marathon county north central health care (nchc) … · 3/11/2016 · a review, revise and adopt...

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MARATHON COUNTY NORTH CENTRAL HEALTH CARE (NCHC) OVERSIGHT

TASK FORCE

MINUTES Wednesday, March 9, 2016 – 5:30 p.m. (5:54 following Executive Committee)

Employee Resources Conference Room, Courthouse

Attendance: Present Absent Kurt Gibbs, Chair X Chad Billeb X Jean Burgener X Matt Hildebrandt X Lee Peek X John Robinson (Via Phone) X

Also Present: Deb Hager, Scott Corbett, Jeff Zriny, Michael Loy, Mary Palmer Call Meeting to Order

The meeting was called to order by Chair Kurt Gibbs at 5:54 p.m.

1. Public Comment – None

2. Approval of the Minutes from September, 3, etc. February 16, 2016. MOTION BY PEEK; SECOND BY HILDEBRANDT TO APPROVE THE MINUTES AS AMENDED AND NOTED. MOTION CARRIED. A member of the Task Force did not approve of portions of the minutes from September 3rd, September 19, October 5, and November 24, 2015 meetings. Consensus emerged from the Task Force members to put a disclaimer on each set of minutes: Many statements included in these minutes do not reflect the position of the Task Force, rather they reflect the personal sentiments of Task Force members expressed during meetings. (Amended presented by Task Force 3/9/16)

3. Policy Issues Discussion and Committee Determination to the County Board for its Consideration A Review, Revise and Adopt NCHC Oversight Task Force Final Report for the Executive

Committee Consideration Discussion:

Grammatical errors were corrected. Working off from Supervisor Robinson’s draft suggested changes were reviewed and accepted.

Action: MOTION BY PEEK; SECOND BY HILDEBRANDT TO ACCEPT THE FINAL NCHC OVERSIGHT TASK FORCE REPORT AS AMENDED AND FORWARD TO THE EXECUTIVE COMMITTEE FOR CONSIDERATION. MOTION CARRIED

Follow through: Send to the Executive Committee to be considered at their meeting on March 17 after being proofed for consistency in language.

4. Next Meeting, Time, Location, Agenda Items: This was the final meeting of the NCHC Oversight Task Force. Chair Gibbs thanked everyone for their hard work, input and time commitment to this task force.

5. Adjournment MOTION BY HILDEBRANDT; SECOND BY PEEK TO ADJOURN THE MEETING. MOTION CARRIED. Meeting adjourned at 6:44 p.m.

Minutes Prepared by Mary Palmer

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North Central Health Care Oversight Task Force Final Report To Executive Committee

March 9, 2016

Task Force Members: Kurt Gibbs, Chair, Lee Peek, Matt Hildebrandt, John Robinson, Chad Billeb,

Jean Burgener

On May 19, 2015, the Marathon County Board of Supervisors by a unanimous vote adopted

Ordinance 14‐15 creating the North Central Health Care (NCHC) Oversight Task Force. The

following Charter was developed to guide the work of the Task Force:

I. Task Force Charter

North Central Health Care Oversight Task Force

Purpose: To integrate and coordinate the recommendations from multiple efforts (listed

below) to provide clear policy recommendations to Marathon County Board of

Supervisors in a holistic and comprehensive way regarding the services, performance

expectations, accountabilities, cost and roles and responsibilities of North Central Health

Care.

Background: There are multiple task forces, panels and workgroups addressing facets of

Marathon County’s relationship with and expectations regarding service provision by

North Central Health Care. These include but are not limited to the Governance Task

Force, Long Term Facilities Plan Task Force, Independent Mental Health Panel for

Offender Populations, Evidence Based Decision Making in Criminal Justice Grant, Therapy

Pool, etc. However, there is no coordination and integration of these efforts to guide the

Marathon County Board of Supervisors in making policy decisions regarding capital,

service/ operating expectations and expenditure of funding (federal, state and local) on

behalf of Marathon County. The lack of a comprehensive approach to clarifying

relationships, expectations, outcomes, cost of providing services and future needs has

resulted in multiple groups working on varying aspects with no one having a full vision of

what the Marathon County Board of Supervisors expect and are willing to support.

Membership: Chair and Vice Chair of County Board, the Chairs of the Public Safety and

Health & Human Services Committee or their designees, and the Sheriff or his/her

designee.

Support will be provided by County Administration with the assistance of the chairs or

team leaders of the various task forces, panels and workgroups already underway.

The task force reports directly to the Executive Committee.

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Duties and Responsibilities:

1. To review and discuss recommendations from the task forces, panels and workgroups.

(See Section II)

2. To develop policy recommendations based on number 1 for action by County Board

(See Section III)

3. To prioritize the recommendations (All recommendations have been adopted by

County Board)

4. To create a financial plan for implementation of recommendations (In process)

5. To develop a performance management contract for provision of services based on

the recommendations adopted by County Board (See Section III)

6. To have a long term facilities plan for the North Central Health Care Campus (See

Section III)

Duration: To begin no later than May 31, 2015 and completed by March 31, 2016.

The Task Force held its initial meeting on June 11, 2015, the task force met on the following

dates:

July 23, 2015 September 3, 2015 September 15, 2015 October 5. 2105 November 24, 2015 December 30, 2015 February 16, 2016 March 9, 2016

II. Recommendations from Task Forces, Panels and Workgroups

As was mentioned in the Task Force Charter a number of efforts have been undertaken to

review mental health services available to the criminal justice system and review the

governance structure and relationship between Marathon County and North Central Health

Care. These efforts were undertaken to try to address the need to provide mental health

services to those in the criminal justice system in an effort to reduce recidivism and avoid the

need to construct an addition to the Marathon County Jail and to meet the needs of

vulnerable populations. The efforts included the following:

A. Marathon County Task Force on Governance of North Central Health Care and

the Relationship of North Central Health Care to Marathon County

The recommendation of Governance Task Force was a modification of the existing

governance contract between Langlade, Lincoln and Marathon counties. Its

recommendation is a ten year agreement to continue the existing relationship. All

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three County Corporation Counsels had reviewed the tri‐county agreement. The

Health & Human Services Committee had received the Governance Task Force

recommendations but deferred to the Oversight Task Force prior to moving the

agreement forward to the County Board. In addition to the tri‐county agreement,

there was also a Facilities Use agreement and the Nursing Home agreements

which only apply to NCHC and Marathon County.

Recommendation: Until the Oversight Task Force completes its work and any

recommendations of the Oversight Task Force are agreed upon by the County

Board and incorporated into the tri‐county agreement, the agreement should

not be moved to County Board for its consideration.

B. Marathon County Task Force to Oversee the Creation of a Facilities Plan for

North Central Health Care Facilities.

The Facilities Task Force was told by NCHC representatives that a long range

facilities plan existed for the entire campus except for the space occupied by

ADRC‐CW. NCHC did not present a written plan. They did present efforts for the

remodeling of Mount View Care Center and the aquatic therapy pool study.

ADRC‐CW expressed frustration with the lack of movement on a plan to remodel

space consistent with their needs. This planning was tabled until a decision is

made on the current aquatic therapy pool. Given an inability to secure a plan

from NCHC and its assertion that a long range facilities plan does not make sense

in the fluid and dynamic health care world, the Facilities Task Force recommended

that Health & Human Services develop a plan for ADRC‐CW’s needs once there

was clarity regarding the aquatic therapy pool.

No additional action or recommendations were developed by the NCHC Oversight

Task Force at that time.

Final Recommendation: Develop a five year capital plan for the NCHC campus

which should include but not be limited to the nursing home renovation, aquatic

therapy pool, psychiatric hospital, behavioral health unit and other facility

needs.

C. Aquatic Therapy Pool

U. S. Aquatics presented several options to address the aging therapy pool at

NCHC. After input from stakeholders and County Board members, the Health &

Human Services Committee recommended the rectangular pool option on a new

site. Through the 2016 CIP and budget process County Board approved a

consultant to secure a more definitive cost estimate for construction of the new

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pool and a repurposing of the existing foot print. This is necessary to secure the

appropriate level of bonding for this project if approved by County Board.

Facilities and Capital Management has released an RFP and interviewed proposers

to complete the schematic design and conceptual construction estimates for initial

review by March 31, 2016 and final presentation by April 30, 2016.

Recommendation: Based on the construction cost estimates and repurposing

cost estimates decide whether to proceed with the project and bonding for the

same.

D. Sheriff’s Independent Panel on Mental Health Services in Corrections

In response to growing numbers of offenders experiencing mental health crisis in

the jail and the lack of responsiveness to these concerns by NCHC, the Sheriff

convened an Independent Panel on Mental Health Services in Corrections. The

charter for the panel is in Attachment A:

In response to the concerns raised by the Sheriff’s Department mental health

services began in the jail as of July 1, 2015. These services included up to 8 hours

of tele psychiatry for medication management and 40 hours of forensic mental

health services.

The following services are being provided in the jail as an integrated approach to

addressing mental health needs of offenders:

40 hours of forensic mental health services primarily focused on behavior

management during incarceration – provided by NCHC

Up to 8 hours of tele psychiatry for medication management – originally

provided by NCHC and now by Correctional Services under a contract with

the Jail

Full time Social Worker conducting transition planning with offenders for

their release

The transition to Correctional Services providing tele psychiatry has led to a

reduction in concerns about prescription of drugs not recognized within

correctional formularies. Access to outpatient therapy services including

psychiatry for medication management remains a concern upon release from jail.

The panel completed its work in September. Final report is attached.

(Attachment B). The Sheriff’s Department created the 2015 Marathon County

Mental Health in Corrections Work Plan (Attachment C) as a result of the final

report.

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At its December meeting the Task Force also evaluated the Sherriff’s Department

Work Plan in response to the Independent Mental Health Panel recommendations

relating to access to health insurance and requested that the County accelerate

efforts to contact legislators on the issue. The Public Safety Committee advanced

and the County Board passed a resolution #R 3‐16 on January 19, 2016 requesting

that the State of Wisconsin change its policy of termination of public benefits

upon incarceration.

Recommendation: Develop an action plan to address the critical needs

regarding crisis services.

E. Evidence Based Decision Making (EBDM) Initiative

The charter for Marathon County’s Evidence Based Decision Making Team is in

Attachment D.

The goals established by the Evidence Based Decision Making Team on 11/25/15 are:

Long Term:

An offender has no further contact with any part of the criminal justice system as a

defendant.

Shorter Term:

The periods of time between incarcerations lengthens

No re‐incarceration for the same/similar crime

First time offenders never reoffend

Reduce and/or lessen harm to victims and the community

Reduce the number of offenders who commit crimes due to historical trauma.

