Guam – The DMHSA has released the following report highlighting its accomplishments in 2012 and its goals for 2013.
Department of Mental Health – “Your Community Behavioral Health Center”
To provide comprehensive inpatient and community-based outpatient mental health, alcohol and drug programs, and services for the people of Guam and to continually strive to improve, enhance, and promote the physical and mental well-being of the people of Guam who experience the lifedisrupting effects of mental illness, alcoholism, and drug abuse, as well as those who are at risk of suffering those effects and who need such assistance; and to provide such assistance in an efficient and effective manner in order to minimize community disruptions and strengthen the quality of person, family and community life. (P.L. 17-21, 10 GCA Chapter 86 & 93, Budget Acts)
GOALS AND OBJECTIVES:
I. INCREASE THE COMMUNITY’S CAPACITY IN THE PRIVATE AND PUBLIC SECTOR TO SUPPORT, SERVE, AND TREAT INDIVIDUALS AND FAMILIES SUFFERING FROM THE EFFECTS OF MENTAL ILLNESS & SUBSTANCE AND/OR ALCOHOL ABUSE.
Objective l: Recruit and hire allied health professionals to include, but not limited to, Psychologists, Psychiatrists, Behavioral Specialists and Social Workers.
Obiective 2: Continue to implement Crisis Intervention Program for individuals and families.
Objective 3: Continue to implement a Community Outreach and Support Program.
Objective 4: Continue to implement Respite Care Program.
Objective 5; Develop additional funding sources to support communitybased programs in tandem with Government agencies to include BBMR, DOA and the Guam State Clearinghouse.
Objective 6: Update and implement a Maintenance Plan for facilities.
Objective 7: Create programs that are ready for community-Based implementation as noted in the Comprehensive Implementation Plan and the Guam Strategic Plan for the Expansion of System of Care for Children/Youth with Mental Health Challenges and their Families.
Objective 8: Federal Management Team’s Plan of Action
II. PROVIDE THE MOST APPROPRIATE TREATMENT, SUPPORT, PLACEMENT, AND LEVEL OF CARE FOR THE DIAGNOSIS AND NEEDS OF INDIVIDUALS REOUIREING THE SERVICES OF THE DEPARTMENT.
Objective 1: Implement multi-disciplinary team in all patient treatment planning.
Obiective 2: Improve behavioral programs for patients with co-occurring disorders.
Objective 3: Develop appropriate programs to expand the professional capacity and workforce development such as Counselors, Psychiatric Nurses, and Psychiatric Technicians for education and training.
Ill. DEVELOP AND IMPLEMENT PROGRAMS RESPONSIVE TO THE COMMUNITY’S MENTAL HEALTH NEEDS.
Objective 1: Implement the Guam System of Care Unified Expansion Plan.
Objective 2: Implement the Client Satisfaction Survey.
Objective 3: Conduct community needs assessment.
Obiective 4: Continue the following programs:
Program Target Group Services
Objective 5: Provide for a new Day Treatment Program as part of the Drug and Alcohol Rehabilitation Program.
Objective 6: Provide for Residential Behavioral Treatment for adult consumer found Not Guilty by Reason of Insanity (NGRI).
IV INCREASE AND IMPROVE THE QUALITY AND LEVEL OF CLIENT/PATIENT CARE.
Objective 1: Reduce the caseload ratio of counselors and case managers per client/patient where warranted. Increase efficiency in those areas identified.
Objective 2: Hire critically needed clinical vacant positions.
Objective 3: Improve current written policies and procedures.
Objective 4: improve and increase availability of medical records.
Objective 5: Upgrade medical charting and record keeping standards.
Obiective 6: Increase staff development and clinical training.
Objective 7: Conduct periodic quality review of services and programs and implament recommendations that improve and correct deficiencies found.
The department continues to be impacted dramatically on all facets of the organization due to increasing demands of federal and local mandates. Program mandates are affected by federal laws that are enacted to address program weaknesses and enforcements. DMHSA strives to provide the best level and quality care and ensure a safe and healthy environment for both patients and statt, with available resources, as well as to explore other means that will support and maintain objectives. Critical and vital objectives of main concern and calling for greater attention:
* Availability of qualified clinicians and support staff recruitment retention.
* Current ratio of consumers (clients/patients) to professional care providers of services and the level of care, type of service, and treatment they need that must be addressed in the multi-disciplinary determination process.
