Greetings! It seems that Spring is finally here and we can look forward to the celebration of Mental Health Month throughout May. Today, I want to celebrate mental health and more through an important story. It is the story of a decade of transformation at DBHDD. Since becoming a standalone agency in 2009, we have gone through a remarkable transformation, and it is time for us to honor our achievements.
This is our story.
In 2009, our system was inconsistent and fragmented. We were underfunded; many of the people we served were “stuck” in the wrong places in our system; we over-relied on our hospitals and lacked community services; we had outdated systems, and our compliance and quality improvement mechanisms were inadequate. The public safety net was broken.
The department we are today has completely transformed from this broken and fragmented system to one that embraces the hope of recovery and independence for Georgia’s most vulnerable citizens.
This transformation was not accidental. It did not happen overnight. We did not do this alone. Our transformation is the result of leadership, dedication, partnerships, and a commitment to doing better.
The first essential step was an acknowledgment of our deficiencies. Throughout this decade, we have successfully navigated a settlement agreement under the Civil Rights of Institutionalized Persons Act (CRIPA) with substantial and sustained hospital improvements. We have also made dramatic progress toward fulfilling our obligations under the Americans with Disabilities Act (ADA) Settlement Agreement.
Our transformation has at times been messy, but it is meaningful, authentic, and measurable, leading us to demonstrated outcomes that impact the lives of those we serve. It is important to tell our story to remind all of us of what we have undertaken and what we have accomplished.
After acknowledgment of the things that challenged us, our next step was commitment. We made a commitment that we were going to improve. We made investments in our system. We executed adjustments to our infrastructure and the way we do business. Under the leadership of Commissioner Frank Berry, we prioritized engagement of key partners. These changes fostered the development of updated strategies and enabled noteworthy enhancements to our service delivery system. Through all of these reforms, we have been able to make measurable improvements in the experience of interacting with DBHDD and our community service providers.
Since 2011, our system has had an infusion of $256 million dollars—more than any other state in the country. Through the generosity of Governor Nathan Deal and the Georgia General Assembly, we have used this funding to make significant improvements across our system.
In behavioral health, we transformed our safety net into an accountable, community-based, recovery-oriented system of care. We tiered our provider network, clarified standards, implemented key performance indicators, and reformed our funding structure to incentivize productivity. In 2009, we didn’t have assertive community treatment, behavioral health crisis centers, mobile crisis, supported housing vouchers, or supported employment. We have also expanded peer support to include youth, parent, and forensic services. Today, we have built a broad statewide behavioral health service continuum. We have more work to do, and we believe we have the vision, the support, the skills and partnerships to keep growing.
In intellectual and developmental disabilities, we have developed a system that is more individualized and responsive, and promotes independence. We have redesigned our waiver program to serve people in the most flexible and integrated manner possible. We’ve added intensive case management, and enhanced support coordination, supported employment, and community and family support. We have also expanded self-directed services, transformed nursing services, added nutritional services, and created high-risk surveillance to monitor people’s health and wellness in the community. In both behavioral health and intellectual and developmental disabilities, we have engaged with providers, advocates, families, and stakeholders, and the people we serve throughout our transformation so that our work truly reflects what is needed.
At the enterprise level, we implemented a reorganization to modernize our internal structure. We have centralized and functionally aligned our field offices and central office, and we increased oversight of our hospitals through governing body. We have maintained experienced, capable, and passionate leadership teams across our hospital system. We contracted an administrative services organization to streamline administrative functions with better tools to manage system use and performance. We continue to improve these elements. Our internal offices of Information Technology, Learning, Legal Services, Budget and Finance, and Facilities Management have made significant shifts in their focus on serving their customers within the department; and our Office of Public Affairs led a brand refresh to update our logo and branding in a way that truly reflects DBHDD’s professionalism and values. We have a smart, engaged board that provides support, guidance, and perspective on our mission and plans.
Finally, we have focused on staff development to make DBHDD an exciting place that people want to work by offering a number of great opportunities like the Strengths Deployment Inventory (SDI) and the Management Academy. We did this because our employees matter. You matter. Your experiences in your jobs and with each other influences your work and your heart for service. I am so proud to represent what we have achieved and our commitment to continuous improvement.