F. Stepping Up Initiative

The National Association of Counties’ initiated a nationwide effort to reduce the

number of alcohol and other drug abuse (AODA) and mental health issues in the

jail. A series of webinars were presented through November of 2015, to provide a

common understanding of the dynamics and share best practices to support local

planning. The Marathon County Board of Supervisors adopted Resolution #R 36‐

15 on 6/23/15 to participate in the Stepping Up Campaign.

III. Policy Recommendations from the NCHC Oversight Task Force

A. Human Services Needs Assessment Request for Proposal

Recommendation to provide up to $75,000 to conduct a Human Services Needs

Assessment and Organizational Structure study. The Task Force identified the

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need to have a consultant assist in the efforts to identify future needs and to study

the service delivery structure at its October 5th meeting and recommended

funding be provided to conduct the study. The Request for Proposals was let in

late 2015 with no responses. Based on feedback from potential vendors, the

Request for Proposals was let for the Human Services Needs Assessment only with

a closing date of February 1, 2016. The County received three proposals.

Morningside Research and Consulting, Inc. out of Austin, TX was awarded the

contract. The study will evaluate current and future needs for human services,

identify assets and gaps, identify trends that will influence and/or impact service

delivery, analyze the fiscal implications and assist County Board in establishing

priorities and expectations for human services in Marathon County. A final report

is due to County Board by August 5, 2016.

B. Transition Facilities and Maintenance of NCHC to the County

Recommendation directs Marathon County to create a plan to transition

maintenance of the county property known as the North Central Health Care

campus from NCHC to Marathon County Facilities and Capital Management no

later than July 1, 2016. Recommendation was adopted by County Board on

January 19, 2016, and County Administration has begun the transition planning

with Facilities and Capital Management Department and NCHC. Housekeeping

services will be evaluated separately.

C. Define Community Mental Health

Recommendation to define Community Mental Health as follows:

A comprehensive continuum of mental health and addiction services that is readily

accessible, affordable and acceptable to all members of the community.

Provides services to children and adults with disorders that affect an individual’s

cognition, emotion and/or behavior control, interferes with ability to learn and

function in the family, at work and in society.

Services provide prevention, early diagnosis and treatment, continuity of care in

communities, rehabilitation, linkage to a variety of health and human services,

supervision and compliance of outpatient commitments, support of persons with

mental illness or mental health difficulties and promote social integration of

people with mental health needs.

Continuum of services includes:

Residential care

Emergency/crisis care

Supported housing

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Inpatient services

Day center/clubhouse

Halfway houses

Outpatient therapy

Vocational training & opportunities

Social & recreational opportunities

Groups (therapy, day report, etc.)

Case management

Rehabilitation services

Detoxification

Transitional care

Forensic mental health therapy

Medication management

Aftercare

Definition is derived from Chapters 51 and 46 of Wisconsin State Statute and

Department of Health Services Administrative Code Chapters 34, 124, 75, 36, and

63.

D. Performance Management Contract

The Task Force requested a comprehensive report of services provided by NCHC

including outcomes and financial information. To view the report:

http://www.co.marathon.wi.us/Portals/0/Departments/CAD/Documents/NCHC_

MCBoardReport_20150720.pdf

The Task Force recommended the first performance management contract begin with

mental health services for offender populations given the concerns raised regarding

provision of mental health services to the criminal justice system. On January 19, 2016

the County Board adopted Resolution #R 4‐16 authorizing the County Administrator’s

Office to Enter into Contract with North Central Health Care for Mental Health

Services to Marathon County Offenders.

The first year of the contract is setting current performance as a basis for establishing

performance standards for 2017. (Attachment E)

IV. Recommendations and Issues Needing Further Consideration

a. Develop a five year capital plan for the NCHC campus which should include but not

be limited to the nursing home renovation, aquatic therapy pool, psychiatric

hospital, behavioral health unit and other facility needs.

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i. Decision as to the construction of a new aquatic therapy pool, including

bonding be made upon receipt of the schematic design and estimates for

construction and repurposing of the existing footprint are complete.

ii. There are concerns about the existing physical plant of the psychiatric

hospital including the crisis unit that promote trauma informed care and

the diverse needs of mental health, detox and youth in crisis.

b. There are ongoing concerns regarding adequate resources for outpatient

psychiatry, dually certified mental health counselors that need to be addressed.

c. Establish the performance standards for 2017 based on the data reported in 2016

under the performance management contract for mental health services for

offender populations.

d. The performance management contract for mental health services for offender

populations must be finalized.

V. Conclusion

On January 19, 2016, the Marathon County Board of Supervisors passed a resolution #

R 8‐16 (Attachment E) expressing its intent to pursue the creation of a Human Services

Department and vote on a resolution approving withdrawal of Marathon County from

the Tri‐County Joint Contract which creates the North Central Community Services

Program Board and termination of Marathon County’s relationship with North Central

Health Care. Furthermore the resolution directs County Administration to develop a

feasibility study and draft implementation plan to create a human services

department. County Administration was directed to utilize the Human Services Needs

Assessment Study previously authorized and to continue to collaborate with the

appropriate officials from Lincoln and Langlade Counties to ensure that they are fully

advised on Marathon County’s findings and to receive their input regarding the effects

of Marathon County’s withdrawal on the residents of Lincoln and Langlade Counties

prior to any final vote. It is anticipated that a final vote will be taken no later than the

September, 2016 County Board meeting. In light of this action any remaining issues

that have not been addressed should be addressed through the work being done on

the feasibility study and implementation plan. As a result of this action this is the full

and final report of the NCHC Oversight Task Force.

Respectfully submitted, Kurt Gibbs, Chair Lee Peek John Robinson Matt Hildebrandt Chad Billeb Jean Burgener

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Attachment A

INDEPENDENT PANEL ON MENTAL HEALTH SERVICES IN CORRECTIONS 1. Purpose: To develop an action plan which achieves these outcomes: A. Recognized as the best array of mental health services provided to offenders in the State

of Wisconsin. B. Professionals involved in correctional mental health services have clear expectations on

what services are available for whom and how they can be accessed. C. Resources are aligned to support the Action Plan. 2. Relationship to County Government Structure: The panel reports to the Sheriff and will

share its findings with the Marathon County Board of Supervisors and the North Central Health Care Board.

3. Member Appointment: Six members appointed by the Sheriff 4. Deliverable: A work plan, similar in structure to that created by the Independent Jail Security

Panel, which articulates steps and identifies resources needed to achieve the outcomes listed under #1 Purpose above.

5. Term: Completed by September 1, 2015.

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Attachment B

September 4, 2015

Sheriff Scott Parks Marathon County Sheriff's Department 500 Forest St. VVausau, VVI 54403 Brad Karger Marathon County Administrator 500 Forest St. VVausau, VVI54403 Dear Sheriff Parks and Administrator Karger: Thank you for the privilege of representing the various stakeholders in working to improve Mental Health Services in Corrections in Marathon County. Attached is the final report of the Independent Panel, the members who are named below. VVe believe that without the diligent assistance, and project improvement mindset of both Chief Deputy Chad Billeb and Jail Administrator Sandra La Du-lves, the panel's work would have been more challenging. VVe encourage you and the County Board to trust that they are able to bring much-needed clarity to the issues, and prospective solutions, reported herein.

VVe trust that you, and County Board Chair Kurt Gibbs, who attended at least one of our meetings, will shepherd the much-needed corrective measures to fruition. Again, thank you for the opportunity to be a part of finding solutions to this vital community concern. Respectfully Submitted,

Kevin Hermening, Chair Peter Fuchs John Shirck John Robinson Craig McEwen Deb Hager

ATTACHMENT: FINAL REPORT

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September 1, 2015 Sheriff Scott Parks Marathon County Sheriff's Department 500 Forest St. VVausau, VVI54403 Brad Karger Marathon County Administrator 500 Forest St. VVausau, VVI 54403 Dear Sheriff Parks and Administrator Karger: The following is a report by the Independent Mental Health Services in Corrections Panel whose members were asked to review procedures, evidence-based best practices, and technology to determine how mental health needs are being met at the Marathon County Jail. VVhat follows are an Executive Summary, Summary of Key Findings, and Recommendations.

Overview/Executive Summary The Marathon County Sheriff organized this six-member Independent Mental Health Services in Corrections Panel to determine whether or not the level of mental health services provided to the Marathon County Jail adequately met the needs of the offender population utilizing the services of the Marathon County Jail. Panel members include: • Kevin Hermening, Chair (Citizen Member) • Peter Fuchs (Citizen Member) • John Shirck (Citizen Member) • John Robinson (County Board Member, Chair of Health and Human Services) • Craig McEwen (County Board Member, Chair of Public Safety) • Deb Hager (Marathon County Deputy County Administrator) • Marathon County Sheriff Support Staff: Chad Billeb, Chief Deputy The panel was asked to review procedures, policies, evidence-based best practices, and technology to ensure the mental health needs of inmates and the offender population in the Criminal Justice System are being met. Additionally the panel was asked to make recommendations to improve delivery of mental health services to individuals incarcerated at the Marathon County Jail. The Sheriff established several goals to guide the work of the panel. Charter goals were: • Recognize the best array of mental health services provided to offenders in the State of

VVisconsin. • Ensure professionals involved in correctional mental health services have clear expectations of what services are available, for whom and how they can be accessed. • Any resources identified are aligned to support an Action Plan that provides a high level of services and support to the offender population.

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2 Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page 2

The panel began meeting on May 5, 2015, and used a variety of resources on which to base its findings and recommendations. Resources included: • A jail tour • Review of jail space needs reports - Kimme Reports • Review of All About Jails May 2011 insurance risk report • Emergency Detention Process Flow Chart Final • Northcentral Health Care Combined Financial Statements • Bridge Clinic Jail Contract (Current) • Evidence Based Decision Making Model (EBDM) Timeline for Phase V activities • Northcentral Health Care Jail Contract (Past) • Value Stream Map for Mental Health Services in the Marathon County Jail • Information from Jail Administrator Sandra LaDu-lves. • Information from Deputy Jail Administrator Paul Mergendahl • Ongoing information and explanation regarding jail processes and procedures from Chief Deputy Chad Billeb. • A tour of and input from staff at North Central Health Care (NCHC) to include Gary Bezucha and Toni Simonson. • Review of information from National Association of Counties Organization relating to the "Stepping Up" Initiative. It is important to recognize that our identification of problems and recommendations for improvement are based upon facts we received beginning in May 2015, leading up to the time of this report. Since we began meeting, many improvements have already been initiated by the Marathon County Board of Supervisors, Marathon County Sheriff's Office and North Central Health Care. We applaud these efforts, and recognize that while early progress is good, it must be sustained.

