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April 3, 2023
In this issue ...
The days are getting longer and warmer as we head into spring. Spring blossoms and holidays to celebrate, from Passover to Easter to Eid al Fitr, mark how we interact with nature and with our communities. The way we show up for each other, the way we walk with each other and celebrate with each other is what makes a community.
April is Autism Acceptance Month. Every autistic person experiences autism differently, with this variety of experience sometimes being referred to as a spectrum. Autistic people are in every community.
Autistic people report some common experiences, like sensitivity to sound or light, differences in the way they think and communicate, and how they interact with the world. To learn about the many facets of autism, explore community-led websites such as Autistic Self Advocacy Network (ASAN). ASAN advocates for a world where all autistic people have equal access, rights, and opportunities.
When we show up in a different way, and open ourselves to the experiences of every community, the more we can see how our needs and hopes are the same. A world that is more accepting and willing to understand the autistic experience, is more accessible and available to everyone. When we make space for others, we often find brand-new, wide-open spaces, that we didn’t even know that we needed.
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Promoting help seeking and help giving is a key mission for health promotion and prevention at Clackamas County Behavioral Health. In October of 2022, Kathy Turner, Health Promotion and Prevention Coordinator for Behavioral Health attended the American Foundation for Suicide Prevention Out of the Darkness Suicide Prevention Walk handing out suicide prevention and mental health resources. At the walk, she met Katie Gilmore working with Transportation Security Administration (TSA) from Portland International Airport. Katie shared with Kathy that she was working to promote and improve their peer support program for TSA staff working at the airport. She told Kathy that a greater number of TSA staff at the airport were experiencing major stressors in the workplace and outside of work. Katie invited Kathy to share a table with her the TSA Health Fair on November 17 and bring resources for suicide prevention for the staff and their families.
Information about the peer support program, cards with local and national suicide prevention lifelines, and firearm safety cable locks were popular among the TSA staff during the day. Katie and Kathy connected with over fifty people about the warning signs of suicide and encouraged staff to carry the lifeline phone numbers in their wallets in case their kids, family members or friends, co-workers or even they themselves, experienced emotional distress and thoughts of suicide. Katie also talked with her co-workers about the value of the peer support program and next steps for getting trained to be a support for other staff.
Nationally, about 20% of the TSA workforce are veterans and studies indicate that about 45% of veterans have firearms. TSA staff, whether they had served in the armed forces or not, expressed gratitude for the free cable locks as a measure for firearm safety. Of the fifty plus people that came to the table that day, more than half took a cable lock with them – increasing the likelihood of putting time and distance between a distressed person and a firearm.
Ableism is a term that refers to the bias and unfair treatment of people with disabilities; it centers on the idea that people with disabilities are less valuable than nondisabled people. Ableism is one of the most common types of bias, and in the United States nearly 1 in 5 people lives with a disability. Some examples of ableism:
- Saying, “You do not look disabled,” as though this is a compliment.
- Viewing a person with a disability as inspirational for doing typical things, such as having a career.
- Questioning whether a person’s disability is real.
There are many ways to challenge one’s way of thinking, and people do not always know they are thinking or behaving in an ableist way. A good resource to learn about bias is NPR’s Hidden Brain series: Revealing Your Unconscious, Part I and II.
There are several types of ableism.
- Institutional ableism, such as medical ableism, sees a disability as something that needs fixing. This can affect the entire healthcare system and the well-being of patients.
- On the interpersonal level, ableism affects our relationships and interactions, such as the parent of a child with a disability might try to “cure” the disability rather than accept it.
- Ableism can be experienced on the internal level as well; this is when a person consciously or unconsciously believes the harmful messages they hear about disability and applies them to themselves.
Ableism affects everyone. It shapes how people think about physical or mental differences, which anyone can experience during their lifetime. It can lead to barriers to getting healthcare, and to avoidable illness and death. Ableism damages society when there is limited access to transport, education, and the internet; increased levels of unemployment and poverty; and unnecessary institutionalization.
To interrupt ableism, it’s important to have anti-ableist people on the board of your institution and/or in positions of power. Seeking the voice of the population you are trying to serve is the best place to start, both in person and through websites including articles and books written by the people who experience the disability. Achieving health equity starts with voices of people with lived experience.
In November 2021 OHA began a full review of Medicaid reimbursement rates for youth services across Oregon’s behavioral health programs. The study included three phases of rate reviews:
- Phase 1 included psychiatric residential programs at all levels (psychiatric residential treatment services, subacute, and secure inpatient),
- Phase 2, which included youth residential programs for substance use disorders and psychiatric day treatment,
- Phase 3 focused on intensive in-home behavioral health treatment (IIBHT) and behavior rehabilitation services (BRS).
The goal of the rate study was to gather information on multiple types of provider costs so rates could better reflect the true cost of services that providers need to cover. Information was gathered on provider staffing, as well as costs for buildings, infrastructure, and administrative needs. We also gathered information not only about current program needs, but also hopes and goals for the future to support innovation and clinical improvements. The study then included national benchmarks, such as wage data from the Bureau of Labor Statistics and average market rates.
