Innovative and collaborative mental health services reach people across Southwest Washington
According to Eric Yakovich, chief executive officer for Cowlitz County Guidance Association (CCGA), one in four people will deal with some sort of mental illness every year. In Southwest Washington that represents 142,968 people. Unfortunately, said Yakovich, far less than half of those receive care. In addition, said Yakovich, mental illness is the number one cause of missed days at work in the world’s developed economies and causes billions in lost wages and lost productivity.
“There’s a stigma around mental illness – no one wants to be crazy,” said Yakovich. “And, since those with mental illness aren’t in a wheelchair, or have a cast, or have lost their hair, people think nothing is wrong. Nothing could be further from the truth.”
In an effort to bring consistency to care across the region, as well as achieve cost efficiencies, Clark, Cowlitz and Skamania counties have combined administration of the region’s public mental health services. The new entity, formed last October, is called Southwest Washington Behavioral Health (SWBH) regional support network (RSN). Pacific and Wahkiakum counties, part of the Timberland RSN, have a “memo of understanding” with SWBH, and work closely to promote best practices.
“When we come together as a group, we can leverage our individual strengths,” said Geoff Knapp, SWBH Communications Coordinator. “Erasing borders between counties improves transferability of people in need and availability of services.”
SWBH contracts with providers across the region, such as Lower Columbia Mental Health Center in Cowlitz County and Columbia River Mental Health Services in Clark County, to provide publically funded mental health care.
The complexity of needs
According to Connie Mom-Chhing, SWBH chief executive officer, one of the main challenges for providers of mental health care is the complexity of needs.
“Most individuals have multiple needs,” said Mom-Chhing. “It’s not just mental health – there’s also chemical dependency, primary care health needs and even a housing component.”
Mom-Chhing said that this complexity requires a holistic approach to treatment.
“We strongly feel we have to do a better job of working with partners to meet needs,” said Mom-Chhing. “If you don’t treat the whole individual, they will get worse and end up in the emergency room or jail.”
Falling through the cracks
An even larger challenge, said Yakovich, is that because the majority of mental health care funding comes through Medicaid, there is a significant number of people who need care but are not eligible. Yakovich said that the state’s increased focus on using Medicaid funding for mental health care meant that 4,000 people per year are no longer able to receive care in Cowlitz County, although the CCGA budget remained fairly static. Brad Alberts, SWBH chief operations officer, said that the state was due to recalculate the Medicaid reimbursement rate in March.
“We never know what our rate will really be – it could drop a million dollars in one month,” said Alberts.
Some services do exist for non-Medicaid-eligible patients. For example, the Lower Columbia Mental Health Center offers a free counseling clinic that is open five days a week for four hours a day and a homeless outreach program. But, Yakovich said, it’s not enough. The tragic school shooting in Connecticut, he said, provides a graphic example.
“Young men in their late teens and early twenties are expected to go to work,” said Yakovich. “If they don’t have income or insurance, there is not funding to provide treatment. That’s an additional tragedy that needs to be addressed.”
Lynn Samuels, executive director of Columbia River Mental Health Services, said that they have a process to constantly assess risk associated with the people they serve – but this process applies only to those in the system.
“How can we get more people in our system that aren’t now getting the care they need?” asked Samuels. “That’s what creates risk.”
Samuels also predicted that the lack of available treatment dollars for the “working poor” was going to become an even greater problem in the next fiscal year. She expects the state’s K-12 education funding mandate will mean cuts in state-only human services dollars. Alberts said that the SWBH has used reserve funding to sustain same levels of service despite cuts to state funding two years ago, but those reserves have been almost used up.
“Other RSNs had to reduce services because they didn’t have the depth of reserves we had,” said Alberts.
Samuels said the region’s mental health care providers are committed to the safety of clients, their family members, staff and the community at large. For example, Columbia River Mental Health Services participates with a suicide response work group put together by the sheriff’s department.
Yakovich and Mom-Chhing said that their organizations have placed therapists in schools and for the last several years have provided student threat assessments for students who have “crossed the line between poor behavior and becoming a threat.”
“We try to be proactive and engage kids in services ahead of time,” said Yakovich. “But services are voluntary…the key is to be welcoming and provide information that will help them realize services can be a benefit to them.”