Based upon our review: • We find that there is a significant disconnect in the manner in which mental health services have been provided at the Marathon County Jail; • We believe that one of the key underlying problems is that there is a fundamental misunderstanding of governance which needs to be clarified between Marathon County and North Central Health Care (NCHC); • We believe there must be a clarification of roles and expectations between Marathon County and NCHC; and, • Coupled with a lack of communication and/or understanding of communicated needs, corrective action must be addressed immediately.

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• In addition to the aforementioned issue, Marathon County lacks a consistent process flow from jail admission to services provided during incarceration to release back into the community. o Multiple roadblocks are present that must be addressed to ensure the offender population has access to resources both while incarcerated and upon release. o We believe that these missed opportunities results in increased recidivism rates.

In order for a system like this to be effective all parties must have an understanding of the unique needs of the offender population and services while in jail and back in the community must be tailored to those needs. o We have learned that these needs are always increasing during a time of scarce resources.

While it is clear that the authority of the jail and services provided rests with the Sheriff, there are channels by which others who had knowledge about these deficiencies should and could have sought or implemented change. In some cases, requests by the Sheriff and others for additional services appeared to have not been met or gone unanswered. We believe specific examples of these concerns should be outlined for members of the County Board. As stated earlier, during the early stages of our work, the county and NCHC took steps to address some of the issues that were identified. Although this is commendable, long-term solutions will take a continued commitment from both parties. What follows is a summary of our key findings (in no specific order) from our review and recommendations going forward.

Key Findings/Recommendations Internal (within the jail): • A process flow to identify and address mental health needs is needed. A high level

version is complete; drive one level deeper and address decision/action boxes so people don't slip

through the cracks, from first contact to last.

o Solutions need to be evidence based.

o First contact including officer training on how to keep situations from escalating.

o Last contact including a successful transition plan back into community

with appropriate mental health services (e.g. case management).

• Implement process established during LEAN event for mental health service

provision in the jail.

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4 Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page4 • Marathon County should establish performance expectations and contracts

with any vendor/partner providing services at the Marathon County Jail. This includes mental

health services.

• Make Evidence Based Decisions - this will result in less liability and using best

practices.

• Ensure there are processes in place to get mental health/ Alcohol Other Drug Abuse

(AODA) services as soon as identified. • Establish an evaluation system to ensure each step of the care

process is being followed. Identify accountability for the responsible party and use the

results to continually improve the process.

• Attend forums at least annually to stay engaged with trending programs and Evidence

Based Program guidelines.

• Provide training to all members of law enforcement on how to identify mental health

issues and how to link to appropriate services in the community.

• Dedicate more room inside the facility for providing mental health services.

• Develop a process to determine whether jail is an appropriate setting for offenders in

crisis and disposition of those when not appropriate.

o Work on a process of diverting inmates who don't necessarily need to be in jail.

• Institute a release plan from jail that supports offender successful transition back into the

community.

• Ensure appropriate forensic medical/behavioral health care in the jail.

• Adjust formulary and/or identify alternate coverage sources to ensure that needed

medications can be continued while incarcerated.

• Work with drug companies so inmates continue to get their meds at affordable costs.

• Determine the prevalence rates of mental health and AODA in the jail. External (NCHC/ NACO and EBDM, etc.): • Match the care with the need; don't over-treat, don't under-treat. Treat with

appropriately trained professionals.

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5 Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page 5 • Identify and align service requirements within process flow to identify and

address mental health issues, particularly crisis level services.

• There is a significant need for mental health services and follow-through at the Marathon

County Jail. Increase these services to provide assessment stabilization and treatment services.

• Psychiatrist services are expected to increase; evaluate this process periodically based

on metrics TBD (use Tele-Psychiatry as a cost effective measure; equipment is already in place

at the jail).

• Develop a continuum of care to address the alcohol and other drug abuse needs of the

community.

• Continue involvement with "Stepping Up" initiative through the NACO; this is

a step towards "the best mental health care" model; board passed declaration.

• Participate in and embrace Evidence Based Decisions Models

• Collaborate with providers - Break the recidivism cycle with a comprehensive transition

plan into the community by the Jail and NCHC.

• Provide case management where appropriate working with the offender population.

• Work to ensure medication compliance with those individuals that are being served by

NCHC. This could be done in conjunction with the Marathon County Jail.

• NCHC has a drug dispensary at its Sturgeon Eddy Campus; it is presently used by

patients, as well as employees of NCHC. NCHC should be requested to provide this service

to inmates receiving services through NCHC.

• Provide, if possible, residential/placement opportunities for appropriate individuals in

offender population.

• Offer employment assistance during incarceration and after release.

• Pursue retaining an AmeriCorps Volunteer(s) to assist in efforts to enroll parties in health

insurance through the Affordable Care Act .

• NCHC needs to identify performance metrics to ensure that it is meeting terms of

agreements and commitments it has with the County.

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6 Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page 6 o Continue the Forensic Therapist 40 hours and 4-8 hours of Tele-

Psychiatry per week. There needs to be a back-up plan in the event main provider is not

available.

o Provide forensic mental services consistent with NCHC proposal by November 1,

2015.

o Provision of crisis services as proposed by NCHC by November 1, 2015. • Request that the Medical College of Wisconsin incorporate Forensic Psychiatry in the

Medical College of Wisconsin program that is being established in Wausau, if not already

included.

• Develop seamless transition from jail treatment to community treatment.

• Provide whole person dual diagnosis treatment specific to offender population (mental

health and AODA). It is essential that the provider have a forensic background.

County (County Board, Judges, Probation Parole): • Identify "Who's driving the bus?" County Board has oversight and needs to

identify and understand what services they need, and what they are receiving. County Board

must define the relationship between NCHC and County including development of

performance expectations and contracts.

• County Board is urged to support the Stepping-Up Initiative, the EBDM model.

• Identify occurrence rate of "out of county" persons who are now utilizing

Marathon County services due to being placed in Marathon County. This includes group

homes that are "popping up" across the county; this may need to be addressed at a legislative

level.

• Consider passing a County Board resolution that encourages the Legislature to review

the law that requires the termination of certain benefits while incarcerated. Encourage a

suspension of those benefits allowing the person to access benefit upon release.

• Work with the Judges on programs that allows individuals who are in treatment

programs to use time at those treatment centers and credit on their sentence of they successfully

complete the program.

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7 Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page 7 • County Board should consider expansion of residential treatment center services.

• Work with others engaged in behavioral health services to explore and develop

components needed for a continuum of mental health services available for offender and non-

offender populations that includes all ages.

• Develop strategies to address/mitigate the impact of adverse childhood trauma.

• Develop forensic mental health services that track for offender populations

in the community.

• Address the needs for effective treatment and crisis services for youth.

• Convene a broader community discussion on mental health needs and challenges in our

community.

• Evaluate the potential for an interim transition living arrangement (e.g., Portage House).

• Consider the assistance of the AmeriCorps Volunteer program. These individuals could

assist in linking offenders with benefits prior to or upon release from the County Jail.

Community Role: • Police Officers across the county should receive additional training on how assess and

keep a situation from escalating when individual has mental illness (CIP/CIT). • Reinforce the relationship with NTC to incorporate mental illness and behavioral health

training into their current law enforcement training classes.

• Pursue a County wide Mental Health Summit to identify needs and opportunities.

Engage all the local legislators and Health Care Providers.

• Law enforcement is trained in trauma informed care and is able to respond more

appropriately.

• Educate mental health providers across all systems so they understand the interface

between mental health, AODA and the criminal justice system.

• Educate physicians working with the offender population on forensic diagnosis. (Lie vs.

actual).

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State (Medical Assistance):

• Ensure continued mental health care coverage while incarcerated to help ensure that

inmates do not suffer mental health decline while in custody or during transition back to society

due to formulary changes.

• Review Badger Care regulations so inmates don't lose their coverage.

• Develop incentive to encourage more students to pursue a career in Psychiatry.

• Ask the legislature to review how they regulate all the private group homes to ensure

mental health needs are addressed.

• Legislative advocacy to change State policy from termination of medical assistance

(ACA) upon incarceration to suspension of benefit. Summary: Ultimately, communications between NCHC, the Marathon County Jail and the Marathon County Board need to improve. There seems to be a fundamental lack of understanding of what services are needed and what services are provided as well as who should be providing them. Future needs must be identified, understood and communicated and addressed; this type of review should be done at a minimum annually. In addition, performance expectations, measures and contracts need to be established for services. Without the knowledge and approval of the Marathon County Board of Supervisors resources committed by the County to NCHC for programs have been reallocated for other purposes. Concerns have been expressed relating to the internal transfer of funds at NCHC and the impact of those transfers upon mental health services, Procedures should be developed to ensure proper notification and approval by the County Board before those transfers occur in the future. Conflicts exist between statutes and administrative regulations that create lack of clarity about service provision and who is responsible. Examples would include differences between Wisconsin State Statutes 51.42, DHS Code and DOC 350 regulations. This needs to be clarified in contracts including what is expected by all parties. The fact that no detailed agreement exists between NCHC and Marathon Countv is inexcusable. Certainly many of the problems that now exist would have been handled differently had a detailed written understanding existed. A detailed contract should be part of the County's 2016 budget process.

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Independent Mental Health Services in Corrections Panel Report September 1, 2015 Page 9 This Panel highly recommends that an Action Plan be drafted to monitor and track all of the recommendations of the panel. Additionally, NCHC and the Sheriff's Department should follow up and report to appropriate standing committees of the County Board semi-annually on the progress or disposition on proposals made by this panel. As a panel we believe that if these recommendations are put into action, Marathon County will be recognized as having the best array of mental health services provided to offenders in the State of Wisconsin. Respectfully Submitted,

Kevin Hermening, Chair Peter Fuchs John Shirck John Robinson Craig McEwen Deb Hager

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Attachment C

November 2, 2015

2015 MARATHON COUNTY MENTAL HEALTH IN CORRECTIONS WORK PLAN

CORE STRATEGY #1: IMPROVE THE INTERNAL WORKFLOW AND MENTAL HEALTH SERVICES WITHIN THE MARATHON COUNTY JAIL.

Activity

What We have Already Done

Outcomes

Time Line

Progress Progress

1. Develop a process flow for delivery of Mental Health services at the jail. Evidence based.

Responsible Person(s): Jail Administrator

LEAN Process completed to determine best manner for delivery of Mental Health Services. Includes medical, mental health and corrections staff.

Inmates receive the best array of Mental Health Services while incarcerated. Fewer mental health crisis situations

within the jail. Inmates receive care or referral for

care early or upon arrival at the jail.

December 2015 There has been considerable improvement in services provided at the jail. Staff are involved in the process. There were and continue to be minor bumps in the process but these are being worked out.

2. Develop performance contracts for the delivery of Mental Health services at the Marathon County Jail.

Responsible Person(s): Corp. Counsel, County Administration, Sheriff Administration.

