Category: Commissioner JFitzgerald

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were “stuck” in the wrong places in our system; we over-relied on our hospitals and lacked community services; we had outdated systems, and our compliance and quality improvement mechanisms were inadequate.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.

Judy Fitzgerald
Commissioner

Spring Greetings!

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
• Library
• 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

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.