Putting Kids First Developing Local Funding for Mental Health and Substance Abuse Services

1. Putting Kids FirstDeveloping Local Funding for Mental Health and Substance Abuse Services Rita McElhany Community Development Manager Missouri Department of Mental Health Bruce Sowatsky, M.S.W. Executive Director Community & Children�s Resource Board of St. Charles County

2. What are Mental Health Boards? A statutorily-recognized forum to address and coordinate mental health needs in a particular jurisdiction Mental Health Boards Citizen Boards to address mental health needs are usually formed to build a statutorily-recognized forum to address and coordinate mental health needs within a certain designated jurisdiction or jurisdictions AND to pass a sales tax or mill levy (property tax) to fund services to meet those needs. The applicable statutes provide rules for board (or commission) formation, membership, ballot language, maximum tax or levy amount, guidance for collection, retention and disbursement of funds allowable services and expenses, and other guidance. Mental Health Boards Citizen Boards to address mental health needs are usually formed to build a statutorily-recognized forum to address and coordinate mental health needs within a certain designated jurisdiction or jurisdictions AND to pass a sales tax or mill levy (property tax) to fund services to meet those needs. The applicable statutes provide rules for board (or commission) formation, membership, ballot language, maximum tax or levy amount, guidance for collection, retention and disbursement of funds allowable services and expenses, and other guidance.

3. Doesn�t there have to be money? Some counties have mental health boards but do not have tax revenue. Why? The ballot issue has not passed or; The issue has not gone to ballot Some counties (or cities) have mental health boards that do not have a tax or levy attached either because they have not chosen to go before the people in an election or they have been unsuccessful but continue to find benefit in bringing interested individuals and providers together to build a better understanding of the mental health needs of the jurisdiction. Some Boards have funding from a combination of public and private sources and some have no funding at all. BUT THAT DOES NOT MEAN THAT THE BOARD IS WITHOUT A ROLE IN THE COMMUNITY!!!! Some counties (or cities) have mental health boards that do not have a tax or levy attached either because they have not chosen to go before the people in an election or they have been unsuccessful but continue to find benefit in bringing interested individuals and providers together to build a better understanding of the mental health needs of the jurisdiction. Some Boards have funding from a combination of public and private sources and some have no funding at all. BUT THAT DOES NOT MEAN THAT THE BOARD IS WITHOUT A ROLE IN THE COMMUNITY!!!!

4. Then what do you need? Essential elements of a successful mental health board: Shared vision and goals A needs assessment Strategic plan Resources Broad representation Open and inclusive environment Regular meetings with an agenda Essential elements of a successful mental health board: Shared vision and goals Needs assessment doesn�t have to be fancy, expensive, or done by a consultant Strategic plan�.what do we want to do, what do we want to say to whom, and when? Also doesn�t need to be fancy Resources - money, time, skills, talents (it helps to have organizational backing Broad representation across community. Consumers and families, politicians, mental health providers, housing providers, criminal justice and youth services, court system, social service providers, health providers, the media. Open and inclusive environment Regular meetings with agendas Essential elements of a successful mental health board: Shared vision and goals Needs assessment doesn�t have to be fancy, expensive, or done by a consultant Strategic plan�.what do we want to do, what do we want to say to whom, and when? Also doesn�t need to be fancy Resources - money, time, skills, talents (it helps to have organizational backing Broad representation across community. Consumers and families, politicians, mental health providers, housing providers, criminal justice and youth services, court system, social service providers, health providers, the media. Open and inclusive environment Regular meetings with agendas

5. What can your board accomplish? Board can increase the voices for mental health in the community Increase public awareness of the impact of mental illness and substance abuse on the community Public statements Press releases Co-sponsor events Advise local officials on policy Board can increase the voices for mental health in the community Increase public awareness of the impact of mental illness and substance abuse on the community Public statements Press releases Co-sponsor events Advise local officials on policy