Deputy County Administrator has been working with Corporation Counsel to develop contracts.

Marathon County and those entities who provide service to residents of Marathon County will have a clear understanding of what is expected and at what cost.

January 2016 In the beginning stages of establishing what these contracts will contain.

3. Provide training and/or attend forums to stay informed of latest trends and best practices for delivery of Mental Health Services.

Responsible Person(s Jail Administrator

Working with NTC to provide CIT Training to all staff now and CIP for selected staff in the future.

First responders will be better trained to work with people in crisis. Better linking of services for

individuals in crisis. Fewer use of force incidents

associated with working with people suffering from mental health issues.

January 1, 2016 Captain Plaza is currently working with NTC. Instructors are being lined up.

4. Ensure space is available for the delivery of Mental Health Services within the Marathon County Jail.

Working with Facilities and Capital Management to find space in the jail. Quotes have been obtained for modernized storage areas to make room for new offices for MH.

Mental Health providers will have an area to work with inmates in a confidential and productive setting. Feeling of being part of the

organization and team.

March 2016 FCM has received quotes and is in the final stages of planning and presenting to Jail leadership.

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Responsible Person(s): Jail Administrator, Chief Deputy

5. Institute a release plan that supports transition back into the community

Responsible Person(s): Jail

Administrator, Chief Deputy

The new Social Worker in the jail is working on these types of activities. There has been some progress but there is much more to do as it relates to linking inmates to resources.

Inmates leave the jail with a n enhanced ability to thrive on their own. Inmates are linked to resources they

can lean on during a time of crisis.

March 2016 Still working on establishing lists of resources and individualized plans for inmates.

This is a new position that is still getting established.

6. Ensure there is always appropriate forensic medical/behavioral health care services at the Marathon County Jail.


Administrator, Chief Deputy

Contracts are being established and new medical providers at the jail could be enlisted to assist if agreements can’t be reached with NCHC.

Consistent delivery of MH services to the inmate population.

March 2016 Deb Hager has met with Corporation Counsel to discuss what contracts might look like. Work is continuing.

7. Review and adjust if needed the formulary for medications prescribed at the jail. Look to provide medications inmates can afford upon release


Administrator

Adjustments and agreements have been made with NCHC and the Psychiatrist. Working with a new medical

provider beginning December 1, 2015. This may provide additional opportunities.

Inmates receive the best care while in custody. Inmate stabilization while in custody. Inmates receive medications that they

have access to and can afford upon release.

March 2016 There have been adjustments to the formulary to allow NCHC and their Psychiatrist to prescribe certain medications to inmates. These medications were not on the formulary in the past.

Most prisons do not allow the medications we are allowing. This could be an obstacle.

8. Work with drug companies and other sources to continue inmate medications at an affordable cost.


Administrator

We have made phone calls and are working with companies but have learned that by the time we receive a response, often the inmate has left our care.

Inmates have cost affective access to medications.

March 2016 Ronda Zastrow has made contact with some Rx companies. This is a long process with wait times that often don’t benefit the inmate who most likely will have left our care.

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9. Determine the prevalence rates of mental illness and AODA concerns among inmates booked into the Marathon County Jail.


Administrator

Questions have been identified and have been added to the inmate booking process. Questions will start Jan 2016 to

obtain a solid data set going forward. Staff are being trained on the

questions and how to ask them prior to releasing questions. This is being done so that data is as consistent as possible.

Marathon County has a better idea of the prevalence of MH concerns in our jail.

Ongoing Paul Mergendahl has set up questions in Tiburon. CO’s will begin this process January 1, 2016.

CORE STRATEGY #2: EXTERNAL PARTNERS AND INITIATIVES (NCHC, BRIDGE CLINIC, NaCO and EBDM).

Activity


Outcomes

Time Line

Progress

1. Increase mental health services at the Marathon County Jail

Responsible Person(s): NCHC Leadership

NCHC is providing 40 hours of Forensic Mental Health Therapy time per week.

Up to 8 hours of Tele-Psychiatry per week by NCHC.

Bachelor trained Mobile Crisis available upon request.

Psychologist available and fill in for Forensic Mental Health Therapist.

Inmates receive a consistent high level of MH care while incarcerated at the Marathon County Jail.

July 2015 - Ongoing Systems are in place and appear to be working very well.

We will be researching a Psychiatrist from CCS or another vendor to provide consistent Correctional MH Psychiatry services.

2. Implement psychiatry services at the Marathon County Jail.


Psychiatrist available up to 8 hours per week.

Services have been expanded from initial implementation.

Inmates receive a consistent high level of MH care while incarcerated at the Marathon County Jail.

July 2015 - Ongoing

Initially services started at 4 hours per week but were increased due to the volume of inmates either being referred or requesting to see MH staff.

Looking to bring in a Psychiatrist that has experience working with the inmate population. Possibly through a vendor like CCS.

3. Community need for an expanded detox program. Expand beyond what is currently provided.


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4. Partner with Marathon County on

Stepping-Up Initiative. Embrace Evidence Based Decision Model.


The Marathon County Board has signed a resolution supporting the stepping up initiative.

Staff and leadership are participating in Stepping Up webinars to learn more about best practices.

Creates a system where best practices are employed. Ensures inmates are receiving care

that models other areas of the country.

August 2015 - Present Marathon County Board has signed a resolution acknowledging that we will participate in and take steps towards working with inmates who have MH concerns.

5. Collaborate with partners with a goal to break the recidivism cycle with a comprehensive transition plan by jail/NCHC staff.


. .

.

6. Provide; if possible residential/placement opportunities for appropriate individuals in the offender population.


CORE STRATEGY #3: MARATHON COUNTY BOARD AND CRIMINAL JUSTICE PARTNERS.

Activity


Outcomes

Time Line

Progress

1. Define the relationship between NCHC and the Board including development of performance contracts.

Responsible Person(s): County Administration, County Board Leadership.

Meetings have taken place as well as the formation of a Mental Health Taskforce to identify the relationship.

County Administration is working on contracts.

There will be a consistent and clear expectation of needs and services provided at a specific cost.

January 2016 Taskforce meets regularly. Contracts are being established by County

Administration and Corporation Counsel.

2. Identify occurrence rate of “out of county” persons utilizing Marathon County Services due to being placed in Marathon County.


Difficult to assess. Many of the problem facilities are no longer causing the problems we saw earlier this year.

Citizens who utilize these facilities receive quality care in an appropriate facility.

Ongoing Contact we have made with facilities that provided these services have decreased. We have worked with some of them to identify what their role is and what requires a law enforcement response.

3. Support the Stepping-Up Initiative and EBDM.

The Marathon County Board has signed a resolution supporting the stepping up initiative.

Creates a system where best practices are employed. Ensures inmates are receiving care

August 2015 - Present Marathon County Board has signed a resolution acknowledging that we will participate in and take steps towards working with inmates who have

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Staff and leadership are participating in Stepping Up webinars to learn more about best practices.

that models other areas of the country.

MH concerns.

4. Consider passing a County Board Resolution that encourages the Legislature to review the law that requires the termination of certain benefits while incarcerated. Encourage a suspension of those benefits.


This has been discussed by a number of committee’s and taskforce groups. There is discussion about waiting for a joint meeting to address specific wording and ideas about the resolution.

State leaders will be aware of the challenges we are facing in Marathon County. We believe these challenges are occurring across the state.

Inmates have access to medical and mental health services immediately upon release without need for re-application for services.

April 2016 Waiting for joint meeting of Public Safety and Health and Human Services. December 2015

5. Work with the Judges on programs that allows individuals who are in treatment programs to use time at those treatment centers and credit on their sentence of they successfully complete the program.

Responsible Person(s): County

Administration, OWI Court

6. Explore & develop components needed for a continuum of mental health services available for offender and non-offender populations that includes all ages and develop forensic mental health services track for offender populations in the community.


Administration

7. Evaluate the potential for an interim transition living arrangement (e.g. Portage House).


Administration

December 2016 No progress at this time. Could be part of a larger system that we are currently working on.

8. Develop strategies to address/mitigate the impact of adverse childhood experiences.

Staff are being selected to be Train the Trainers to educate all of our staff about TIC.

County efforts around TIC from

All County employees are trained in TIC and understand how to minimize trauma to people we come in contact with.

June 2016 Working on grant funding and training opportunities.

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Responsible Person(s): NCHC

Leadership, Marathon County Leadership

multiple county departments.

CORE STRATEGY #4: EDUCATION OF KEY STAKEHOLDERS.

Activity


Outcomes

Time Line

Progress

1. Police Officers across the county should receive additional training on how to keep a situation from escalating when individual has mental illness (CIP/CIT).

Responsible Person(s): Chief Deputy

Working with NTC to provide CIT Training to all staff now and CIP for selected staff in the future.

Training is scheduled for Spring 2016.

Staff are better prepared when working with individuals who have mental illness/AODA concerns.

June 2016 Training is being scheduled.

2. Law enforcement is trained in trauma informed care and is able to respond more appropriately.

Responsible Person(s): Chief

Deputy

Staff are being selected to be Train the Trainers to educate all of our staff about TIC.

County efforts around TIC from multiple county departments.

All County employees are trained in TIC and understand how to minimize trauma to people we come in contact with.

June 2016 Working on grant funding and training opportunities.

3. Pursue a County wide Mental Health Summit. Educate mental health providers across all systems to understand the interface between mental health, AODA and the Criminal Justice System.


Administration Leadership

Meeting with Criminal Justice staff and potential partners on December 1, 2015 to identify opportunities for the future.

Partners invited include private counseling firms, NCHC, law enforcement, judges, prosecutors and defense attorneys.

Starting with Jail programs, then extend to the community.

Community understands the challenges associated with Mental Health and AODA in our community.

December 2016 First meeting established. Will wait for feedback on ideas for expansion of

this message.

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Attachment D

Marathon County Evidence Based Decision Making (EBDM) Team

Charter 6/9/2015

Team Vision: The Marathon County EBDM Team’s vision is that Marathon County is the safest county in the State with offenders

increasing self‐correcting behavior resulting in less crime and fewer victims.

Team Mission: The purpose of the Marathon County EBDM Team is to implement practices that improve the criminal justice system

and deliver results (reduce recidivism, decrease crime, fewer victims).

Team Values:

Honesty – We value transparency with each other and the public

Quality – We value responsiveness to needs and the use of best practice to deliver results

Knowledgeable – We value multidisciplinary expertise, professional discretion and informed conversation.

