of that we believe is from the big beautiful bill that came through and um has really affected people seeking services or um being eligible for Medicaid. And the other issue that came up then was the expiration of Obamacare. So we're finding that more people can't afford those premiums and uh they are doing without insurance and then they are either coming to us without insurance or uh which is driving up that charitable care or they're just seek not getting services until it becomes a crisis. We aggressively pursue payment according to what the person can pay. It's a formulary based on poverty level and number of household members. Um and uh we we are very aggressive in securing donations and things to offset that gap. The merger is resulting in a cost savings, but it was outpaced by the cost of putting a merger together and the rising costs uh that everyone's experiencing. So, the technology has been the most expensive piece. Uh an electronic medical record uh had to we had to launch on January 1. uh so that we would all be connected in the same and meet be compliant. You're looking at a ledger with uh new uh uh accounting systems, payroll systems, email systems uh all

and everything related to that. So we are very grateful to the support and the foresight that the commission the county commission had in supporting us through this merger. So thank you very much for that. My last comments are just that the merger efficiencies uh we've already seen in our governance and leadership. Uh the integration of systems will help us provide better continuity of care and are very expensive upfront. So we don't see them yet but we will see some long-term value over time. And then the there's long-term benefits of uh other efficiencies that we create um that once those initial costs uh come out then we'll start seeing some savings there we believe. Now at the same time you have rising interest rates and costs and uh we expect more um more eligibility challenges for people who need Medicaid and that will affect um us as well. So we're we're kind of fighting it on both ends with continued uh state and county support. What you can expect from us is uh better access, better outcomes, a much more robust data system that will be able to present to you exactly how um how we're doing and less pressure on county and state systems. And with that, I'm happy to answer any questions.

Questions? Commissioner Mace, so the pie charts and things you you have in here, good information. It only it's 2025. I mean, is the mix sort of the same for 2026 um or I guess did it change a lot?

Yeah. So to combined it was 50% of the services uninsured and going forward what we uh what is still to encounter is increased eligibility um from annually to it could be every six months. There's a bill in the in the uh legislature for every 3 months eligibility. These are folks that can be in transitional housing, never receive the paperwork, or are so living such chaotic lives daytoday that they don't get that filled out and in. So then they lose their Medicaid. Um, so what one of the things we're doing to try to help with that is to add benefit specialists that can assist them when they are uh presumptively eligible for Medicaid and assist them with getting that paperwork. But there's going to be some that um that followthrough is just not going to be there very well. So we expect to lose some. Nationally they're saying expect 27%. Loss of people covered currently by Medicaid.

Okay. And then of the people that are covered maybe by Medicaid, Medicare, um, private insurance, do most of your claims get approved? Like if you're if if you have somebody in there for treatment and you file a claim on that, is it usually get covered or are they denying services or anything like that that you're having uncompensated care even for people that have insurance?

So insurance is not caught up with good value of services. So I would say yes in terms of like psychiatry, medication delivery and licensed therapy, but when it comes to going out into the community, we know that the results skyrocket at keeping people out of the hospital, keeping people in their homes, keeping families intact when we use community-based services, which is a requirement and uh that we have and that has been supported so much that Kansas has a waiver for youth to make sure that if they need that service and don't have that don't have that coverage, they can get on Medicaid for those reasons and um and then we can deliver those. We do not have that on the adult side and so those folks kind of fall through the cracks or end up in our um in our charitable care costs. So then whether you're covered or not, my point is that it does not cover community-based services which is cheaper to provide and just as effective.

Okay. Thank you. Uhhuh. I had a question about the school-based mental health. um among participating students says 80% improve in attendance what does that look like I mean what are they attending what are they just appointments or so uh what we're talking about in attendance we're talking about school attendance okay

so it what happens is when you are having mental health struggles you're more likely not to come to school. You're more likely to go home sick. Um, but even more so, you're likely to go to an appointment maybe at our office and then not come back the rest of the day. providing services on site. We were a little leerary of, and this is why we wanted to measure this, was that would we be pulling kids out of class and disrupting their academics because we want to make sure we're holistically taking care of that child's needs. And what we learned is that of f of the students who had an issue with attendance and we serve them right in the schools, their attendance went up by 83% in the schools.

It's a major improvement. Major improvement. Yeah, these are unbelievable um data points that that that program really works. That one also is on the cutting block right now at the state. uh 15 million goes into the what is called M hit MHIT mental health intervention teams and um they are that's one of the things that they could cut before the end of the session. Commissioner May, you have

now we we would we we have a way that we think we can provide it whether that gets cut or not. Uh but it will it will take some special contracting with the schools for it. So, uh, as you know, we're building the behavioral health unit at the jail right now, uh, which should be open pretty quickly. Um, how do you envision that? I mean, is it is it going to take a load off of you guys in some ways or I mean, I know that obviously Department of Corrections and and you guys work together, I assume, quite a bit. Um, so I mean, tell me like from your perspective. I mean, I've heard the Department of Corrections perspective, but I I'm I'm interested how you guys feel that's going to help or or hurt or whatever. I mean,

it it's a wonderful thing. Um the I've been there twice now. Um

and uh worked with Brian and um staff and our staff. I'm still kind of in my learning curve about getting back into adult services. I I was over adult services in my previous employment, but uh not at family service and guidance. And so I'm having to get back into that. So I'm still learning, but uh and I I bet these folks would be a little more on uh on point with that. However, what I can tell you is that the need to treat people who are in there with we know that they have a high acuity of mental health issues in jail, right? And so the whole idea of this is to be able to treat that and then maybe they don't need the incarceration. Um we also are working on step downs from there to us. But also when we have someone who is you cannot contain safely in the community, they need a place to go as well. So, it I think there's this back and forth that will make it more effective. As long as it doesn't get log jammed where you can't get someone out to the right level of care that you need, it's going to be super effective.