* Availability and access to services provided by other departments such as the Department of Integrated Services for Individuals with Disabilities (DISID), GHUHA Housing, Food Stamps, Welfare, Public Health, Child Support Services, etc.
* Community support for residential, group homes, and other programs in the neighborhood.
* Overall mental health of our community and address the issue of stigma.
* Funding from federal grants and other sources.
* Cultural milieu of island regarding conceptualization of mental health.
DMHSA is constantly facing shortages in critical clinician position mostly because of the lack of qualified professionals on the island (i.e., psychiatrist, counselors, pharmacist, and nurses). Although the department has made some progress at acquiring the services of these professionals, much more needs to be done.
Funds for medical supplies have been made available but pharmacy stock level are still being addressed due to a lack of adequate local suppliers and the cumbersome procurement regulations that govern psychotropic medications. The department is still focusing on refining the process within the confines of regulations so the DMHSA may readily obtain the medications required for consumers in the most efficient manner.
Continued funding for implementation of the DMHSA Comprehensive Implementation Pian is also critical to meet minimum care and national Olmstead requirements.
We envision that through “Caring Communities,” DMHSA will be the forefront health care service provider. Major accomplishments have already been made and are listed as follows:
* Implementation of the Direct Support Provider Program.
* Continuation of reducing the residential Wait List.
* Implementation of the Guam’s Comprehensive Implementation Plan that provides community services and supports for proper placement of individuals with disabilities in the least restrictive settings.
* Improvement of our Management information System (MIS), which sets to successfully implement electronic recordkeeping of clients’ records, electronic filing of documents, and provide for paperless filing of records.
* Organization and implementation of Muitidiscipiinary teams to comply with the mandates of the Amended Permanent injunction.
* Opening of four new group homes.
* Authority to bill and collect for adult fees and services through P. L. 31-239.
* Capital improvement projects ongoing or near completion are for the facility cable system, entry cover and reception waiting room area, recreation area cover, window refurbishment, furniture for ward and out-patient waiting area, exterior lighting for parking lots, electric lights re-wiring, maintenance storage building, and exterior painting to name a few major projects.
* Completion of the updated Guam Profile 2011 on Substance Abuse and Suicide.
* Development of Mass Media Campaign and Training for Suicide Prevention.
* Establishment of Governor’s Executive Committee for System of Care through Executive Order 2012-16.
* Fees and services for Children Adolescent Services Branch authorized by Public Law 31-274.
* Read Flag/Green Flag presentations conducted in 9 local elementary schools.
* Nurse examiner recognized and received the National Sexual Violence Flesource Center’s 2012 Visionary Voice Award and the received National Recognition Citation from the Governor’s MagPro Awards.
The Department of Mental Health & Substance Abuse operations covers an array of many important and critical purposes. They range from providing the best level of health care services to the development of a “road map” to continue the “TFlANSFOFlMATlON” to community-based, consumer and family driven continuum of services and support. Through the adoption of the concept “Caring Communities”, our families are given the opportunity to have a “voice” of their service delivery.
These priorities include sustainability of our operations that include recruitment and retention of critical staff, encumberìng contractual obligations, and securing potential outsourcing of programs.
The department’s operational needs are based on local and federal mandates that must be focused on by every government body who participate inthe sphere of mental health care from the community (mayors), to hospitals/clinics/DPHSS, to judicial services, and all others that affect the success or failure of service delivery for behavioral (mental health) care. Our mission can only be achieved successfully through the positive contributions of all who influence in some way the outcomes of DMHSA efforts. Federal audits, lawsuits, and court orders mandate services must be fulfilled to avoid injunctions and penalties and further adverse actions through inactions. DMHSA continues to work with available resources to ensure continuing
compliance of the amended permanent injunction and the plan of action. Funding for the plan is currently being provided by the U.S. District Court order for deposit of stipulated installments specific to the implementation of the plan as scheduled by the Federal Management Team.