Ground Rules & Operating Norms:

All members have equal status within the group for purposes of input and decision making

Be prepared and participate

Start on time and end on time

Agendas and meeting notes will be sent out in advance by e‐mail

Each member may add items to the agenda

Be courteous (Don’t talk over each other, don’t interrupt and don’t check e‐mails, text messages, phone calls during

meetings unless you are on call)

Everyone is committed to the success of the team

Everyone collaborates to create and implement solutions that reduce recidivism and makes our county safer.

Refreshments will be provided.

Decision Making Guidelines:

Decisions will be reached by consensus

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The chair will use the thumb method to determine if the group is in agreement. A thumbs up means that the person

supports the decision. A thumb to the side means that the person may not fully support the decision but “can live with it”. A

thumbs down means that the individual cannot support the recommendation. The individual who cannot support the

decision must provide an explanation of what it would take for the individual to support the recommendation. The team

continues deliberation until all individuals give a thumbs up or to the side.

If there is not a consensus, at some point the group will need to decide and move on. If no consensus can be reached after a

reasonable amount of time/effort the group will move ahead with a recommendation when the majority of individuals

indicate support.

At any point, a member can submit a “minority report” if he/she did not support the group decision but feels strongly

enough to want to put the view in writing. The minority report will be submitted along with the EBDM Team

recommendation.

No proxy voting is allowed. If a member cannot attend a meeting, they have the option to submit in writing to all team

members their view on an agenda item in advance of the meeting.

Team Membership:

The following individuals representing diverse/representative disciplines and interests have agreed to serve on the

Marathon County EBDM Team:

Vicki Tylka – Social Services

Jane Graham Jennings – Domestic Violence/Victim Advocate

Ken Heimerman – District Attorney

Shirley Lang – WI Courts

Connie Elbe – Department of Corrections

Melanie Strand – Treatment Courts

Dick Lawson – Defense Attorney

Greg Huber – Judicial

Sandra LaDu‐ Ives – Marathon County Jail

Suzanne O’Neill – Public Defender

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Greg Hagenbucher – Local Law Enforcement

Michelle Hubbard – Department of Corrections

Laura Yarie – Justice Alternatives

Susan Byrnes – WI Courts

Scott Parks – Sheriff’s Department

Craig McEwen – County Board of Supervisors

Greg Grau – Judicial

Rachel Pagel – Treatment Providers

Deb Hager – County Administration

Team Roles & Responsibilities:

The following roles have been established to support the effective work of the EBDM Team:

Marathon County EBDM Team Chair (Deb Hager):

Chair the EBDM Team meetings

Work with the Team Coordinator to prepare for and follow up on team meetings

Recruit members to participate on workgroups to address specific issues

Act as the chief spokesperson for the team

Provide oversight and support and promote initiatives agreed upon by the EBDM Team

Marathon County EBDM Vice Chair (Sheriff Parks):

Take over responsibilities in the Chair’s absence

EBDM Team Coordinator (Laura Yarie):

Schedule meetings, assist with agenda development and send out agendas

Serve as primary contact for the project with team members, State Coordinator and Technical Assistance Provider

Maintain timelines established by EBDM Team and oversee activities

Coordinate all EBDM team activities, work group activities as assigned

Take minutes and provide updates to the team

All Team Members:

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Serve as the liaison to the agency they are representing, carrying back key discussion points to their agency & reporting

feedback to the team

Support the decisions made by the policy team (includes decisions that may not have been team member’s preferred

choice)

Abide by consensus decision making process

Team members will follow up with Team Coordinator for updates if absent from a meeting

Actively participate in fulfilling the team purpose by helping with administrative tasks, serving on short‐term workgroups

and completing assignments on time between meetings

Technical Assistance Provider (Becky Nye):

Assist with facilitation

Provide direction & access to areas of expertise needed

Neutral source who can ask tough questions

Communication liaison with National Institute for Corrections & technical assistance provider team

Tasks/Goals: To assist in the implementation of recommendations, develop implementation plan for proposed

changes such that staff and managers will be able to carry them out. This includes:

Determining what obstacles might exist and how best to overcome those obstacles

Providing advice on what specific steps and procedures should be taken to ensure that the change will be carried forth

successfully (timelines, communication, support training)

Determining the best method to reach out to non‐EBDM Team staff to solicit their views and ideas (surveys, interviews, e‐

mail requests for input)

Meeting Frequency and Duration:

The Marathon County EBDM Team is expected to begin its work in April, 2015 and finish it by April 30, 2016. Meetings will be

held once a month beginning in September for two hours. If work requires more or less frequency the Team may change this

structure. It may also set up workgroups to get the work done in a more timely and efficient manner.

30

The State’s Target Matrix (Attachment D‐C) shows the areas that are being addressed in all participating counties including

Marathon County’s focus which is primarily in mental health services to offender populations.

In December, 2015 an Overview of Marathon County Community Mental Health Services for Offender Populations was presented to

Public Safety and Health & Human Services committees (Attachment D‐D) which resulted in the Mental Health Services for Offender

Populations Work Plan (Attachment D‐E).

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Attachment D‐C

TARGET CHIPPEWA MARATHON OUTAGAMIE LACROSSE ROCK WAUKESHA STATE

Universal Risk Assessments X X

Stakeholder and Public Education/Buy‐in X X

Front End Decision Making

‐Risk Assessments X X X X X X

‐Reduce Cash Bail X X

‐Pre Trial Programs X X X X

‐Expand EBP Behavior and Violation Interventions X X X X X

‐Examine high volume justice system individuals X (jail) X ?

‐Diversion/Deferred Programs X X X X X

Problem Solving Courts

‐Increase participation/retention X X

‐Reduce entry time X X

Mental Health

‐CIT training X X ? X

‐Expand Crisis Services‐ 24/7 X X X X

‐Expand diversion/deferred programs X X X ? X

‐Continuum of EBP behavioral change interventions X X X ? X

‐Reduce Emergency Detentions X X

‐Behavioral Health Information Sharing X X

Law Enforcement Data Coding for Calls for Service X ?

‐Arrest Protocols X X

Eliminate delays at state crime lab X X ?

Victim Services/Issues‐ including financials X X X

Court Scheduling X X X X

Community Supervision

‐Holds/Length of Stay X X

‐Revocations‐ timelines, custody, ATR’s X X

‐EBP conditions of supervision X X

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Attachment D ‐D

Overview of Marathon County Community Mental Health Services for Offender

Populations

I. Basic Background Information

A. NCHC is a governmental entity created by the county under WI Stat. 66.0301

B. NCHC’s core service to the community is provision of community (public)

mental health services (provision of mental health services to those who

cannot access private mental health services)

C. Offender population is a subset of the larger community mental health

population

D. Attic Correctional Services under a contract with Marathon County provides a

much smaller treatment program for moderate to high risk offenders on

probation

II. Three Core Points of Service

A. Crisis – NCHC sole provider – current service level includes mental health crisis

and detox

Seen in a 24‐72 hour window for an acute episode

Primarily taken into custody by law enforcement

If deemed not appropriate for crisis unit may be transported to another

facility or jail

Question: Does Marathon County want to expand crisis services to include a

continuum of services?

Other jurisdictions have implemented services to identify early

symptoms of decompensation and address to avoid or avert crisis

Create drop off centers with no refusal policies

Post discharge from acute crisis to transitional services/living prior to

release to community

Potential impact could be reduction in the number of inpatient/crisis bed days

utilized

Question: Should Marathon County revisit some of the policies of NCHC that

result in diversions to out of county facilities?

Too dangerous/violent – Outagamie County’s policy is that the

danger/violence must be demonstrated on the ward/floor (not at the

time initial custody action or in past history not on the ward/floor)

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Non‐violent sex offenders – Outagamie County’s expectation is that

inpatient staff will manage sex offenders as a part of the inpatient crisis

population

Potential impact could be reduction in the number of out of county transports

(all done by the Sheriff’s Department)

B. Jail Services – NCHC sole provider

8 hours of telepyschiatry

40 hours of forensic mental health services

Manages behavior in jail and increases overall safety for offenders and

staff

Due to volume and varying duration of stay limited therapy occurs

Mingled with general population

Question: Does Marathon County wish to develop a secured facility for

offenders with mental health needs? (See Behavior Health Behind Bars and

Beyond article attached)

Concern that money and resources to provide would be wasted if the

continuum and availability of community mental health care for offenders

remain status quo upon release

Question: Should the Jail contract with the correctional medicine vendor for

telephsychiatry?

Potential Impact:

Better coordination between correctional medicine doctors and psychiatrist

to reduce drug seeking behavior while incarcerated

Dedicate the current telepscychiatry hours in the jail to persons on

probation to better manage medication after release to the community

C. Outpatient (Community) Mental Health including AODA treatment – provided

by NCHC and Attic Correctional Services

Current Service Levels – NCHC

Outpatient counseling provided once a month

Approximately 4 weeks to complete the screening process

4 to 8 weeks after initial screening to first counseling appointment

Counseling approach traditional non‐offender therapy

Current Service Levels – Attic Correctional Services

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Provides counseling sessions based on evidence based best practice for

mental health & AODA services for moderate to high risk offenders,

frequency is more often than once a month

Limited enrollment to 100 offenders

Recidivism rate 11.4%

Current waiting list ranges from 6 to 16 offenders for 3 to 6 weeks

Question: Should Marathon County expand its evidence treatment program

for moderate to high risk offenders?

Question: Does Marathon County wish to create the same treatment program

through NCHC for moderate to high risk offenders?

Question: Does Marathon County wish to reallocate resources to address the

current wait list through Attic Correctional Services?

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Attachment D -E

MENTAL HEALTH SERVICES FOR OFFENDER POPULATIONS WORK PLAN

12/30/15

CORE STRATEGY #1: Expand crisis services to include a continuum of services

Activity


Outcomes

Time Line

Progress Progress

Review what other jurisdiction are doing regarding a continuum of crisis services (Deb Hager, Laura Yarie, Chad Billeb, EBDM Team)

Learned about continuum of crisis services through Stepping Up

Review of literature through EBDM initiative regarding effective crisis

Sheriff’s Department participation in NCHC quality improvement process regarding crisis

RFP has been released for Human Services Needs Assessment

Persons in crisis receive treatment rather than incarceration Decrease the number of

hospitalizations due to crisis Reduce the number of inpatient/crisis

bed days utilized

Begin contacting other jurisdiction regarding crisis services and understand their model – First Quarter, 2016

Draft an analysis of best practice models for Public Safety & Health & Human Services Committee review by June30, 2016

Incorporate this information into Human Services Needs Assessment report by August, 2016

Conduct an analysis of what resources are needed to implement one or more of models, including staffing, physical plant, financial, licensure, training and specific delivery components (Deb Hager, Laura Scudiere, Kristi Kordus, Brenda Glodowski)

Incorporate this information into Human Services Needs Assessment report by August, 2016

Develop costing model and business plan for identified changes in crisis system (Deb Hager, Laura Scudiere, Kristi Kordus, Brenda Glodowski)

Recommendation to Public Safety & Health & Human Services Committees for consideration including any budget allocation considerations by September, 2016

Determine appropriate provider for the delivery of services

36

(County Board)

CORE STRATEGY #2: Reduce the number of diversions to out of county facilities

Activity


Outcomes

Time Line

Progress

Review best practices of other jurisdictions and current policies that contribute to our of county transports

(Deb Hager & Chad Billeb)

Initial information about Outagamie County’s approach gathered by EBDM Team

Reduce the number of out of county transports by Sheriff’s Department

Gather data on the number of diversions and the reason for diversion (Deb Hager & Chad Billeb)

Detailed agreement with NCHC asks for specific data regarding out of county placements including number and reason

NCHC crisis improvement team is collecting some data

Determine if Marathon County is experiencing a significantly different population than the rest of the State by June 30, 2016

Review barriers to serving offenders at NCHC – policies, physical plant, etc. by June 30, 2016

Develop recommendations to be considered by County Board by August, 2016

CORE STRATEGY #3: Develop treatment block(s) within the jail for offenders receiving mental health care while in custody.

