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of C:ri:-:-Ie Co:;tro~i uR .. E']:~ILE~" ="~()I~L-~\~U)~, Clin=~cal P~~;-c~DloS·isti

F~~E~ ~~O~~E, Director of ~esidential Services; Ch~ROLL SOUTH, Director of ~he ~e?3rt~ent of I~stit~tjo~s; ~~VID BRIGGS, District I\! ~,'e:J~o.~ :-;~31-'.=]-~ C-:;:-_ter Di~ec'f-=-or; :J:? .. ~.~_.J,~~::=S ~-:;: ___ ··'~~~l.-S, ~··a~::T: S~=l~~~:::'~s

MR. CHISHOL~ stated back ln 1977, there was formed an Inter Agency CO!T::ni ttee on Emoticnally Disturbed Children, to study the needs of the emotionally disturbed child. This ,,'as a subordiDate cClTUTLi ttee o~ the p2~e!1t cO~T:i t tee on Bandi.::ap::?ed Child~en. He ,·;anted to discuss the curreDt program and its streD9ths and we?k~esses. ~he issue of the U~it being at Ka~m S9rings since 1975, the adeSGacy of the staff, how easy is recruitment in that area, does the current facility comply with current life safety codes, can it be certified, is the capacity adequate, does it support the program architecturally. The population to be served is something the CODllli ttee on the Emotionally Disturbed Child [-,as beer: working on for some time, and their investigation into that issue would suggest there is a population out there that is not being served, and the incidences of this acute mental illness is on the rise. This facility should be expanded above the current capacity of the present facility which is 30 beds. Also to be discussed is a self-contained facility, what type of aL~osphere needs to be created. He feels architecturally it can be constructed so that the "least restrictive environment" is foremostin their minds. The projected cost being discussed was based on square footage require­ments and not on any special design, so they would be completely flexible in that area. The Department's position regarding location is to build a 60 bed unit to meet JCAH accreditation and to be built in Anaconda.

REP. HURWITZ feels the need has been pretty well established, and the concept of placing it in Anaconda troubles the members in the Committee. Another question is whether it should be 40 bed vs. 60 bed. He noted MR. ROSENLEAF has stated he feels the numbers are going to increase.

SEN. TBO~-tl':.S stated he felt the r,eed has been established but the conflicting testimony has been the university system and the ~nvolve~ent they would have in this program. ~he tvoe of treat­~e~t has been pretty well establis~ed to the Corr~ittee m~mbers,

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~~E~ta: ~021t~ Ce~ters are \ery 2cti:e, 3~d it is di~iicult to ~i~d o~t ~~Ere their ~ara~~~2rs are, Sl~ce ~o two a~c?e o~ anyone

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• JGDY (=;~?~5()~': sta.ted a~o·Jt th2:"22 ~72ars 3g0, t~e CC~Lttittee did lj2ve a s~u~y of t~e ~isso~la area in regard to setting ~? a facility

DR. ELOURE stated he ~asn't sure things fell apart, but as he recalls there were two proposals sut~ittea. One ~as a ~issoula proposal and o:,e v,'as from Great Falls. The CO:Tuctittee cc.,ose the Great Falls ?rcposal over the Missoula pro?osal.

DICK ROSENLEAF, Director of the Children's Unit, stated he has three concerns regarding the location of the building. First of all they have s?ent five years training a staff, and in the polls he has taken, they would lose a~out 60% of that staff. Secondly, Anaconda is the o1!ly community th3.t has invited ::'he Chil.dren's Unit to be placed there, and thirdly regarding location in a larger town, he feels the priorities need to be looked at. The priorities of the university system are education, research and treatment, if there is time. If you are setting up treatment centers, then the first priority must be evaluation, and treatment, it should not be edu­cation and research. He stated they can develop an internship program wherever they are located.

THE CHAIru~~N asked that as far as the staff was concerned, the Unit did have a program to proceed on their treatment.

MR. ROSENLEAF stated he based this on the experience they have had in the past six years. The program has been developed, they have the lowest turn over of staff of any u~it in the state hospital. He feels what keeps them in that program, is the fact they run a good program, allowed. to do what they are trained to do, and get good support for this training. He feels if you have a good viable program, then you can recruit.