This is who we are. This is what we do. This is our story.
I hope you will join me in telling it and celebrating all the work you have done to transform our system for the people we serve.
The 2018 Legislative Session adjourned at the end of March, and I am pleased to report that it was a successful Session for DBHDD. We are very grateful to Governor Nathan Deal and the Georgia General Assembly for their generous support of our mission through the FY 2019 budget. I invite you to read DBHDD’s Gold Dome Report, which highlights key funding and legislation affecting our department and the people we serve.
During the Session, DBHDD’s essential work continues. As you know, we have led a dramatic transformation in the last decade, shifting from a system that is over-reliant on hospital-based care to a community-based and recovery-oriented system of care. The evidence of this transformation can be seen in many communities around the state. That said, our five state hospitals still play a critical role in our service continuum. As our community service system expands, our hospitals will be reserved for two populations: First, individuals with long-term chronic mental illness who cannot be adequately treated in a community-based setting; and second, the growing population of individuals with mental health needs who have forensic status, meaning that they are involved with the judicial system. These individuals may have a short- or long-term stay with us as the court determines their ability to return to a community setting. DBHDD embraces the dual responsibilities of protecting public safety and creating an environment that fosters recovery for each individual in our care.
Given our commitment to wellness, I am proud to announce the March 16, 2018 opening of the new Center for Wellness, Hope and Learning at Central State Hospital in Milledgeville, Georgia. The center consolidates the hospital’s treatment mall services into one innovative, state-of-the-art facility designed to support recovery in an education-like environment.
The new center demonstrates the considerable strides Georgia has made in forensic services, signifying a shift from an institutional model to one that is based on recovery. In February, I announced DBHDD’s new policy on Recovery, Wellness, and Independence as a cornerstone in our commitment to the people we serve. The Center for Wellness, Hope, and Learning embodies the goals and values articulated in this policy.
The center follows a recovery model focused on hope, wellness, respect, and self-responsibility while helping people learn practical skills that prepare them for a life beyond the hospital. The space is serene and inviting, featuring large windows, open hallways, and an emphasis on natural lighting. The décor is comfortable, visually appealing, and creates a pleasant atmosphere in which individuals can learn and grow. Retractable walls allow for a large common space to be divided into two, three, or four classrooms for multi-functional use. An apartment-style classroom creates a real-life environment where people can learn the skills of independent living.
We envision that recovery is possible for every person who comes through our door. The center’s thoughtful and detailed design is modeled after a community setting. Here, individuals can develop independence while learning how to be safe and how to interact with others, so that they can thrive in the community. This is a place where hope begins.
Quick Facts about the Center:
- Construction began in December 2016
- 21,427 square feet, plus 5,120 square-foot multipurpose room/gymnasium
- Can serve up to 184 people, the capacity of the hospital
- Seven regular classrooms, plus specialty classrooms for music, art, computer
- skills, exercise, and work therapy
- Life skills classroom, modeled after an apartment
- Large flexible space that can be transformed into two, three, or four
- classrooms with movable walls
- Interior garden space
- Therapeutic Incentive Program (TIP) store modeled after a retail setting
Many of our DBHDD colleagues played a part in the realization of this remarkable facility. I want to specifically acknowledge Dr. Karen Bailey, Statewide Forensic Director; Susan Trueblood, Central State Hospital Administrator, and the CSH team; and Greg Hoyt, Director of Hospital Operations. None of this would have been possible without the generous support of Governor Deal and the General Assembly, who are deeply committed to the people we serve, as well as local public officials who support DBHDD’s vision and mission.
Check out the photos from the center’s ribbon cutting!