Activity


Outcomes

Time Line

Progress

Explore other jurisdictions models of incarceration and treatment (Deb Hager & Chad Billeb

Article on Behavioral Health Behind Bars and Beyond

Determine best practice Review of jurisdictions’ models by July 1, 2016

Determine the number of offenders that may be served in Marathon County (Deb Hager & Sandra LaDu-Ives)

Conduct brief mental health screen in jail beginning first quarter of 2016

Determine the number of persons to be served

Review preliminary numbers by July 1, 2016

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Develop business plan and cost model

(Deb Hager & Chad Billeb)

Determine the cost and potential return on investment

Determine long term impact on recidivism rates

Business plan and costing model by September 1, 2016

CORE STRATEGY #4: Expansion of Outpatient (Community) Mental Health including AODA treatment

Activity


Outcomes

Time Line

Progress

Assess current capacity and effectiveness of mental health and AODA services for offenders. (Deb Hager and Laura Yarie)

NCHC provides outpatient services

Attic Correctional Services provides outpatient to moderate to high risk offenders

Offenders receive effective and appropriate dosage of treatment to reduce likelihood of re-offense.

Determine effectiveness of current treatment

Determine cost to expand offender treatment by June 1, 2016

Determine resource reallocation to fund expansion by August 1, 2016

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Attachment E

AGREEMENT FOR MENTAL HEALTH SERVICES TO MARATHON COUNTY OFFENDERS

AUTHORITY: This agreement is entered into pursuant to sec. 51.42(5)(a)12, Stats., which requires that

the 51.42 Board “[d]etermine, subject to the approval of the . . . county boards of supervisors in

counties with a multicounty department of community programs and with the advice of the county

community programs director appointed under [sec. 51.42(4), Stats.], whether services are to be

provided directly by the county department of community programs or contracted for with other

providers and make such contracts . . . [T]he county boards of supervisors in counties with a multicounty

department of community programs may elect to require the approval of any such contract by the . . .

county boards of supervisors in counties with a multicounty department of community programs.

PURPOSE: The purpose of this agreement is to is to provide effective treatment to offenders involved in

all phases of the Marathon County Criminal Justice System in order to reduce recidivism due to Mental

Health or Alcohol or Other Drug Dependence (AODA) issues that result in an unchecked cycle of

offenders from Jail to North Central Health Care (NCHC) to private sector care providers back to Jail.

OBJECTIVES/GOALS:

To extend the period of time between incarceration for offenders.

No further incarceration for the same or similar crime.

First time offenders never reoffend.

Reduce and/or lessen harm to victims and the community

Reduce the number of offenders who commit crimes due to historical trauma.

An offender has no further contact with any part of the criminal justice system as a defendant.

Reduce utilization of medication for behavioral management during incarceration

APPLICATION: This Agreement applies to Offenders, Courts, Prosecutors, Probation and Parole, Sheriff’s

Dept., and NCHC

POLICY GUIDELINES:

1. All parties recognize that treatment to an offender population presents more challenges than

treatment to voluntary motivated patients. Degree of cooperation with treatment is often

dependent on the status of the offender within the Criminal Justice System. Outcome

expectations must be tailored to the level of motivation for treatment displayed by each

individual offender.

2. Not all offenders require treatment for mental illness or AODA issues. This highlights the

absolute need for prompt and effective assessment.

3. It shall be the policy of all partners to craft Release of Information forms that will facilitate the

exchange of mental health and AODA records to greatest extent permitted by law.

39

4. It is understood and agreed that data exchanged during 2016 shall form a baseline for definition

of further performance measures during the second year of this agreement.

5. The parties hereto agree that they shall jointly establish “satisfactory levels of services,” as that

term is used below, no later than 1‐1‐2017.

6. It is understood that the Reporting Requirements set forth below are to contain only census,

demographic or aggregate data for the purpose of understanding the volume of services

required and supplied and to help the parties identify and define satisfactory levels of services

as well as opportunities for improvement and service gaps. Said reports under this agreement

are to contain no personally identifiable health information.

OFFENDER STATUS:

1. Pretrial offenders‐are in absolute agreement to avoid further prosecution. There is actual

consent by offender to enter voluntary treatment as an alternative to potential penalties

2. Post‐disposition offenders

a) Plea Agreement‐Although entered into by mutual agreement of prosecutor and

defendant, there is less motivation to cooperate with treatment. Sanction and

revocation are the remedy for failure to cooperate with treatment.

b) Contested Sentence‐Least amount of motivation for treatment. Possible increased time

of incarceration is the consequence for failure to cooperate with treatment.

TERM: January 1, 2016‐December 31, 2017.

EFFECT ON CURRENT SERVICES:

It is understood and agreed by the parties that the services provided by NCHC not specifically identified

and made subject to this Agreement for Mental Health Services to Marathon County Offenders shall be

continued at current levels and that all other agreements between Marathon County and Lincoln and

Langlade Counties, NCHC and the North Central; Community Services Board, not specifically modified

herein, shall remain in full force and effect. However, it is also recognized by the parties that services

defined and supplied pursuant to this agreement may supplant other community supports or have an

effect on maintenance of effort with respect to different service groups in the non‐offender population

due to limited resources.

DEFINITIONS:

1. “Aftercare” means a treatment plan after discharge/release from a service insuring a continuum

of care.

2. “Assessment” means a structured process for gathering information to understand the

offender’s issues, concerns, how and why problems developed and for the foundation for a

treatment plan.

3. “Compliant with treatment” means

Attends sessions

Interacts adequately with the therapist

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Maintains sobriety

Cooperates with testing

Compliance does not mean disclosure of content of discussion with therapist

4. “Forensic therapy” means both AODA and Mental Health treatment for offenders involved in

the Marathon County Criminal Justice System, including:

Assessment results

Diagnosis

Treatment Plan

Updated Progress‐including timely notification that the subject is not compliant with

treatment

Discharge Plan

Aftercare Plan

5. “Offender” means a person who has been charged with or convicted of committing a crime.

GENERAL EXPECTATIONS:

For services identified as part of this agreement North Central Health Care will provide the following to

Marathon County:

1. Documents that specify the State of Wisconsin’s expectations regarding services identified by

NCHC as: North Central Health Care Programs, hereinafter referred to as “identified services,”

including State Statutes, Wisconsin Administrative Code sections, inspection reports,

memorandums or any other executive or administrative directives that affect provision of these

services.

2. Copies of all contracts and MOUs that North Central Health Care has entered into regarding the

identified services executed at any time from January 1, 2016 through December 31, 2017.

3. Copies of North Central Health Care’s administrative policies and procedures related to the

identified services. Any changes to the administrative policies and procedures must be

submitted to Marathon County at least 30 calendar days before the effective date of the

change.

4. Copies of the Community Services Program Board’s policies related to the identified services.

Any changes in the Community Services Program Board’s policies must be submitted to

Marathon County at least 30 calendar days before the effective date of change.

5. The term: “Changes” includes changes in wording as well as alterations in levels of service or

termination of service. NCHC shall distinguish between changes in policy or service made in

response to regulatory requirements as opposed to discretionary changes.

6. Quarterly reports as set forth below to Marathon County Administration due no later than the

30th of the month following the close of each quarter (e.g. April 30, July 30, October 30 and

January 30).

7. Report annual cost per unit of service for each identified services no later than March 31st.

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SERVICES:

1. Crisis – Specialized assistance with urgent mental health, developmental disability or substance

abuse needs to alleviate the crisis

2. Detoxification

Medically monitored

Ambulatory – an outpatient service for individuals requiring detoxification from drugs

and alcohol including assessment, patient observation, monitoring of vital signs,

treatment of withdrawal symptoms, substance abuse consultation and referral for

ongoing addiction and substance abuse treatment.

3. Psychiatric Services

Medication Management – Assessment and evaluation of medications for mental

health.

4. Forensic Mental Health Services – Assessment and behavior management planning for offenders

during incarceration including assessment of crisis needs, medication management and care

planning upon release from the jail.

5. Inpatient Treatment – Behavioral health services in an inpatient setting for persons with severe

psychiatric and detoxification needs including assessment, evaluation and treatment of mental

health and psychiatric needs in addition to medication management to ensure stabilization of

acute mental health crisis.

6. Residential Treatment – Provides support and structure in a group home setting or other form

of community‐based residential care for mental illness and addiction issues.

7. Outpatient Treatment

Day Treatment – a structured and intensive multi‐disciplinary recovery program for

individuals who are obtaining substance abuse treatment to aid in recovery including:

o Group therapy

o Individual therapy

o Rational emotive behavioral therapy

o Cognitive behavioral therapy

o Substance abuse education (alcohol and other drugs)

o Co‐occurring education

o 12 step recovery philosophy

o Music therapy

o Art therapy

Counseling/Mental Health Services/Substance Abuse & Addiction Services ‐ Non‐

residential services for evaluation, diagnosis, and treatment of mental, emotional, and

substance abuse challenges. Including but not limited to:

o Anxiety

o Depression & Mood Disorders

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o Addiction

o Schizophrenia

o Personality Disorders

o Behavioral Disorders

o Abuse/Trauma

o Stress

o Relationship challenges

o Grief & loss

o Major life changes

o Conflict resolution

Driving with Care – an evidence based educational and therapeutic program to reduce

the frequency of drinking and driving, and break the chemical dependence of offenders

who have had four or more OWI convictions or OWI convictions involving serious

accident or injury. See Attachment E‐A for specific service delivery requirements and

reporting.