MR. CHISHOLM stated one of the issues that need to be discussed is the self-contained program. He stated he wanted to clarify a state­ment made the other day regarding it would be self-contained so that MR. ROSENLEAF was not looking at local school systems to provide educational services. He stated that he may in fact do that, ~~t it would be the exception, not the rule. The program is to be

t~ey can So o~ o~t

~~aco~da couJd ~crk 2S ~ell as 22Y ot~er area in I~ t21ki~g tc ~~e ~1jV0YS:ty ?oople, t~ey~re2 t~ere

?EP. 2~?~ITZ 2sked if it ~as a big :ss~e over a long period of time re0ardi~g the training of staff.

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~nree ~o ~lve years. about a year to know ~~at is going OD, and by the third :ear you are getting more of a skilled worKer. Another issue is the type of person who would work in a Children's Unit, because these children give so little Lack. He felt the cor;~unities in A.nacor~da, Butte and Deer Lodge have had a lot of experience working with people in institutions, and they are quite tolerant of this. He no-ced he averages around 17 run a',~'ays a month, and the co~r:lUni ty doesn't get too concerned about this. Last year he lost one psychologist and one RN. He has a total staff of 41.5 FTE.

l'1R. CHISHOLM stated the COITuni ttee did not come up wi th the pro­posal for the site to be in Anaconda, he stated his Department working with the Governor's Office came up with this proposal site.

DAVE LEWIS explained the process they went through regarding their recommendation. They looked at the good program at Warm Springs, the good staff, and the placement of that program and the staff in tact was considered. There didn't seem to be any great argu­ment in placing it anywhere else. Given the fact that Anaconda is a community that has recently been devastated economically, there didn't seem to be any compelling argument of pulling those jobs from Anaconda and placing them elsewhere. The program is working, they have the staff making it work, they have a history of working with institutions, and they need the job~ basically covered the main issues.

MR. ROSENLEAF stated he has been observing this type of child for over 20 years, and there always seems to be a fight over whether or not the child should be mainstreamed. He stated he is not opposed to mainstrearning children, however, the type of child, who comes to this institution, has absolutely bombed out from all other programs. He usually has been suspended from school around age of 14. This child has been through all of the corrununity base services. The child usually gets sent by the other cO~luni-ties and the judges, who label the child as one is ~ot only disturbe~, but disturbing, ~ho is outraged a~d outraging and they do not ~ant -::his cr-~ild in ~~e cO~··~lunity. T:-:e iC0a of tl~e 521f-cG!'ltai!1 12d Uflit

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to ~2ve str~ct~::-e fro~ within.

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building be bui~t and staffed according to JeAH standards, even t~ou~h over a ??riod of time the federal su?port will be limited. T~ t~ey co~ply ~ith these standards, ~~ will h~~G to b8 ~_2r~ted as a self-contai~ed Jnit anyway.

THE CH2\Iruv~L.N stated he did not feel there \,-as an:i sense in building a 40 unit, when the cOlTtITlittments are already above that.

3~LL RILEY, Board of Crime Control, feels the 60 bed facility is needed. T~e estimation of the records from the Youth Court is one in 23 children will need this facility. The justice system feels there is a problem when the child needs to be referred to Warm Springs and there is a waiting list, and no place for the child to stay except in jail. T~ese numbers are going up and a 60 bed unit is needed. He stated as far as location goes, he agrees with ~R. CHISHOLM'S statements.

He stated the problem the juoges have is not the treatment, but the waiting list and not getting them in plus the legal problems this involves. He feels the type of child being discussed here, more community interaction and mainstreaming would cause more and more failures for them. He agreed the self-contained unit seemed to be the answer.

SEN. ~HO~~S asked if the age was a concern in the construction of this facility, and having 40 unit pods would be more effective.

MR. RILEY stated he didn't feel he could answer this, since it is more of an administrative matter. He didn't feel this would make any difference to the judicial system, whether it was one or tvm pods.

DR. MOLUNEUX stated last fall there was a study which contacted 200 inservice providers in the state, and asked them to identify the severely and moderately disturbed child in their cOIT@unities. (EXHIBIT A). The results of the study indicate they do need a 60 bed facility. He stated he is a Clinical Psychologist, and he has no problem with a 60 bed unit as long as it not be con­structed similar to the old dormitories. You could have four 15 bed units separated in that matter.