The CCGA also provides a yearly 40-hour crisis intervention training course to first responders. Yakovich said that so far, they have trained more than 225 officers and first-responders in Cowlitz County.
Collaboration Is key
Knapp said that they are working on a service integration initiative, so that mental health, chemical dependency, and primary care providers can collaborate.
“We need to better integrate and coordinate our services to meet overall health needs,” said Knapp. “We can’t continue to treat people from a silo perspective.”
According to Yakovich, the region’s mental health care organizations have made great progress over the last few years, raising awareness of the benefits of mental health care.
“Mental health care is becoming viewed as part of primary care,” said Yakovich. “The reality is that treatment helps – it relieves illness and symptoms.”
Locally grown: Innovative programs in Clark County
Lynn Samuels, executive director of Columbia River Mental Health Services, said they have embarked on an exciting new Psycho-Social Rehab (PSR) program. She described PSR as an intensive day-program, focused on positively engaging people who need mental health care services. The program will provide support and structure, and prepare participants for moving on to more traditional outpatient services. The program opened last December, and currently has about 10 participants. Eventually, said Samuels, she expects to have availability for 30 to 40 participants.
Consumer Voices Are Born (CVAB)
This program, located in Vancouver, encourages self-determination and self-sufficiency for people in mental health and addictions recovery. The REACH center offers self-help classes, recovery groups, access to computers, volunteer opportunities, and social activities. The Val Ogden Center is a community of peers working together to achieve recovery goals in an environment similar to a typical workplace. Vancouver’s CVAB has assisted other peer-run associations in the state, and is building a network of similar centers across the state through a grant from the Substance Abuse and Mental Health Services Administration.
Child Wraparound Program
Eric Yakovich, chief executive officer for Cowlitz County Guidance Association (CCGA), said their Child Wraparound program is a promising service for children and families that are involved in multiple support systems. The program focuses on helping the family become the leader of their care, instead of simply being told what to do by several different agencies or entities. Yakovich said the program has shown outstanding outcome for children and family, in terms of behaviors and functionality, and is based on a national wraparound initiative (see www.nwi.pdx.edu/wraparoundbasics.shtml). Clark County also offers a child wraparound program, coordinated through Catholic Community Services.
At the forefront is controversial Ascot drilling proposal and widespread kids programming
The Gifford Pinchot Task Force, which opened a new office in Clark County this year, is at the forefront of the controversial Ascot drilling proposal, among other forest-friendly and conservation initiatives.
At press time, the Bureau of Land Management (BLM) was about to issue its final ruling on proposed exploratory drilling for gold, silver, copper and molybdenum on a parcel of land adjacent to the Mt. St. Helens National Monument and within the Gifford Pinchot National Forest. Although he was somewhat reluctant to discuss the drilling project, Garth Smelser, deputy forest supervisor for the Gifford Pinchot National Forest, said that after the BLM ruling is released, forest officials will decide whether or not to issue a “letter of consent.” Go-ahead from both entities is required for the drilling to proceed.
Protecting the forest
Jessica Walz Schafer, conservation director for the nonprofit environmental task force, said the drilling proposal by Canadian mining company Ascot Resources Ltd. has stirred controversy among local citizens, the BLM and the forest service.
“This area has always been a valuable place for recreation and wildlife,” said Schafer. “It’s a special place, and should be set aside.”
Although the permit under consideration is for experimental drilling only – not for an actual mine, which would be subject to a separate permitting process – opponents still fear damage to natural resources, especially the Green River watershed. According to Schafer, the Green River, which feeds into the Cowlitz River, is less than a mile from the proposed drilling site.
“Drilling and mining uses a lot of water,” said Schafer, “and there has been no assessment of where the water is coming from.” Ascot’s proposal states that they could use up to 5,000 gallons of water per day during the drilling process.
Hard hitting evidence shows domestic violence is up dramatically in Southwest Washington
In 2011, there were eight domestic violence homicides in Clark County, second only to Pierce County’s nine. King County, which includes the city of Seattle, also had eight – but that was King’s lowest number since the year 2000, while it’s Clark’s highest. The year before, nearly 2,500 domestic violence arrests were made in Clark County. That’s almost seven arrests for every single day of the year, more than in any other offense category.
Around Southwest Washington, the picture is much the same. Cowlitz County’s Emergency Support Shelter served 1,051 domestic violence victims in 2010, up from 641 in 2008. Clark County YWCA’s SafeChoice program’s domestic violence hotline was flooded with 17,751 calls in 2011, compared to 7,209 calls – less than half – in 2008.