During the 2022 legislative session, behavioral health received unprecedented funding for wage and rate increases. OHA utilized the wage study to support those discussions, and the study informed increases for staff wages and for behavioral health rates which went into effect in the fall of 2022.
HB 4012 (2022) required the Oregon Department of Human Services (ODHS) to work with OHA and Oregon Youth Authority (OYA) to review rates and submit a report. Representatives from the three agencies met frequently to review the rate study tool to make consistent decisions across all our programs on how to use the information to increase rates for BRS programs. The cross-system collaboration was incredibly valuable, and we are so grateful to our partners in ODHS and OYA. If you are interested in the full report, you can read it by following this link.
Moving forward, OHA plans to revisit the study for each biennium to provide the Legislature with a planful and informed request for rate increases. We are excited and optimistic that the impact on young people and their families will be felt throughout the state in improved access to services, improved retention of staff, and livable wages for those people doing the work.
The Healthy Transitions program at Portland State University (PSU) is a project funded by a SAMHSA grant that aims to reduce barriers and gaps in services for transition-aged youth, as well as increase youth and young adult engagement and advocacy efforts within Oregon's mental health system of care.
PSU staff are currently working on the Healthy Transitions Oregon Podcast. The podcast gives Oregon youth between the ages of 16 and 25 a platform to share their lived experiences of mental health struggles, with a focus on hope, resilience, and recovery.
They are searching for more youth to join them in recording a podcast episode wherein they would share their story. Please fill out this form if you’re interested. There are no “criteria” for your experiences. Answer the questions in any way that feels true to you. All participants will be compensated at $25 per hour for their time and may remain anonymous in the publication of the podcast if they would prefer.
For those who would like to listen to previous episodes of the podcast, they may do so by searching "Healthy Transitions Oregon" on Google Podcasts, Apple Podcasts, or Spotify.
If you have any questions about the podcast, contact Sarah Rasmussen, rasmus24@pdx.edu, Youth & Young Adult Coordinator for the Healthy Transitions program at Portland State University.
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Save the date! Thursday May 11 is Oregon Family Support Network (OFSN)’s Children’s Mental Health Acceptance Day Event.
The month of May is recognized as Mental Health Awareness Month and the second week of May (May 7th through 13th this year) is Children’s Mental Health Acceptance Week. OFSN is an organization that focuses on families with children who experience mental or behavioral health challenges. Acceptance is found when people advocate and act to change the attitudes, behaviors and systems.
This year you can join them in increasing awareness and acceptance of mental health, participate and engage in methods of how to advocate at local and state levels, and finally, recognize and celebrate advocates that continue to fight and create change in Oregon’s children’s mental health.
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Date: Thursday, May 11, 2023
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Time: 9 a.m. to 3 p.m.
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Cost: FREE event
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Where: Salem, Oregon
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What: Resource fair, guest speakers and open mic, lunch (registration required), activities, legislative training session
More details coming soon, go to OFSN’s site for more information. Registration should open soon.
Capacity monitoring for Intensive Treatment Services
Intensive Treatment Services capacity remains a critical concern to CFBH. Each week we receive data on capacity for acute care, sub-acute and psychiatric residential, as well as substance use disorder residential programs. OHA monitors these to understand patterns and to offer help in keeping programs operational.
The graph below shows capacity over time. The top line represents the goal for the system established in 2020, of having 286 beds available for youth. The line below shows the highest possible capacity that could have been available, given full staffing and removal of all other barriers.
The bottom bar chart represents a monthly summary of reported weekly operational capacity, a combination of beds in use and open beds. In the last 12 months the largest impact on capacity has been the ongoing struggle to fill workforce vacancies and manage staffing levels.
Interdisciplinary Assessment Teams
We continue to meet with community and system partners to assess the needs of the Interdisciplinary Assessment Team (IAT) project. The first goal, set out in Senate Bill 1 (2019), is to provide rapid access to evaluation, assessment and stabilization services for youth - and especially for those who are in child welfare custody and placed in temporary lodging - in emergency department boarding, in shelter care, in county juvenile facilities or in the custody of Oregon Youth Authority.
We are excited to announce that a demonstration project of the Expedited Assessment Services for Youth (EASY) is about to launch in Multnomah County. EASY provides quick access to full psychological and assessment services within seven to 10 days of referral. It includes a full review of clinical documents, determination of need for testing, conducting of psychological testing, communication with current clinical providers and (where appropriate) coordination with local Intellectual and Developmental Disabilities intake screening departments. EASY can be mobile and meet the youth in the community, either in person or via telehealth as needed. In some situations, all that may be needed is a full psychological evaluation to help a youth and family get on the right path to the services they need.
If you are interested in this work, please contact John Linn at john.r.linn@dhsoha.state.or.us.
Oregon doesn’t have enough treatment or housing for people with mental illness: Oregon Public Broadcasting looks at the roots of major problems and promising strategies to address these issues.
Events, opportunities, trainings and resources may be found by following this link to the mid-monthly positing and many of these trainings can also be found on our website. They will be sent out mid-month, look for the next one in your inbox on April 15.
For feedback and suggestions for our newsletter and information: kids.team@dhsoha.state.or.us
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