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~R. ~~O~_, ____ ~~.\:~~~r:~ sta.tec he ft:-~els ·ts-Je~:- 21~2 t~-J:::~e, c\ut -v\7hen t~2:Y get 13, ~~e~ a~~ SG~ti~g bi~~er, a~d ~c~e to ~~e a~tention of the law.

S3~. ~~O~AS aske~ Dr. ~olu~eux to discuss the pros and cons of ~avins it near the University system.

0~. ~<J=-)_->~-=:~:X C0"2S 2-10t fE::eJ. ':L~lat ~C1CG-:'::'C'~! lS -~!12t 2-T:-llJc}rta~-lt to -:~-;e -::~.,-;e of "tTeGt~:0~t 7_~-_at v:ill ~_,s ~.)rc)y"j(~>~d, Sl:'1Ce t~-~is is a self-cGntained unit. He feels r2gardi~g treat~ent p~rposes for different ages, in the study they broke it down to 12 and under and 13 and over, for treatment the 12 and under child should be separated from the 13 and over group. He would suggest a 15 bed unit set aside for the children 12 and under.

SE~\. T!:iO!-1.2:l.S as'ked i f t~Jere v,70uld De any benef it having the Un it placed closer to Eastern Montana College.

~R. MOLU~EUX stated the Yellowstone Boys and Girls Ranch is already in Billings and has just opened a 20 bed facility for intensive treatment. Twelve of those beds have been designated for evaluation and treatment, and feels this would be a duplication of services in the Billings area.

~1R. ROSENLEA? stated in terms of the intensive treatment center, not the ranch specifically, their length of stay is approximately six months. Children needing a longer term would probably need to return to the Children's Unit.

THE CHAIP~AN asked if there were advantages of having this type of facility and coordination of services similar to the Yellow­stone Boys and Girls Ranch.

DR. MOLUNEUX stated at the Ranch, they do not have the experience or the expertise similar to the Children's Unit. He stated they are talking about the continum of care, with a facility for the severely emotionally disturbed children on one end, and group homes and foster homes on the other end.

~HE CHAIRl'1AN asked if there was an advantage of having an inter­mediate care facility along with the intensive care facility together.

MR. ROSE~L~AF stated he would like to see continum services built ~or the chil~ren in ter~s of the least restrictive environ~ent and the most rEstrictive enviro~~ent. He would like to see it

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is now only seven c~ild~en out of st~te. All of the instate facilities are full with a long waiting list. ~he feels t~ey are 60ing a better job in placing these chil~ren, c"}::) ~-:,=,t S;j~:'-t ~~\·~-LtC.~ r,~·::c;_~=cc·:?s G\-3.-i.=_c.~21e -=-n -~·:C~-lt2:->3,

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stated with SRS, the social wcr~er where the child should be placed. into the program, their role is to fa.cilit~l·

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C~~SOLL SOUTH stated he feels responsibility forthe proposal of 60 beds because this figure was based on the children in need of these facilities, and with 37 there at the present time, he did not want to co~e back at a future time and request a larger facility. He stated to those \!ho feel they don't need another institution, he would answer they already have the program that is taking place in an institution, it is a good program and very needed. Regarding the type of treatment in this program, he noted this is the Department's program and if the treatment needs to make the change. He didn't feel they needed to be influenced by an outside source as to the type of program they will have. Relative to the placement in Anaconda, it is the Department's position at this time. They do have an offer of free land, and also have a community that is receptive. He feels due to the time problem of the session, it may be necessary to set up a Site Selection Committee, and they may make a decision they could regret two years from now. He feels this is a good choice, and if they go anywhere ~lse without working the terms out with a community, the Legislature could find the money has been appropriated, and the site and the working bids may not be approved by the community involved.

REP. HURWITZ asked how important it \,'as to have a hospital nearby.

HR. ROSENLEAF stated in terms of bites, scratches, etc. they are a constant source of irritation wherever they are. Some children have eye, speech and ambliatory difficulties, and they do require some medical attention and supervision. The site proposed being so close to the hospital would be utilized.

THE C~~~I?..21-~~:~ aS~:ed \·l:'l·3"t l)l~oble~;s ~lac 1)s2n i:-' .. -Jol\7ed in disc·ussing sit0s anywhere else.