What is going on?
Money plays a role
The economic downturn has seemed to lead to an increase in domestic violence. Lee Watts, director of community services at SafeChoice in Clark County, said that unemployment leads to more stress for perpetrators, and more time to exert control. With fewer financial resources, women choose to return to their abusers.
“It’s hard enough to leave in good times,” said Beth Hansen, executive director of the St. James Domestic Violence Program in Wahkiakum County.
The nature of domestic violence also seems to be changing. Sherrie Tinoco, executive director of Cowlitz County’s Emergency Support Shelter, said that over the last couple years, the Cowlitz program has seen evidence of escalation, such as black eyes and broken bones, compared to less violent pushing, shoving and verbal abuse. Amy Buettner, assistant director of the Skamania County Council on Domestic Violence and Sexual Assault, said that Skamania’s program has seen more domestic abuse of already-vulnerable populations such as the elderly and people with developmental disabilities.
There’s help, but not enough
Each Southwest Washington county has a domestic violence program to try and stem this tide of violence. In Clark County, the SafeChoice program, administered through the YWCA, provides a 33-bed shelter, 24-hour hotline, general and legal advocacy and support groups. Similar, smaller programs, like those mentioned above, exist in Skamania, Cowlitz, Wahkiakum and Pacific counties.
Unfortunately, the bad economy is hampering programs’ ability to serve domestic violence victims. More than 80 percent of programs reported an increase in demand for services in 2011, but 62 percent reported a decrease in funding. Watts said that SafeChoice’s budget has been cut from just over $1 million to $882,000, and it has closed the office on Fridays to make ends meet. The shelter and hotline remain open 24/7.
But there is also evidence that the community outreach and education activities these programs engage in is having an effect. Hansen said that her program has seen more women seeking legal remedy to end abusive relationships. This is typically done through a protection order, which removes the abuser from the home, and allows the victim and children to remain.
“Without these critical, life-saving services, people would be left without help, in danger and in fear,” said Watts.
Education makes a difference
“You don’t have to work in a domestic violence program to make a difference,” said Kelly Starr, director of communications for the Washington State Coalition Against Domestic Violence.
She suggested talking to young people about healthy relationships, and contacting local programs to see what they need. For example, Tinoco said they were in need of canned food, toiletries and towels, as well as volunteers who could help with leading children’s activities and community education. Debbie Medeiros, program manager at the Cowlitz Tribe’s Pathways to Healing program said they needed cash donations and household items. SafeChoice needs support for their annual holiday toy drive, as well as additional volunteers for support group facilitation and hotline staffing.
Educating yourself is one of the best things you can do, said Buettner. That way, if you know someone who is a domestic violence victim, you have information ready to help them.
“Violence is really isolating,” said Buettner. “If people are knowledgeable, that removes the isolation.”
National stats paint a bleak picture
According to the U.S. Department of Human Services and U.S. Department of Justice statistics, in the United States, a woman is beaten every 15 seconds, and domestic violence is the leading cause of injury to women between the ages of 15 and 44 in the U.S. — more than car accidents, muggings and rapes combined. And, unbelievably, 63 percent of the men between the ages of 11 and 20 who are serving time for homicide killed their mother’s abuser.
“You always checked to see if my bathwater was too hot or too cold.”
To one little girl in foster care in Vancouver, this simple act of kindness by her foster mother, Kimarie Glover, meant a lot.
“It was something automatic for me,” said Glover, who is also a liaison for Families for Kids (FFK), a nonprofit organization that contracts with the Washington State Department of Social and Health Services (DSHS) to find and retain foster parents. “But to her it was a big thing – it meant I cared about her.”
According to data from the “Timeliness of Dependency Case Processing in Washington State – 2011 Annual Report,” the number of dependency cases (children legally removed from their birth home) in Clark County rose from 212 in 2008 to 360 in 2011. Statewide, dependency filings increased 33 percent from 2009 to 2010, setting an all-time high, but decreased 8 percent in 2011.