8. OWI Assessment – See Attachment E‐B for specific service delivery requirements and reporting.

9. Comprehensive Community Services – Services for adults with substance abuse, mental health

issues or co‐occurring disorders including treatment, rehabilitation and support services.

Including:

a. Assessment

b. Recovery planning

c. Service coordination

d. Communication and interpersonal skills training

e. Community skills development and enhancement

f. Employment related skill training

g. Medication management and assistance

h. Physical health assistance and monitoring

i. Psycho‐education

j. Recovery education and illness management

k. Counseling

l. Groups to aid in skill building and quality of life enhancement

m. Peer specialist services, includes counseling

10. Community Support Program ‐ Services for adults with severe and persistent mental illnesses

including support, treatment and rehabilitation. This population includes persons with

substance abuse, mental health issues or co‐occurring disorders. Includes:

a. Initial and in‐depth assessments to help determine the best course of treatment for the

individual

b. Recovery planning that integrates vocational training services, psychosocial

rehabilitation, psychiatric and psychological counseling, psychotherapy and supportive

services

c. Medication prescription, administration and monitoring

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d. Assistance in managing symptoms.

e. Daily living, social and recreational skill training.

f. Health, nutrition and wellness management

g. Crisis intervention.

AGREEMENT:

NCHC agrees to provide and Marathon County agrees to pay for the foregoing services to offenders. In

order to monitor compliance and verify level of services provided, NCHC shall provide quarterly reports

as follows:

1. Daily census data for inpatients served, including:

a. Number of inpatient beds filled on unit at NCHC

b. Number of inpatients held on locked psychiatric units at other facilities

c. County of residence of each inpatient

d. Number of consecutive days each inpatient has been held

e. Insurance status of each inpatient, including

1) MA/Badger Care or other income‐based public insurance

2) Medicare

a) With supplement

b) Without supplement

3) Private Insurance

4) Other Insurance

5) No insurance

f. Legal Status of each inpatient

g. Number of days since last admission of each inpatient to a locked psychiatric care unit

2. Crisis data, including

a. Number of calls/contacts per day

b. Source of call/contact, including identification of referral, to the extent permitted by law

c. Time of Day of each call/contact

d. Day of Week of each call /contact

e. Disposition of each call/contact, including:

1) Whether resulted in Crisis Team assessment

2) Whether resulted in referral to:

a) Emergency Room Services

b) Private provider

c) Internal NCHC provider

d) Other, specify:

f. Number of all Crisis Team assessments per day regardless of whether assessment

performed by phone or in person:

1) Whether assessment resulted in admission

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a) Voluntary

b) Involuntarily

2) If assessment did not result in admission, what observable behavior, or other

circumstances, was noted by staff as reason to decline admission

3. Number of staff dedicated to each of the SERVICES identified above

4. Number of OWI assessments performed each day

5. Number of inmates served each day, for each inmate state

a. Whether Release of Information (ROI) has been signed

b. What SERVICES were provided from list 1‐10 set forth above

c. Identity and dosage of each psychotropic medication administered to inmate in jail under

supervision of NCHC staff

d. Supplemental Services provided, not included in list above

e. Additional or Supplemental Services recommended.

6. Number of offenders, other than jail inmates, served each day, for each offender state

a. Whether ROI has been signed

b. What SERVICES were provided from list 1‐10 set forth above

c. Whether offender was compliant with treatment, including how offender failed to comply

pursuant to DEFINITION set forth above.

d. Supplemental Services provided, not included in list above

e. Additional or Supplemental Services Recommended

Marathon County agrees to provide NCHC with the following information on a quarterly basis as set

forth above:

1. Number of offenders referred to NCHC for services

2. Number of jail inmates referred for services, for each inmate

a. Time spent on suicide watch (Days/Hours)

b. Use of restraints (Hours/Min)

c. Time spent in Administrative segregation (Days)

3. Number of out‐of‐county transports of patients to other locked psychiatric care facilities

ENFORCEMENT

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1. Marathon County agrees to pay budgeted tax levy in quarterly installments to NCHC for the

provision of satisfactory levels of services set forth above and upon compliance with the above

reporting requirements.

2. In the event NCHC fails to act in good faith to jointly establish performance measures for

satisfactory levels of services by 1‐1‐2017, or to provide satisfactory levels of services, once

established, to offenders or fails to comply with reporting requirements, Marathon County may

withhold payment

3. Marathon County shall withhold $1000 from the agreed payment for each out‐of‐county

transport reported quarterly by Marathon County to NCHC pursuant to this agreement, except

that the penalty set forth herein shall not apply to transports of juveniles 12 years of age or less

to and from Wisconsin State Mental Health Institutes

ADMINISTRATION

Marathon County’s contact for this agreement is the County Administrator or his designee. All

correspondence should be addressed to:

Brad Karger County Administrator Marathon County Courthouse 500 Forest St Wausau WI 54403 CHANGE ORDERS: The scope of services to be performed under this Agreement may be

amended or supplemented by written agreement of the parties.

Non‐Appropriation of Funds: Not withstanding anything contained in this Agreement to the

contrary, no event of default shall be deemed to have occurred under this Agreement if adequate funds

are not appropriated during a subsequent fiscal period during the term of this contract so as to enable

the County to meet its obligations hereunder, and at least thirty (30) days written notice of the non‐

appropriation is given to North Central Health Care.

Dispute Resolution: If a dispute related to this Agreement arises, all parties shall attempt to

resolve the dispute through direct discussions and negotiations. If the dispute cannot be resolved by

the parties, and if all parties agree, it may be submitted to either mediation or arbitration. If the matter

is arbitrated, the procedures of Chapter 788 of the Wisconsin Statutes or any successor statute shall be

followed. If the parties cannot agree to either mediation or arbitration, any party may commence an

action in any court of competent jurisdiction. If a lawsuit is commenced, the parties agree that the

dispute shall be submitted to alternate dispute resolution pursuant to s802.12, Wis. Stats., or any

successor statute.

Unless otherwise provided in this contract, the parties shall continue to perform according to the terms

and conditions of the contract during the pendency of any litigation or other dispute resolution

proceedings

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IN WITNESS WHEREOF this Agreement has been executed by the parties. North Central Health Care County BY: By: TITLE: TITLE: DATE: DATE:

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ATTACHMENT E - A

AGREEMENT BETWEEN MARATHON COUNTY and NORTH CENTRAL HEALTH CARE FOR PROVISION OF

DRIVING WITH CARE SERVICES THIS AGREEMENT between North Central Health Care (NCHC), a Wisconsin organization headquartered in Wausau, WI and County of Marathon (hereinafter “County”) with its County Seat in Wausau, WI, shall establish the terms and conditions for provision of Driving with Care I. Terms and Conditions

1. Provider Status: The parties agree that NCHC shall be the sole vendor providing Driving with Care programming for the County.

2. Services Provided: NCHC will provide the Driving With Care curriculum without

deviation. At least one facilitator will be trained in the Driving With Care curriculum per group. NCHC will conduct up to eight (8) cycles consisting of thirty-three (33) two hour sessions over eighteen (18) weeks. At least two (2) of the eight (8) cycles will be begin after 5:00 p.m. to increase access for employed offenders. Each group (cycle) will have a minimum of ten (10) participants per group. NCHC will provide twelve (12) months of aftercare upon successful completion of Driving With Care.

3. Quality: NCHC will provide at minimum one (1) certified AODA staff as facilitator for

Driving With Care cycle. NCHC will ensure that additional AODA certified staff is available to meet participant/facilitator ratios consistent with NCHC licensure.

4. Wait List: NCHC will establish a wait list to ensure a minimum of ten (10) people per

group. The wait list cannot exceed six (6) weeks. NCHC must notify the County as to the reason for the wait list and seek a waiver either to the wait list time or minimum number of group participants requirement.

5. Compliance with NCHC Smoke Free Environment Policy. Driving with Care participants will comply with NCHC Smoke Free Environment policy. The Driving with Care facilitator will inform all participants of NCHC smoke free policy and indicate that failure to comply with smoke free policy may result in the participant being expelled from the program. Marathon County expects that at the first violation of the smoke free policy the facilitator will immediately address the issue with the participant and inform the participant that any future violations will result in expulsion. The facilitator will document this conversation and send the documentation to the County’s Justice Systems Coordinator. Prior to expulsion the facilitator will inform the County’s Justice Systems Coordinator of the second infraction and intent to expel the participant for non-compliance with NCHC smoke free policy.

6. Reporting Requirements: In addition to the notice specified in Section 4, NCHC must

provide the following: a. notice as to when a cycle begins and ends; b. completion rates and reasons for failure to complete;

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c. track referrals and reason why referral did not enter Driving With Care program; d. monthly status report of participant progress; discharge and reason why; and

successful completion; e. discharge report to Division of Community Corrections Probation & Parole agent; f. aftercare reporting including number of inactive and why; number successfully

completed, number of relapses, and number of new OWI offenses.

7. Release of Information: NCHC will obtain appropriate releases of information such that information regarding referral, reasons for non-acceptances or discharge, progress, completion and aftercare results can be shared with the County and Department of Corrections.

8. Coordination: the County’s Justice Systems Coordinator (currently Laura Yarie) shall

be the program administrator for the County and NCHC shall work efficiently with him/her to address problems which may arise, to jointly plan administrative policies which are needed to clarify expectations and implement this Agreement, and to continuously improve the quality of service provided under this agreement.

9. Agreed Upon Charges for Driving With Care: NCHC and the County have agreed to

charges for the period of January 1, 2015 to December 31, 2015, of $6,765 per cycle (33 sessions per cycle, $205 per session). NCHC will provide an invoice of the number of sessions conducted on a monthly basis.

II. Expected Outcomes

NCHC will provide Driving With Care services and produce the following results: 1. Wait List will not exceed six (6) weeks for referrals. 2. NCHC will maximize efficiency by having no less than ten (10) participants per group. 3. Successful completion rate for Driving With Care including aftercare of 94%. 4. Less than 10% of participants who successfully complete Driving With Care have a

new OWI charge within two (2) years of completion. 5. Maintain fidelity in provision of Driving With Care program.

III. Standard County Contract Language

1. Change Orders: The scope of services to be performed under this Agreement is not expected to change. However, should something unexpected occur and/or the County desires an expansion of the services provided, this Agreement may be amended or supplemented by mutual written agreement between the parties to this Agreement.

2. Gratuities and Kickbacks: It shall be unethical for any person to offer, give, or agree to

give any elected official, employee or former employee, or for any elected official, employee or former employee to solicit, demand, accept, or agree to accept from another person, a gratuity or an offer for employment in connection with any decision, approval, disapproval, recommendation, preparation or any part of a program requirement or a purchase request, influencing the contents of any specification or procurement standard,

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rendering of advice investigation, auditing, or in any other advisory capacity in any proceedings or application, request for ruling, determination, claim or controversy, or other particular matter, pertaining to any program requirement or a contract or subcontract, or to any solicitation or proposal therefore.