6. For Kids Applicable Missouri Statutes: Children�s Services Tax (Sales) 210.861 (allowable services) or; Children�s Services Tax (Mill) RSMo 210.860 Proposition guidance RSMo 67.1775 Children�s Services Tax (Sales) 210.861 (allowable services) Proposition guidance RSMo 67.1775 A minimum of 9 members appointed by county commission Covers services from birth to age 19 for the following: Temporary Shelter Services Respite Care Services Services to Teenage Parents Outpatient Psychiatric Services Outpatient Substance Abuse Treatment Crisis Intervention Transitional Living Services School Based Prevention Programs Home-based and Community-based Family Intervention Services Individual, Family, and Group Counseling Children�s Services Tax (Sales) 210.861 (allowable services) Proposition guidance RSMo 67.1775 A minimum of 9 members appointed by county commission Covers services from birth to age 19 for the following: Temporary Shelter Services Respite Care Services Services to Teenage Parents Outpatient Psychiatric Services Outpatient Substance Abuse Treatment Crisis Intervention Transitional Living Services School Based Prevention Programs Home-based and Community-based Family Intervention Services Individual, Family, and Group Counseling

7. Kids through Adults The original: County Mental Health Tax (property) RSMo 210.975 (There is also a version for St. Louis City for adults only) County Mental Health tax (property) RSMo 210.975 Member County Commission appointed board forms prior to passage Covers mental health services across the lifespan Specific membership outlined: 1/3 represent public or private providers 1/3 concumers or consumer�s family members 1 physician Number of providers may not exceed � of board membership No member receiving funds may be represented (no conflict of interest) Provides structure for multi county boards Comprehensive Mental Health Services Inpatient Services Outpatient Services Daycare and other Partial Hospitalization Services Emergency Services Diagnostic and Treatment Services Liaison and Follow-up Services Consultation and Education Services Rehabilitation Services Prevention Service Screening Services Follow-up Care Services Transitional Living Services Alcoholism and Alcohol Abuse Prevention and Treatment Services Drug Addiction and Drug Abuse Prevention and Treatment Services County Mental Health tax (property) RSMo 210.975 Member County Commission appointed board forms prior to passage Covers mental health services across the lifespan Specific membership outlined: 1/3 represent public or private providers 1/3 concumers or consumer�s family members 1 physician Number of providers may not exceed � of board membership No member receiving funds may be represented (no conflict of interest) Provides structure for multi county boards Comprehensive Mental Health Services Inpatient Services Outpatient Services Daycare and other Partial Hospitalization Services Emergency Services Diagnostic and Treatment Services Liaison and Follow-up Services Consultation and Education Services Rehabilitation Services Prevention Service Screening Services Follow-up Care Services Transitional Living Services Alcoholism and Alcohol Abuse Prevention and Treatment Services Drug Addiction and Drug Abuse Prevention and Treatment Services

8. A Designer Statute Senior Services and Youth Program (sales) RSMo 67.997 � Senior Services and Youth Program (sales) RSMo 67.997 Perry County specific Group went to their legislator and asked for a statue to fund particular organizations/needs 7 member Commission appointed by county commission Funds are equally divided between seniors and youth Services for seniors and youth � Senior Services and Youth Program (sales) RSMo 67.997 Perry County specific Group went to their legislator and asked for a statue to fund particular organizations/needs 7 member Commission appointed by county commission Funds are equally divided between seniors and youth Services for seniors and youth

9. Decisions, decisions There is no perfect statute to meet the political and service needs of every county Lotta work! Need help from people who have made it happen��..

10. Proposition 1Putting Kids First After 2 unsuccessful tries in 2000 and 2002, St. Charles County passed an 1/8 cent sales tax for children�s mental health services in November 2004. In the same election, Jefferson County passed an 1/8 cent sales tax and the City of St. Louis passed a property tax for the same purpose.

11. Additional Successes 2005�Lafayette County passes a sales tax 2006---Lincoln County passes a � cent sales tax 2008---Perry County passes a 1/8 cent sales tax for children and seniors 2008---St. Louis County and Franklin County pass � cent sales taxes (Estimated $38 million annually) In total, about $55 million raised annually for children�s mental health services!