In Clark County, more than 630 children are in foster care, said Cindy Hardcastle, area administrator for the Children and Family Services arm of DSHS. But there are only about 430 active foster homes in the county. Tina Day, supervisor for the Cowlitz Court-Appointed Special Advocate (CASA) program, said there are about 200 children in the program, but according to Jeanmarie Moore, a recruitment and retention specialist for FFK, there are only about 100 foster homes, down from 150 prior to the recession.
Because of the poor economy, “we’ve lost a lot of good foster homes,” said Moore, herself a foster parent for nine years. “People aren’t sure what they’ll be doing, and it’s gotten much harder to recruit foster parents.” Skamania County also has a poor ratio of foster homes to needy children, said Hardcastle – about 20 children and only 12 foster homes.
“Our number-one challenge,” said Rachael Curtin, foster care placement coordinator for Cowlitz and Wahkiakum counties, “is lack of licensed foster parents – it’s hard to keep sibling groups together.”
Budget cuts to Washington’s child welfare system aren’t helping matters. Day estimates that DSHS has seen about a 30 percent reduction in staff and finances.
“The foster care system is underfunded,” said Laura Osburn, executive director of Family Solutions in Vancouver, a nonprofit mental health organization that treats many children in foster care. “People’s caseloads are enormous.”
Kim Lawrence, another Clark County FFK liaison as well as foster parent for 11 years, said that because social workers’ caseloads have increased, foster parents must “advocate for themselves without a lot of communication. We need families that understand kids’ needs independent of the social workers.”
Unfortunately, said Lawrence, these needs, such as counseling and medical care, are increasing. She said that in years past, neglect was more a problem than actual abuse, but these days “we are seeing severe abuse issues, a lot of which are caused by drugs.”
Osburn has seen the same trend, stating that “kids come in in much worse shape [now] because there is such an epidemic of methamphetamine, cocaine, heroin, and other drugs.”
The poor economy also is contributing to a worsening of the situation, said Osburn. For example, there are many eligible families who could benefit from Family Solutions’ services, but who cannot afford the gas money to come to the clinic.
The foster care system is also receiving more older children than previously, when newborns were prevalent.
“We’re in desperate need of foster parents for teenagers,” said Hardcastle.
Lawrence said that many foster parents were “afraid to take teens,” but that in her experience, she has had more trouble with her own teenage children than with fostered teens.
But whatever age, what foster kids need most, said Glover, is commitment. “There are kids out there who have been let down time and time again. We need committed families,” she stressed. For example, Glover once fostered a 4-year-old girl who had already been in 11 different homes.
Unfortunately, 19.7 percent of Clark County dependency cases that are successfully reunited with their birth home re-enter foster care within 12 months, compared to a national median rate of 15 percent and a state average rate of 13.8 percent. Cowlitz County’s re-entry rate is 35.8 percent.
Moore said that on average, a Southwest Washington foster child moves three times, and added that studies have shown that each time a child changes schools, the child experiences three to six months of academic decline.
“Knowing exactly why the re-entry rate for Cowlitz County is so high is a tough question – there are a lot of factors that play into it.”
One major contributing factor, she said, was that maintaining long-term sobriety was a challenge.
“When we saw the numbers,” said Tina Day, “we asked ourselves, ‘What are we not doing that we should be? How can we get a better handle on this?’”
Curtin encouraged people to consider becoming foster parents, and clarified that parents can choose which kids to foster based on age, gender, and behavioral issues that fit best in their home. The most important thing, she said, was to be “willing to pick up the pieces for a little person in trauma.”
How to get involved
Department of Social and Health Services. General questions about foster care for Clark, Cowlitz, Skamania, and Wahkiakum Counties: Giselle Reyes 360-993-7947. For all other Region 6 counties: Wendi Pumphrey-Rios 360-725-6701
Court-Appointed Special Advocate program. Nonprofit organization needs volunteers to help make recommendations for what is in the child’s best interest, for children legally removed from their birth home. ywcaclarkcounty.com/volunteer/casa
Families for Kids. Foster care, respite care, babysitting, and transportation – provide an hour or a weekend of foster care, or a ride to a doctor’s appointment, to give foster parents a break.
