The 2009 legislative
session was one in which Minnesota’s
mental health community realized key gains and experienced difficult
losses. Cuts to General Assistance Medical Care (GAMC) will have
a severe impact, But there were bright spots as well. Led by NAMI
Minnesota and the rest of the Mental Health Legislative Network,
community members worked hard to protect the gains made during the
2007 session and to advance other key issues.
Seclusion and Restraints
There
is a new law that governs the use of seclusion and restraints on
special education students in the schools. It will go into effect
on August 1, 2011. Every school will have to develop a plan that
includes the list of procedures that they plan to use, how they will
be monitored and reviewed (including an oversight committee and debriefings),
and documentation of staff training.
These procedures can only
be used by licensed personnel who have received specialized training.
The specialized training must include positive behavioral interventions,
communicative intent of behaviors, relationship building, alternatives
to restrictive procedures, de-escalation procedures, standards for
using restrictive procedures, obtaining emergency medical assistance,
physiological and psychological impact of these procedures, monitoring
and responding to physical signs of distress and recognizing the
symptoms of and interventions that may cause positional asphyxia.
The
new law defines restrictive procedures as seclusion and physical
holding. Seclusion is defined as confining a child alone in a room
from which egress is barred. Physical holding and seclusion can only
be used in an emergency. An emergency means a situation where immediate
intervention is necessary to protect a child or other individual
from physical injury or to prevent serious property damage.
Restrictive
procedures must be the least intrusive intervention to respond to
the emergency, and must end when the threat of harm ends. A child
must always be directly observed during their use. Parental notification
is required.
Schools must document each
time seclusion and restraints are used and include what led to their
use, why less intrusive methods failed, the time use began and ended,
and the child’s behavioral
and physical status. There are standards for the room that is used
for seclusion that address safety issues.
The Individualized Education
Program (IEP) can plan for an emergency and thus put the procedures
in the IEP, however, the bill also requires the IEP team to meet
if the procedures are not included in the IEP and are used twice
in 30 days or when a pattern emerges. There is a list of prohibited
procedures that are very similar to prohibitions contained in other
laws and rules covering other types of programs. It includes things
such as withholding food, not allowing a child to use the bathroom,
physical holding that restricts a child’s
ability to breathe, or assuming a position that would be painful.
Finally, all districts are encouraged to establish effective school-wide
systems of positive behavior interventions and supports. This was
a major victory!
GAMC
Funding for General Assistance
Medical Care (GAMC) was vetoed for the second year of the biennium.
This program provides health insurance for more than 30,000 low income
Minnesotans, a majority of whom have a mental illness, chemical dependency
or both. Loss of this funding is devastating for both the people
who depend on the program and for the hospitals, mental health centers
and other health care providers who serve many of them.
Mental Health
911 operators
will now be able to refer to mental health crisis teams and children’s
crisis teams will be afforded greater flexibility in rural areas
by not being required to provide services 24/7. The Willmar Community
Adolescent Behavioral Health Services will be changed to provide
a safety net for children with mental illnesses who need intensive
care and the Anoka Regional Treatment Center will be redesigned to
provide services in 16 bed facilities.
Youth aging out of the foster care system will have access to MinnesotaCare
and will be able to access support and advice from the county after
they turn 18.
The Extended Employment Program
for people with a serious mental illness took a small cut—$80,000 but the BRIDGES housing
program was funded at the same level. Mental health providers, including
inpatient mental health care, did not receive cuts to their payment
rates.
Redesign and Maintenance of
Effort (MOE)
There was a lot of discussion
this session about how to redesign human services and how to allow
counties out of the laws that require them to spend the same amount
of money as in previous years. Unfortunately, most of the focus of
these efforts was on mental health. In the end there were three different
pieces of legislation to address this issue.
For the mental health MOE the state will make it easier for counties
to know how much they have spent and will allow some dollars to be
decreased due to other budget cuts experienced by the county and
population decreases.
On a larger scale, the commissioner
of human services must recommend a new program that consolidates
county property tax contributions across all mandated health and
human services programs and that has an easy funding mechanism, maintains
current services, and ensures equal access to mandated services.
Another effort to reform human
services is the State-County Results, Accountability, and Service
Delivery Redesign Council which would review and certify the formation
of service delivery authorities (SDA) either in a large county or
a group of counties. These SDAs would be able to come together to
provide specific services and use performance measures and outcome
goals. They could obtain waivers from current laws in order to carry
out this “new” way
of providing human services. There would be an accountability process
and penalties for not making progress. The council does have to have
a process to take public input.
There would be a steering committee on performance and outcome reforms
that will review performance and outcome standards for all essential
human services and will develop appropriate reporting measures and
uniform accountability process for counties that don’t make
adequate progress. The steering committee can form work groups that
includes people who provide, receive or advocate for essential services.
Members of the steering committee include county representatives,
clients or client advocates and state agency staff. ![end of story]()
Sue Abderholden is executive director of NAMI Minnesota. Visit the
organization’s Web site at www.nami.org to learn more about
2009 legislation.