Judy Fitzgerald, Commissioner
Cassandra Price speaking at Attorney General Chris Carr’s Statewide Opioid Taskforce meeting, held at Atlanta Technical College
Customer love fuels Slalom’s day to day and speaks to a two-way relationship that can impact all involved on both a professional and personal level. Because of customer love, Slalom consultants are excited to go to work and their clients like working with them. Slalom had a long history of celebrating their internal accomplishment and their people, and the time came for them to celebrate those clients that bring out the best in Slalom. So they thought it was only fitting to recognize their clients that best support them in creating a culture of customer love.
With great pleasure Slalom announced the inaugural annual Atlanta Slalom Customer Love Award that will be presented to an individual that has served as a model client in terms of their engagement of Slalom and their people. This award recognizes a client with a proven track record of working with Slalom and creates an engagement environment that allows Slalom to fully showcase their core values.
This year Slalom had a very strong list of finalists from their clients throughout Atlanta that were reviewed by their selection committee and with great pleasure Slalom Atlanta announced their 2017 Customer Love Inaugural Award winner, Doug Engle of the Georgia Department of Behavioral Health & Developmental Disabilities.
Congratulations Doug on being selected for this prestigious honor by Slalom as you are most deserving of the award and recognition!
View the consultant testimonials
Greetings! Over the next few months, I will be highlighting some of the exciting transformation efforts underway throughout DBHDD. We are a department on the move!
The Division of Developmental Disabilities has been at the center of our efforts to transform. We have multiple service improvements underway. One element of our system has emerged as an area of great importance: the Planning List for people with Intellectual and Developmental Disabilities (I/DD). You may already know that many states have planning lists for people with I/DD. This is a reflection of growing national prevalence, such that demand exceeds current resource allocations. In Georgia, our list has existed for many years and holds the names of thousands of individuals. People have been added to the list whether their need is current or urgent. As a result, it has been difficult to assess the true need in Georgia.
In 2016, DBHDD began the process of reviewing our approach to the I/DD Planning list. This effort was guided by several key principles: customer service, accountability, transparency, consistency, and operational efficiency. We wanted to communicate with families about expectations of placement on the Planning List. The bottom line is that we want to ensure that the I/DD Planning List is accurate and fair. Individuals with the greatest level of need must be prioritized, regardless of their location in the state.
We made adjustments to outdated staffing patterns and have adopted new tools and technology. This technology enables two important advancements: First, it allows more consistent and sophisticated analysis of the changing needs of individuals on the Planning List. Second, more specific and detailed understanding of individual needs helps us to expand additional resources beyond just our COMP and NOW waivers.
We are working hard to make the most of current service systems. It is essential to have support available as close as possible to where need exists. As a result, DBHDD added a Planning List Navigator in each of the six service delivery regions in the state. These Navigators help to address any questions or concerns regarding the Planning List Process. The Navigators will also connect individuals and families with community-based resources. To ensure accountability, we have also adopted new performance measures to assess our progress. We are confident that these improvements will increase accountability and accessibility, while allowing us to remain flexible in a dynamic healthcare environment.
These changes positioned DBHDD to respond to a request from the General Assembly to submit a five-year plan to reduce Georgia’s I/DD Planning List. This report is available on our website. It outlines several strategies for consideration, and also recognizes the financial commitment necessary to make an impact. We would welcome the opportunity to accelerate our pace, and we believe that our provider network can readily respond.
As we continue to implement important improvements, we are mindful of our responsibility to make positive and meaningful changes for the people we serve. We believe that with appropriate supports and services for individuals and their families, people can live a healthy, thriving life in the community.
University Center Project Reaches Five-Year Benchmark in Self-Advocacy
Atlanta, GA: On December 9-10, 2017, the final meeting of the fifth cohort of My Voice. My Participation. My Board (MVMPMB) was held in Augusta, GA. This gathering was the conclusion of a three-part, multi-day training on self-advocacy, which focused on individuals with intellectual and developmental disabilities (IDD) learning how to be effective and engaged members of the board of directors and advisory councils.
Far too few individuals with IDD have had the opportunity to make valuable contributions as members of boards and councils. MVMPMB seeks to change that by training and preparing individuals with IDD to contribute to the work of state agencies, and both for-profit and nonprofit organizations in Georgia and the United States. Project Coordinator, Susanna Miller-Raines, agrees that “having people with intellectual and developmental disabilities on boards and advisory councils as active, participating members and not tokens, is vital to being diverse and inclusive. Their voices, experience and perspectives are valuable.”