It shall be unethical for any payment, gratuity, or offer of employment to be made by or

on behalf of a subcontractor under a contract to the prime contractor or a higher tier subcontractor or any person associated therewith, as an inducement for the award of a subcontract, or order.

3. Insurance Requirements: NCHC shall not commence work under this contract until all

insurance required under this paragraph is obtained, and such insurance has been approved by the County, nor shall NCHC allow any subcontractor to commence work on their subcontract until all similar insurance requirements have been obtained and approved.

A. Worker’s Compensation Insurance. NCHC shall obtain and maintain throughout

the duration of this contract statutory Worker’s Compensation insurance for all of its employees employed at the site or while working on this project. In case any work is sublet, NCHC shall require the subcontractor similarly to provide statutory Workers’ Compensation insurance for all of the latter’s employees, unless such employees are covered by the protection afforded by NCHC.

B. General Liability, Professional Liability and Property Damage Insurance. NCHC shall secure and maintain in force throughout the duration of this contract such General Liability and Professional Liability Insurance as shall protect him/her and any subcontractor performing work covered by this contract from claims for damages for personal injuries including accidental death, as well as from claims for property damage, which may arise from operations under this contract, whether such operations be by NCHC, or by an subcontractor or by anyone directly or indirectly employed by either of them; and the amount of such insurance shall be as follows: Comprehensive General Liability $1,000,000 per occurrence and in

aggregate Professional Liability Coverage, $1,000,000 per occurrence and in

aggregate. Automobile Liability $1,000,000 per occurrence and in aggregate Excess Liability Coverage, $1,000,000 over the general liability and

automobile liability coverage. 4. Hold Harmless: NCHC hereby agrees to release, indemnify, defend, and hold harmless

the County, their officials, officers, employees and agents from and against all judgments, damages, penalties, losses, costs, claims, expenses, suits, demands, debts, actions and/or causes of action of any type of nature whatsoever, including actual and reasonable attorney’s fees, which may be sustained or to which they may be exposed, directly or indirectly, by reason of personal injury, death, property damage, or other liability, alleged or proven, resulting from or arising out of the performance of contractor, its officers, officials, employees, agent or assigns. County does not waive, and specifically reserves, it’s right to assert any and all affirmative defenses and limitations of liability as specifically set forth in Wisconsin Statues, Chapter 893 and related statutes.

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5. Americans with Disabilities Act Compliance: In connection with the performance of work under this Agreement, NCHC agrees that no qualified individual with a disability, as defined by the Americans with Disabilities Act, shall, by reason of such disability, be excluded from participation and the benefits of services, programs, or activities, including employment, or be subjected to discrimination. NCHC is specifically notified that it is subject to all employment requirements listed under Title I of the Americans with Disabilities Act by virtue of its contract with the County, a public entity. NCHC is specifically notified that it is subject to federal requirements to assure participation and access to public facilities, programs, and activities under Title II of the Americans with Disabilities Act by virtue of its contract with the County, a public entity. These requirements mandate separate or special programs or reasonable modification of existing programs, services, and activities without surcharge to disabled individuals as long as safety is not compromised. NCHC shall provide a similar notice to all its subcontractors.

6. Dispute Resolution: If a dispute related to this agreement arises, all parties shall

attempt to resolve the dispute through direct discussions and negotiations. If the dispute cannot be resolved by the parties, and if all parties agree, it may be submitted to either mediation or arbitration. If the matter is arbitrated, the procedures of Chapter 788 of the Wisconsin Statutes or any successor statute shall be followed. If the parties cannot agree to either mediation or arbitration, any party may commence an action in any court of competent jurisdiction. If a lawsuit is commenced, the parties agree that the dispute shall be submitted to alternate dispute resolution pursuant to s802.12, Wis. Stats., or any successor statute.

Unless otherwise provided in this contract, the parties shall continue to perform according

to the terms and conditions of the contract during the pendency of any litigation or other dispute resolution proceedings.

The parties further agree that all parties necessary to the resolution of a dispute (as the

concept of necessary parties is contained in Chapter 803, Wisconsin Statutes, or its successor chapter) shall be joined in the same litigation or other dispute resolution proceeding. This language relating to dispute resolution shall be included in all contracts pertaining to this project so as to provide the expedient dispute resolution.

7. Non-Debarment Clause: NCHC hereby certifies that neither it nor any of its principal

officers or officials have ever been suspended or debarred, for any reason whatsoever, from doing business or entering into contractual relationships with any governmental entity. NCHC further agrees and certifies that this clause shall be included in any subcontract of this contract.

8. Statement of Compliance: NCHC has carefully reviewed the County’s required contract language, pertaining to termination of contract, change orders, gratuities and kickbacks, hold harmless/indemnification, ADA compliance, insurance requirements/proof of insurance, dispute resolutions, and non-debarment, and is in full compliance with all statements and requirements. This contract language is incorporated herein by specific reference as if set forth in full. Any statements set forth in this contract document that conflict with the County’s contract language are superseded by the County’s required contract language.

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9. Entire Agreement: This Agreement set forth the entire Agreement between the parties and stands in place of any previous Agreement, whether oral or written.

IN WITNESS WHEREOF this Agreement has been executed by the parties. North Central Health Care County BY: By: TITLE: TITLE: DATE: DATE:

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ATTACHMENT E ‐ B

Purpose:

The North Central Community Services Program Board has designated North Central Health Care (NCHC)

as the intoxicated driver assessment facility. NCHC will ensure services are provided efficiently and

effectively, as well as being in compliance with DHS 62. The desired outcomes are: 1.) To implement

best practice in determining appropriate treatment and education for offenders. 2.) To increase overall

compliance with successful completion of the Driver Safety Plan. 3.) To increase the affordability and

access to assessment and treatment. 4.) Reduce jail beds. 5.) Reduce recidivism rates among OWI

offenders.

This document has been established to provide clarity of expectations and reporting.

Process:

Communication:

Categories:

1st OWI regardless of which court system is a traffic violation and should have “2015TR” in front of their

case number. These individuals do not have criminal cases and do not participate in the pre‐trial

program. They would seek assessment upon conviction. They may or may not have the fee on their fine

at conviction depending if they went through County Circuit court or Municipal Court. Municipal courts

do not follow the practice of adding the fee on the fine at conviction. Clients should show court

paperwork to prove the fine was added on.

2nd‐4th OWI’s that are misdemeanor criminal offenses would all come through Marathon County Circuit

Court as they are criminal. The case numbers for these offenses would start with “2015CM” These

individuals are eligible for the pre‐trial program and jail reductions. They would be seeking assessment

prior to conviction in order to participate. Not all chose to participate and some may seek assessment

following conviction, at which point their fee should have been included on their fine. Those waiting

until conviction should show court paperwork as proof the fee was added to their fine.

AUTHORITY: This agreement is entered into pursuant to sec. 51.42(5)(a)12, Stats., which requires that

the 51.42 Board “[d]etermine, subject to the approval of the . . . county boards of supervisors in

counties with a multicounty department of community programs and with the advice of the county

community programs director appointed under [sec. 51.42(4), Stats.], whether services are to be

provided directly by the county department of community programs or contracted for with other

providers and make such contracts . . . [T]he county boards of supervisors in counties with a multicounty

department of community programs may elect to require the approval of any such contract by the . . .

county boards of supervisors in counties with a multicounty department of community programs.

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Attachment F RESOLUTION R‐8‐16

APPROVING STEPS TOWARD WITHDRAWAL OF MARATHON COUNTY FROM THE TRI‐COUNTY JOINT CONTRACT WHICH CREATES THE NORTH CENTRAL COMMUNITY SERVICES PROGRAM BOARD AND TERMINATION OF MARATHON COUNTY’S RELATIONSHIP WITH NORTH CENTRAL HEALTH CARE.

WHEREAS, the Marathon County Board of Supervisors have entered into a series of Joint

Contracts to create and renew the North Central Community Services Board as a multi‐county

community services program with Lincoln and Langlade County; and

WHEREAS, the Marathon County Board has determined that a multi‐county community services

program may no longer meets the needs of the residents of Marathon County; and

WHEREAS, the Marathon County Board has determined that it is may be in the best interest of

the residents of the county to take steps necessary to withdraw from the tri‐county agreement and

pursue evaluate the creation of a Human Services Department governance structure to oversee both

social services and the department of community programs require, pursuant to §51.42, Wis. Stats.;

and

WHEREAS, creation of a Human Services Department requires that the county conduct a

feasibility study and draft an implementation plan in order to procure state approval; and

WHEREAS, it is manifestly fair for the Marathon County Board to advise the partner counties of

its intent to withdraw and prudent management to conduct the investigation and fact gathering

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necessary in order to implement such a substantial change prior to taking a final vote on a resolution to

withdraw.

Marathon County Executive Committee met on January 16, 2016 and approved this Resolution.

NOW, THEREFORE, BE IT RESOLVED, that the Marathon County Board of Supervisors hereby

resolves as follows:

approves 1. It is the intent of the Marathon County Board to pursue the creation of Human Services

Department and to vote on a resolution approving withdrawal of Marathon County from the Tri‐County

Joint Contract which creates the North Central Community Services Program Board and termination of

Marathon County’s relationship with North Central Health Care.

2. County Administration is hereby directed to:

A. Conduct a feasibility study and draft an implementation plan for the creation of a

Human Services Dept.

B. Utilize the Human Services Study previously authorized, which is currently in the

Request for Proposal Stage.

C. Continue to collaborate with the appropriate officials from Lincoln and Langlade

Counties to insure that they are fully advised of Marathon County’s findings and to receive their input

regarding the effects of Marathon County’s withdrawal on the residents of Lincoln and Langlade County

prior to any final vote

BE IT FURTHER RESOLVED that all appropriate officials of Marathon County are hereby

authorized and empowered to take actions necessary to effectuate the purposes of this resolution.

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BE IT FURTHER RESOLVED that the expected effective date of this withdrawal is January 1,2018,

unless either of the other two counties involved also decide to withdraw, or the counties otherwise

agree to an earlier termination date.final vote on a resolution to withdraw will be taken no later than

the September, 2016, County Board Meeting

Submitted this ____ day of January, 2016.

EXECUTIVE COMMITTEE

______________________________________ ______________________________________

______________________________________ ______________________________________

______________________________________ ______________________________________

______________________________________ ______________________________________

Fiscal Impact Estimate: No Levy Impact of withdrawal is undeterminedanticipated at this time for 2016

Budget. One purpose of this resolution is to create a mechanism to study fiscal impact. The effect of

this resolution on future budgets will be developed through the regular process.