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zje fel t t~at ~~s ~Er~~?S t~e only site t~~t h~d teen offered. To bE fair ~~~V ~id ~ot ~o Gut ~~d 3c~i~ely ~oljcit fros ~ch co~~unity

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~ .. ~~ .. SC}LT~ ~~at=.1I~ ~!-::2 ='S~~G:L-::'-::-:-"~J)t ~'c.s ::i:1Ce tJ-leir ?ro~;csal, a~!d if the ~e?islature does rot feel it should go in Anaconda, t~en the Depart~ent is uncertain as to where else to look. He stated ~E ~id not ~ant this to fall throuGh t~e crac~s, and he s~p?orted Se~. ~i2:::-'2~_IS ::-:'lot:iC)I1 elf St31ecti~i.C; 2. Si~t2 Sele-c-":i.on C:ci::_"-ni-t.tE:e.

~R. ROSE~~EAF stated a couple of years ago they looked at cO:Tu"1luni ties to locate and found tlJere '0leren' t any COD.I]1,uni ties that wanted them. He noted there was such a wide aivergence of opi:Jion in each COT;"l?:l1jni ty, by the tine you take into aCCou;-'lt the individual citizen, the ?rcbation authority, Justice of the :?eace, County COll1Elis sioner s, the divergence is reIi"arkabl e. Missoula has run into probleDs of zoning over the group homes that have been established, he wasn't sure what they would ao with a 60 bed unit. One site was offered 20 miles out of Missoula around Steve:Jsville, but he feels si:Jce that is so far out, they might as well stay where they are.

JUDY CARLSO~ stated she felt there was need for the 60 beds, and it could be handled architecturally. She feels there will always be continuing needs for this program.

DAVE BRIGGS, Director of Region IV Community Health Service, felt he was acquainted in getting community support regarding this Unit. The location of the facility is not as critical a factor, but rather the type of program and the staff support that is going on in that facility.

SEN. THOMAS stated there are concerns expressed to him by the Mental Health Associations regarding this problem. He stated that Mr. Murphy from Billings stated in his testimony that he would prefer to go with more of a community based program, and a lady in Great Falls feels that Anaconda is not the place. He asked what role would the Mental Health Centers play in getting their exact opinions.

MR. BRIGGS stated he has not done a poll in regard to the location of the unit, he felt that all five Centers do agree there is need for a unit being discussed. The communities cannot handle the type of child being disc~ssed. He stated he agreed that the 60 unit size woula be appropriate.

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cit:y Cind s2hciol S\-S~·2In t~lot :ioS stated O: .... 7e can ~ind rOOft1 for y·o1..l, 2:-:1::: :'1--!e c~ll~i :-:->~--::d2~31 C'~);.~,J:---!i-:'~f t~-:'2t ~-~2S of::-ered i~s se2:-\7~lces, z tl C. t ~.~ e c,:-! 2.. ~y ',= :=:'I = ~ ~~. u :-j ~ -: :y =- ~-: ~=: ~ :--0. 3 S C" ..... - ~ ~~~. 2,:: -'c ~- ; 2 ~_::. n C. 3. [1 d t }~! (:: ~-; ~; ;: :'"~ s to t~is facility.

JOHN LaFAVER, SRS, stated he is pleased ln the tone of the discussion as to not whether or not the Children's Unit should be built, but where it should be built. Ee hoped this was deClced ~nlS sEssion. He felt a key ele~Ent is if you have a prograD that is working now, you shouldn't fool with it. He stated the one program that has impressed him throughout the I~stitutions is the Children's Unit and the staff of that unit. He felt this would be a strong argument in leaving this basic program in place.

SE~. THO~1..P:>.S asked DR. BLOUKE regarding the type of children needed to be placed in an out-of-sta~e facility.

DR. BLOUKE stated that is not the problem of the Department of Institutions, but more of a SRS problem.

JUDY CARLSON stated a number of local school districts send the children directly out of state.