Paige McKay Kubik, the Executive Director of the Frazer Center in Atlanta, GA shares how their experience of having a member of their board with a developmental disability has been so important. “[This individual’s] opinions and feedback are critical. They inform and vet board decisions so that [the board is] respectful and responsive to the needs and desires of the people we support,” said Kubik.
The MVMPMB program consists of three components, all of which help participants prepare for and obtain leadership roles. First is “Self-Awareness & Self-Advocacy”. During the first session, participants identify their personal strengths and how they can contribute to a board or council’s success. Liz Weintraub from the Association of University Centers on Disability (AUCD) was the guest lecturer for this weekend. Next is an in-depth look at “What are Boards of Directors and Advisory Councils?”. Members and peer-mentors will be able to identify the characteristics of an effective board member and ways in which their unique gifts and talents fit in that role. The cohort concludes with “Translating Knowledge into Practice”, where members and peer-mentors will take the knowledge that they have gained in Part One & Part Two and practice the skills they have learned through a series of scenarios and the opportunity to network with professionals within the disability community.
MVMPMB alumni have become involved in over 20 boards and councils throughout Georgia. Alumni serve on boards at the Frazer Center and DIG, Inc. Three alumni serve on the Georgia Council on Developmental Disabilities. They also serve on advisory councils for the Autism Plan for Georgia, the CLD, and the Atlanta Autism Consortium.
This project is made possible through a funding partnership between the Georgia Department of Behavioral Health and Developmental Disabilities and the Carl Vinson Institute of Government at the University of Georgia.
About CLD: The Center for Leadership in Disability (CLD) is a University Center for Excellence in Developmental Disabilities (UCEDD). CLD provides interdisciplinary education, community training, technical assistance, research and information dissemination with the goal of improving the lives of people with developmental disabilities of all ages and their families. CLD is administratively located within the Center for Healthy Development and the School of Public Health at Georgia State University.
2018 is off and running. Between budget and legislative activities, and our ongoing system-wide transformation, we continue to drive toward the end of the ADA Extension Agreement, scheduled for June 30, 2018. As we focus on these significant strategic priorities, I wanted to take a pause and revisit our “WHY?”. Why do we embrace our challenging mission to serve some of Georgia’s most vulnerable citizens?
By now, you are familiar with DBHDD’s vision of easy access to high-quality care that leads to a life of recovery and independence for the people we serve. We talk about our vision often, but it takes more than aspiration to keep us on track to make this vision a reality. It takes a specific focus, commitment, and vigilance. Values are just pleasant words if you cannot see them in action. Our “why” is the belief that recovery is real, and independence is possible.
That is why I am so excited to announce DBHDD’s new policy on Recovery, Wellness, and Independence. This policy touches our entire system: hospitals, providers in our network, and all DBHDD employees. It codifies our commitment to these three tenets that drive our purpose. It articulates our belief in the principles of self-determination, freedom, and personal responsibility as the key to achieving a satisfying, independent life with dignity and respect. We believe that it is important for our employees and providers to be aligned with individuals and families in the goals, values, and principles of recovery and resilience that support independence and wellness. More than just a conceptual framework, we strive to ensure that services are delivered in a way that honors these values and principles.
In the policy, you’ll find definitions of terms like recovery, independence, and wellness. Though you may already use these words daily, I encourage you to read the definitions. You might be surprised at what inspires you as you connect the words to your work and your “why.”
The policy is informed by a series of guiding principles and values that:
- Convey the hope of recovery from behavioral health challenges. Recovery emerges from hope. Therefore, convey messages of hope, encouragement, and the belief that recovery is possible.
- Are informed by the wisdom of lived experiences. Knowledge gained from lived experience is distinct from that gained from education and clinical practice. Each person’s experiences bring something valuable to the table, so it is critical to engage the unique voice individuals and families.
- Address trauma.