That's good to hear. Our jail, we a lot of times get a log jam of people that we be sending to learner to be evaluated, see if they're competent to stay at trial. Um, and I I I believe Valo was helping with that at at one point. Um, is is that still is that still something a service you're providing with the county to to to look at these Yes. individuals and evaluate them and

Yes, I believe you're re you're referring to the crisis intervention center. um that we have passed all lenture except I think we are down to one soap dispenser that needs to be changed out. Um then we have the 24-hour staffing which we have most of it but we have one shift we're still trying to cover. Um and what that that allows for folks to step down from law enforcement or from the emergency rooms. um and could potentially be a solution for 72-hour holds. And I think that's more what you're what you might be thinking about.

Well, I think that what Commissioner Ripon was talking about was when a person has been found incompetent by a court and there's there was a local component that was going to be factored in where Valleo would be helping to do the evaluation. Yes. To assist with the res restoration of competency.

Okay. So that I believe is going very well. Uh so we are providing competency and restoration for adults and we have added that on the juvenile side as well. And um we have gotten lots of praise from our judges and things. Um I think they had a previous contractor and that's been going we're we're seems to be working very favorably for everyone. Yeah, it was the restoration to confidence that I think that you

Yeah. And and and through this merger, the idea wasn't to to take things away or change things up. Uh but we do think we can be more we can be better at what we do and we can be uh more efficient. Mr. May

um in this year's budget um we gave a pretty significant increase in funding um in our allocate in our budget allocations. And I'm curious, I know you said that it sounds like the state is looking at like a $15 million cut right now to mental health services. Were other entities able to step up and increase their funding at all? Um I see when I look at this pie chart that of your funding it says we provide 6% the city of Topek is only 1%. I mean is in terms of you know I guess diversification of revenue are there other entities that also stepped up? Mhm. So when you look at the financial sheet, you're going to see Valo and FSGC separate. And so they they they do a little more on the Valo side than they do on the FSGC side right now. And um I think I think some potential possibilities would be um without dragging down uh even the levy and and things. I think you could we can look at the um opioid settlement dollars um that both city and county have. Uh that's one possibility that might help. I also want to be clear on the state side. we were talking about schools and so that particular um that particular pot of money c when CCBHC came about it it reduced the need for that pot of money for the schools because of what CCBHC requires us to do anyway and under that funding so it's almost more of a shift um on that respect But I will also say that there is still

active in the state legislature an increase of 8 million uh for crisis services for our state. So I think I think it's more just being smart about what the needs are and what has the biggest uh and and how we can cover things with what pots of money effectively. So, as a I know you've been a CCBHC for what, like two years now? Maybe. Four. Four. Wow. I'm sorry. Two as a CCBHC. I thought you were asking about my tenure. No, no, no. As CCBHC. Um, since since Valo, I guess, became a CCPHC. Yeah, we both became at the same time.

Okay. So, I know that that increased the revenues and and the compensation that you're getting from Medicaid, but it also makes it so you can't turn people away. Correct. Um, and so has it been a good thing or has it created more problems? We couldn't turn people away anyway because we can't do that under the CHC statute. Okay.

So, no, no change for us on that. What it what it did capture is holistic care um and evidence-based practices. Uh, we can't treat those populations differently. Um but but the funding that they're providing it does not it supports the safety net by offering the full array of services to help get the same outcomes for the uninsured but it does not fund the uninsured. So when the when the uh federal bill HB1 came down, what we're seeing is besides what's in the bill itself, which did decrease uh those who are eligible for Medicaid, we're also seeing uh the state no the federal um portal that you have to you have to save that you have to enlist in in order to um if you're in Medicaid. So we have families who have citizens as youth as an example uh last year at FSGC whose family now has to register all family members in the entire household on this federal registry which because of ICE issues and whatnot they don't want to be on the registry. So they'll they'll they'll go off Medicaid just to avoid that. That's part of the issue as well, if that makes sense. that's getting kind of into the weeds, but

and KDH has also confirmed that they're seeing a a lower Medicaid rate, which is which is too bad because under CCBHC and particularly while the state is a demonstration state of CCBHC, it's pulling down a lot more federal Medicaid help for Medicaid. Kathy, uh, your juvenile justice partnership,

uh, your intervention with the the juveniles, is that take place in at at your your facility or is that something you have to go on the road to do? We've worked out with um Judge, if I say this right,

Dernovich. And um and then so we've we've tried a couple different things. And no, we're not usually. So if they were our client before they went in, then we follow them. our their treatment team follows them and they get to keep the same treatment team. If they which is a huge benefit, it's not starting over and if they are in process there then it's a contract with juvenile justice and they have been preferring it's been working really well doing teleaalth and they we even do group therapy and um in there at that time which is much more cost-effective for um for the def for that pot of money. So, that's been really effective. And then as they come out, they already have everything in place um to get immediate continued support. So you don't, for instance, you don't have them coming out and then going into homelessness or coming out and uh going back to uh uh a um a family situation that may not be conducive to their continued recovery. And uh we've been work we can work with the families all during that time to help that be more effective and successful. Any other questions? Nope.

Well, then uh Kathy and Jackie and board members, thanks for attending today and very it was insightful for me anyway. So, thank you. Anytime. And if you need any other information, just let me know. All right. Thank you. Thank you. Um next on the agenda is public comment. I don't have anyone signed up for that, but if you're here and you'd like to speak, seeing none, move on to administrative communications. Commissioner Cook, no. Mr. May, nothing for me.

Nothing for me. Um, uh, we do not have a need for executive session, so we're