12. OutcomesWhat we have accomplished Child Abuse Substantiated child abuse/neglect cases 2004 2008 266 205 22.9% decrease in substantiated child abuse in 4 years 15 new respite beds Drop occurring even as population grows by 23% Consistently ranked as the best county in reducing child abuse/neglect (Missouri Kids Count) Source: Missouri KidsCount 2008

13. Outcomes Continued Teenage Pregnancy Births to Teens 2003 2007 262 249 Ranked 5th best county in the state 4.9% drop in teenage pregnancies Less than half the state average Infant mortality went from 118 to 148 and low birth weight went up from 1,255 to 1,612, but not attributable to teen mothers Over the last 3 years: 94% of births were over 5.5 lbs 89% remained in school 0% had a second pregnancy Source: Missouri KidsCount 2008

14. Outcomes Continued Teenage Runaways 2004 2008 Number of Runaways 562 423 A 24.7% decrease! Drop occurring even with population increase Early intervention and counseling with at-risk youth has dropped demand Source: Missouri State Department of Highway Patrol

15. Outcomes Continued Children w/ Serious Emotional Disorders Children w/SED receiving MH 986 services in 2003 Children w/SED receiving MH 1,176 services in2005 85% remained in their own home 98% remained free of critical incidents leading to hospitalizations 88% remained free from further or new juvenile justice involvement 92% remained free from out of school suspensions Source: Missouri KidsCount 2008 and Crider Health Center

16. Outcomes Continued Juvenile Justice 2004 2008 Delinquency Offenses 2,507 1,913 Status Offenses 902 758 A 23.7% decrease in delinquency offenses A 16.0% decrease in status offences Occurring while the population has grown 23% Source: 11th Circuit Family Court

17. Outcomes Continued Graduation Rates An average increase of 2.5%!

18. How to Pass This Measure in Your County Step 1�Creating An Oversight Board Step 2�Needs Assessment Step 3�Polling Step 4�Getting On The Ballot Step 5�Building Your Campaign Team Step 6�Building A Campaign Matrix

19. Step 1--Setting Up A Local Oversight Board Working with local governmental officials Local ordinance needs to include: -Name of the governing board -Set the purpose -Authority to determine who gets funding (Independence) -Size of the board -How members are appointed -Terms and re-appointments -Frequency of meetings -Qualifications -Conflict of interest clause -Ability to solicit other funding

20. Setting Up A Local Oversight Board Setting qualifications of applying agencies: 501c3 non-profits or governmental agency Audited according to statutory guidelines Some require certification or accreditation Establishing expectations for applicant agencies: -Complying with reporting guidelines -Non-compliance consequences

21. The Community and Children�s Resource Board Mission Maximizing Community Resources to Build and Sustain a Comprehensive System of Services for Children and Families in Need Values Collaboration Family Voice Accountability Strength Based

22. Our Vision St. Charles County will be a community in which all adults share responsibility for our children and teenagers; where youth can achieve their full potential in a safe and supportive environment; where personal responsibility and respect for others are taught and practiced; where we have the tools and support necessary to nurture and guide our children; and where the needs of young people are our highest priority.

23. Vision Continued Demonstrate through our words and actions the importance of personal responsibility and respect for people, places and things. Help children and youth develop self-esteem, discipline and a sense of connection that will enable them to respond to the challenges and become productive members of the community in the future.

24. The CCRB 9 member volunteer board Geographic diversity Ethnic diversity Gender balance Experience from diverse fields Consumer voice Dedicated Independent

25. Step 2� Needs Assessment Creates a statistical story Justifies your case to the local government Justifies your case to the community at large Launches your media efforts Provides the basis for polling Is a snapshot in time

26. Needs Assessments Use the state statute to determine categories for your evaluation. We have 10 services listed so evaluate: Temporary shelter services for runaways Respite care services O/P psychiatric services O/P substance abuse services Services to teen mothers Transitional living services Crisis interventions School based prevention services Home and community based services Counseling

27. Needs Assessments Defining current capacity of your system to provide services (bed space, staff, etc.) Demand for services (requests for services, waitlists) Use of outside resources of data to determine if need is greater than demand Strengths or assets Reputation Accessibility Staff Relationships/partnerships Outcomes