NORHA VESTRE stated there is a screeening committee, who have expertise in emotionally disturbed children. They review every referral where children should be placed. The SRS does not place any child out-of-state unless it has gone through the screen-ing committee, and unless the recommendation has been made that the needs of the child cannot be met throughout the state. The out-of-state placements tend to be more expensive at a cost of $2,000 a month. Also if it is necessary to have the family treated along with the child, the out-of-state treatment is very difficult. She feels this facility would decrease the out­of-state placements.

REP. HURWITZ asked about the information regarding the children on a waiting list, the 60 bed facility seems to already be filled.

~R. ROSEN~EAF felt he was not a bit s~r?rised by DR. ~OLU~5UX st-:.ldies, allC1 he felt tr1e a:-:iOUfit of c:=--:otio:::1all~l Gistllr~2Q cljil::3.ren in the st~te was too low.

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!~~st ~~~y rccQ~~2~~ed 40 teds, tut ~ith CJ-~_;~ ~S, :1'? ~C:'0:ls t~n:::t 60 }~·c:\6.s -\,.iou~.d be - -

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~eed =or this cc~n is 0T·='-~\7ir1g t~2 ~~G3d.

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-:;;:O'ut los~_-'JS t~'t~ c~"Ja.J.i-~=/ c'= t ':>::,s:':-:..~. C::::lt 2Jc,t~n £"l"G1Ti. t}le staf:: 2!1d

U:e chilcren.

feels tb~t 60 beds is ~c' b:.::: cG:r~:::i~~·="r.<?G, G~;C: _~<l~;:cc·~rl~a \.,-:=,~',-~ld ~)C: t~le fi.~st c~~oice, ~)U.t

_f ~~~t ~Qu'd ~ee9 t~e ~esis~etu~e frcffi :~ssi~g the ~ill, t~en

pess the bill for funding authorization and have it be decided by the Site Selection Cornmi t tee and recOlCi.mended by Hr. South.

REP. DO~AL~SON stated he wanted to bring up the fact there is a labor problem in Anaconda, and he noted the difficulty in working ~ith six unions. He felt some of the resistence to Anaconda as a site ~as ~ue ~o the unions.

~R. SOUTH stated he doesn't feel there is any difference where this is placed, because under the Collective Bargaining Law, it is just a Datter of time until they are organized everywhere. Glendive is currently enrolling many of the employees at Eastmont.

MR. ROSENLEAF stated they work with the two largest union representatives, one for the professional staff, one for the independent union employee, one for the nursing staff, and the RN and LPN Association. He has not had any personal difficulties with them. He felt wherever you go you will be dealing with those bargaining units.

THE CHAIR~~~ stated the LFA inc ida ted they did a study of the Children's Unit last fall, and would like to see that study. He would also like to visit with people from different areas who might lend some expertise to this issue, and he would like to contact someone from the Yellowstone Boys and Girls Ranch. He would like to know more about the matter of intermediate care.

SEN. THa~mS asked MR. BRIGGS if he could get some type of poll from the directors regarding site, and size. He would like the aSPI to address two issues, one being the out-oi-state placement, and secondly the educational component to this Unit. He would like to find out what type of corrunittment they would make in regard to funding it and their cooperation with this. He would like to have a representative from the Mental Health Center to attain a collective view. with this information, it would be necessary to discuss with other legislators regarding these key issues before ~aking the final decision.

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so cE'ly~-essea, 2n:'is8cial an~/0r "c2-azy" th2t :';-ley Cl~e havir-; ~_~~i:~~d:l:' di ffi-cu} ties acj'Csting ir1 ~heir 0\'1n, foster or gYO~~) nC:-;-I-:'s.. Co:-:se(~LJently 1 they rice~3 ;:::>re

ir~e~sive t~eatDent - usually ~esiaential - but do not ~ave to ~e cor~~~:~6 to a physically secu::-e se~tins as ao sever2ly dis::UIbed children.

NU~~3EH OF SERIOUSLY Ei,lOTIO:l.l,LLY DISTURBED YOUTHS IN MONTANA

IN NEED OF !-lORE INTE~~SIVE T?EATMENT

12 and under 13 and ove~ Total

Grand Total 144

13 and ovey

Total

583

August, 1980 (Unduplicated NTh~ers)

Severely Disturbed

~ales

11 87 98

Moderately Disturbed

102 285 387

Females ------

8 38 --46

Females -------

44 152 lor _--,0

Total

19 125 144

Total -----

146 437 S83

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