- Recognize that recovery occurs through many pathways. Service planning and delivery must be individualized and person-centered.
- Empower communities by working as partners with the people we serve and those in their support network.
- Are based on respect, focused on the strengths of the individual, culturally informed, and anchored in wellness.
Additional values and principles are contained within the policy. As with the definitions mentioned above, I hope each of you will read these closely. As for me, the most essential word is hope. I started this year with a spirit of great optimism and hope, and the amazing work I see every day has sustained that energy!
This policy will be significant for our department, our provider partners, and most importantly, the individuals and families we serve, as it guides us toward meaningful work that is centered on making our vision a reality. You can read the full text here.
I thank you for your tireless commitment and look forward to making continued improvements to our service delivery system that are grounded in recovery, independence, and wellness for the people we serve.
A lived experience essay by Lorenzo Hardy Jr.
My earliest memories as a child are that I never had a period in my childhood where I was happy. Yes, I had fun moments but there were no months or years that I can recollect that were happy. My family did not celebrate birthdays, holidays, or participate in school activities. I was not physically abused but I witnessed domestic abuse on a frequent basis. This is not to say I was not loved or point the finger; I believe my parents did the best they knew.
I was an honor roll student who was told on a regular basis that the world was going to end. As I went through elementary and Jr. high school I felt it was not fair that I could not experience the fun I saw other good children having. I REBELLED and joined the basketball team without permission and was told that I had to quit. It was the first time I felt like a part of something other than family. I made the choice to take a full bottle of prescription drugs and went to sleep for what I thought was an eternity (In my ignorance; I took my sisters pills for female problems). I woke the next morning confused, nauseous, and having severe cramps. My mother took me to the hospital after I informed her of my mischief. I received no psychiatric care other than being asked was I going to do it again. No matter how hard I tried to tell everyone that I believed different and wanted a different life, I was always told to do what they felt was best for me.
After high school, I rebelled again and was the first in my family to attend college. During my freshman year, I was accused of a crime which I did not commit and, after suing the state of New Jersey, was given a small monetary award. The reason I received a small amount was because it was determined my older brother committed the crime and if I did not accept the settlement then they would pursue the case against him. This event was all I needed to hit the streets and justify it by saying, “There is no justice so I am going to get mine by any means available.” After numerous run-ins with the criminal justice system, I was sentenced to 2 years in prison. I came home and attacked the streets with a vengeance attempting to make enough money to secure my life. For the first time in my life, I was heard loud and clear. “Uncle Sam” heard me loud and clear.
The Federal Government had an indictment against me and my lawyers told me I would do a minimum of 20 years. This was not acceptable to me. I decided to pay someone to take me out of my misery and leave my children with a great financial start in life. As with everything so far in my life, this failed. I was shot in the head only to wake up in the hospital for a prolonged stay. I had to serve my time.
I went into prison bitter and thinking there is no way I could serve 20 years. I would complain and act out every chance I could. After acting and coming out of the special housing unit, I was playing chess with a gentleman who was serving 7 LIFE SENTENCES. He gave me a prison education I will never forget. He stated, “You keep crying for justice, give yourself the time you think you deserve because you and I both know the things you did. After giving yourself the correct time, ask yourself how many times you got away with crimes; do you really want Justice?”
It was at this time that I started to accept my responsibility and be accountable for my life. I read over 2000 books and used my new found knowledge to develop new coping skills. Instead of quitting, I started solving my problems and coping with the pains of my choices. I gave others support and used support from others. I realized that HOPE had entered my life and I wanted to become something other than a statistic and stereotype.
Upon release, I went to Georgia Vocational Rehabilitation Agency who paid for my training as a Certified Peer Specialist. Georgia Mental Health Consumer Network became my family and provided countless other training for me including Forensic Peer Mentor.
I am proud to say that I am now a productive citizen with a 775 credit score, I provide volunteer service, and I have been gainfully employed since my release. Ironically statistics show that a person with my criminal background will end up back in prison. I proudly say on this occasion they were right, but I now work at Phillips Transitional Center as a PEER MENTOR.