28. Needs Assessments Service gaps (difference between the need and the capacity of the system Cost of filling the gap # of children/youth Average length of stay Cost per unit Creating a summary chart # of children in need Cost to fill the gap Additional family members affected

29. Needs Assessments Use of local data vs. state/federal data Tracking trends Conduct every two years Share with the media Share with the community Cost of Conducting a Needs Assessment

30. Step 3�Polling Locate a local agency, university or individual qualified to conduct polling Needs assessment data is used to create questions Need to survey 400 people to gain statistical confidence of 5% (800 creates a 2.5 plus or minus) May need more surveys depending on size of area

31. Polling What Polling Answers Is there enough support? What demographics support the issue (gender, geography, age, political affiliation, religion) When to go to ballot Messages that will resonate with the voters Arguments you will have to counter How to target soft yes, soft no and undecideds Useful tool for campaign consultant

32. Polling Ask the ballot question Ask questions based on data from needs assessment Ask questions regarding arguments for the passage Ask questions regarding arguments against passage Re-ask the ballot question Demographic questions

33. Other Polling Tips Work with: Someone who has previous experience Someone who is familiar with your area Someone who will work with you on the front end in writing poll questions Someone who will provide you with useable results Consider: Cost of Polls Re-polling

34. Step 4�Getting On The Ballot Share Needs Assessment and Polling Results with local government leaders Willingness to let the voters decide If they can�t support it, can they not come out against it? Petitions

35. Petitions Advantages Larger voter pool Educates the public Opportunity to pass out literature Likelihood of voting in your favor Disadvantages Time consuming Energy draining Cost

36. Petitions Alert local politicians before starting Meet with the Election Authority or County Clerk Consult an attorney for language Develop a pool of volunteers Volunteers vs. paid petitioners Cost Knowledge about issue Rudeness

37. Petitions Tips for Succeeding Use prior voting days Develop large pool of volunteers Set small goals Incentives Locate places with high traffic Circles of Influence Carry it with you Cost of getting petitions signed

38. Step 5� Building A Campaign Team Agency representatives Campaign consultant Honorary chairs Media consultant

39. Agency Representatives Responsibilities Organizing your staff�s contributions (petitions, dispersing materials, yard signs, polling locations) Leadership in campaign matrix Speaker�s Bureau Financial Endorsements Agency commitment contracts

40. Campaign Consultant Responsibilities Analyzes polling results Sets campaign strategy Determines message Approves materials Focuses on undecideds Provides objective, research based methods for message delivery Knows political arena Cost of hiring a consultant

41. Honorary Chairs Responsibilities Provides outside credibility and support Solicit campaign funds Pull in other leaders Having an oversight board in place will allow the public to see who will be in charge of the money The Board can also prioritize categorically how it would spend the money.

42. Step 6--Building a Campaign Matrix Based on geography and support demographics Brainstorm key leaders Determine a captain and co-captain for each area Develop strategies for dispersing materials and disseminating your message Weekly meetings with brainstorming and progress reports

43. Campaign Matrix Target Areas Churches Schools Service Clubs Businesses/Chambers Unions Seniors Health Care Criminal Justice Veterans Women�s Organizations Colleges Daycare Facilities

44. Campaign Matrix School Example Getting School Board endorsement School newsletters Getting materials to principals, teachers and school counselors Getting a list of PTA meetings and PTA Presidents

45. Campaign Costs Best Guess Estimate Includes: Needs Assessment Polling Petitions Consultants Voter IDs Printed Materials Mailing Signage Take 2/3 of County Population

46. Questions?

47. Contact Information Rita McElhany Community Development Manager Missouri Department of Mental Health 573-751-3220 Rita.mcelhany@dmh.mo.gov

48. Contact Information Bruce Sowatsky The Community & Children�s Resource Board of St. Charles County 2440 Executive Dr., Suite 214 St. Charles, MO 63303 636-939-6200 bsowatsky@sbcglobal.net www.stcharlescountykids.org