Clark & Skamania: Kim Lawrence at 360-448-0861 or Kim Glover at 360-326-3864; Regional: 360-430-1510
Foster Grandparenting. In this federal program in its 47th year, seniors provide one-on-one emotional support, mentoring, and tutoring for children from preschool age to 18 years at schools and other sites in Clark and Pacific counties. Must be 55+, meet certain income level standards, and be willing to volunteer about 20 hours per week. Marianne Falbee at 360-448-9653
Big Brothers Big Sisters Columbia Northwest. Mentoring Youth in Foster Care program provides children in foster placement with a caring, consistent big brother or big sister that can enrich their lives culturally, socially and academically. www.bbbsnorthwest.org. Cowlitz: 360-636-2765; Clark: 360-891-8382; Skamania: 509-427-8904
Donations may also be made to many of these organizations.
Private school enrollment slides as local families look to reduce spending
The struggling economy has affected retail sales and the real estate market. But it is having an equally sobering effect on the education ecosystem of Southwest Washington.
Roger Miller, principal at Vancouver Christian Junior and Senior High reported their enrollment is down almost 25 percent over the last couple years, while Kendra Eimen, administrator for Vancouver Montessori School, said a “lot of people have pulled their children due to economic pressures.”
John and Jane Connell, who up until last year schooled their elementary-age children at Pacific Crest Academy, a private Catholic K-8 school in Camas, made the decision to transfer the two youngest (fourth and sixth graders) to the Camas public school district. Jane also went back to work three years ago.
“We have two kids in college now, and one going next year,” said Connell. “We needed to direct funds toward college.”
Connell said they preferred private schooling for the formative elementary years because of smaller class sizes and the emphasis on faith and values. He said the “outrageous” rising cost of college was “putting the pinch on our plans for grade school and high school.”
According to Ken Townsend, regional director for the Association of Christian Schools International, private schools in Alaska, Idaho, Montana, Oregon and Washington have experienced an average enrollment decline of about 5 to 10 percent.
It isn’t all doom and gloom, however, Townsend reported that enrollment at one private school in Battle Ground has increased, and Tom Bradshaw, headmaster at Cedar Tree Classical Christian School said his school “has been blessed with a 7 percent enrollment increase over last year.”
Katrina Woermann, director of Lakeshore Montessori School, said she has created three- and four-day programs for strapped families. Tamar Parker, Pacific Crest’s principal, said they offer both 10- and 12-month payment plans, and have allowed some families to pay tuition upon receiving their tax return or company bonus. Miller said Vancouver Christian was considering offering online courses.
Bradshaw said they were considering “stepping up” their scholarship fund, due to an increase in families requesting financial assistance. According to the National Association of Independent Schools (NAIS), the percent of students on financial aid at member schools has climbed steadily: 19 percent in 2008/2009, 21.6 percent in 2009/2010, and 22.8 percent in 2010/2011.
Besides tuition, donations are an important source of income for private schools. Parker said they held an annual fundraiser along with an annual appeal, jog-a-thon, and golf tournament. Vancouver Christian recently sent a letter asking for donations from area businesses. But the NAIS reports that for member schools, the average annual giving per student declined 24 percent, from $1,703 in 2009/2010 to $1,280 in 2010/2011. Eimen said that she has noticed a similar decline in donations.
If some students are leaving private schools, where are they going? Some may be transferring to public schools. Mike Merlino, chief operating officer for Evergreen School District, said that Evergreen’s full-day, five days a week kindergarten enrollment has increased about 9 percent since 2008/2009.
“You may be able to infer,” said Merlino, that this increase is due to children “not going to private school for kindergarten.”
Jeff Snell, deputy superintendent at Camas School District, reported that their enrollment was up about 3 percent, and Brett Blechschmidt, fiscal officer for LaCenter School District, said the district was also experiencing an unexpected increase in enrollment. Neither administration had yet pinpointed an exact reason, although transfers from private schools as well as affordable housing were possibilities. Snell mentioned that several people had recently contacted the school doing relocation research.
Homeschooling is another option that financially strapped parents are considering. Dan and Sheila Monaghan pulled their four children from Pacific Crest last year. They used a combination of homeschooling, a co-op, and River Homelink classes.
Although a small promotion made it possible for the Monaghans to return their children to Pacific Crest this year, Dan said that supporting private schooling long-term for all four children would be difficult, and that they would continue to explore options “year by year” including more homeschooling and public school.
The best source of information for financial aid are administrators
at a particular private school. Check these websites, too:
Children’s Scholarship Fund.
Jack Kent Cooke Foundation.
National Association of Independent Schools.
Pacific Northwest Association of Independent Schools.