Our services are provided throughout the Community starting with the intake process at our main facility in Tamuning, auxiliary services at our satellite offices in Hagatna and referrals to the appropriate living and treatment centers throughout the Community rendered by a staff of 191 GovGuam employees and an array of contracted service providers. More information and related resources for “Your Community Behavioral
Hea/th Center’ can be found at www.dmhsa.ouam.oov. www.oeaceouam.oro and www.icareouam.oro
Prevention and Training Branch 2012 Highlights
Garrett Lee Smith Memorial Act Grant (Youth Suicide Prevention) (FY 2015)
Substance Abuse and Prevention Treatment Block Grant (Ongoing)
State Prevention Enhancement Planning Grant (FY 2012 – FY 2013)
FDA State Tobacco Compliance Check Inspection Grant (FY 2013)
Synectics – SEOW (FY 2011-FY 2013)
Focus on Life – Suicide Prevention and Earlv Intervention
1. Establish and/or improve Guam’s surveillance and centralized monitoring and reporting system for capturing data on suicide attempts and deaths, as well as other intentional self-harming that is reportable by identified private and public sector partners;
2. Strengthen public, private and community-based partnerships with the development of culturally relevant suicide prevention resources and training for responding effectively to the community’s identified needs for suicide prevention and education, early intervention, and treatment services;
3. Strengthen Guam’s 24-Hour Crisis Hotline services with the hiring of full-time staff and recruitment and training of community volunteers;
4. Implement culturally appropriate evidencebased suicide prevention policies, programs, and practices among Guam’s key stakeholders; and,
5.. Evaluate the program effectiveness to reduce preventable injuries and suicides and attempts on Guam.
1. Increase community awareness and understanding that suicide is a public health problem that is preventable;
2. Develop broad-based support for suicide prevention in the development and implementation of culturally appropriate, evidencebased prevention programs, policies and practices;
3.. Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse, and suicide prevention services;
4. Develop and implement culturally appropriate, evidence-based communitybased suicide prevention programs;
5. Promote efforts to reduce access to lethal means and methods of self-harm;
6. Implement training for recognition of at-risk behavior and delivery of effective treatment;
7. Develop and promote effective clinical and professional practices;
8. lmprove access to and community linkages with mental health and substance abuse services
9. lmprove reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the entertainments and news media;
10. Promote and support research on suicide prevention; and,
11. Improve and expand on Guam’s Suicide Surveillance and Monitoring System.
Accomplishments to Date:
*Applied Suicide Intervention Skills Training (ASIST) and safe TALK
*23 trainings hosted
*Certified 248 individuals in ASIST and 185 in safeTALK
*Gathering of Native Americans (GONA)
*1 training hosted
*25 individuals completed 4-day workshop
*13 individuals continued for certification to become trainers
*Holiday Crisis Hotline
*Trained at least 10 new community volunteers to be hotline responders
*Received 15 calls, with issues of relationship problems, grief, needing medical assistance, sexual abuse and social problems
*Other outreach presentation and display
> Participated/Hosted 11 outreach presentations at schools, through nonprofit organizations, and in partnership with other government agencies
> Includes suicide prevention forum hosted by the UOG’s |’Pinangon Suicide Prevention Program
> Had a total audience of 962 youth and adults
PEACE State Prevention Enhancement
1.Prevent or reduce consequences of underage drinking and adult problem drinking;
2. Prevent suicides and attempted suicides among populations at risk, including military families and
3. Reduce prescription drug misuse and abuse;
4. Enhance state workforce development; and
5. Develop and enhance Government of Guam policy and funding to support needed services for mental health and substance abuse system improvements.
Objective: To develop a five-year comprehensive plan for PEACE; To bridge the prevention infrastructure with the mental health system of care, Guam’s SPE for PEACE will establish systematic linkages between Guam’s substance abuse and mental health infrastructure that will highlight the correlation between tobacco use, alcohol abuse, mental illness and suicide risk.
Accomplishments to Date:
Completion of four Mini Action Plans for PEACE SPE centered around Data, Coordination of Services, Training and Technical Assistance and Evaluation
Substance Abuse Prevention and Treatment Block Grant
The Prevention & Training Branch staff provides technical assistance, training and resources to policy makers, program managers, community coalitions (faith and school-based), and public and private sector leaders in an effort to empower community-based program leaders with tools and opportunities to effectively reduce the incidence and prevalence of alcohol, tobacco and other drugrelated problems, and to promote overall health and wellness. This Branch adopted the public health model of prevention that recognizes that prevention is a lifelong process and attempts to reduce both the supply of and the demand for alcohol, tobacco and other drugs. Prevention programs and services involve the use of six strategies: 1) information Dissemination, 2) Education, 3) Alternatives, 4) Problem Identification and Referral, 5) Community-Based Process, and 6) Environmental and Social Policies.
1) To annually update Guam’s Substance Abuse Epidemiological Profile, 2006 and A Profile of Suicide on Guam, January 2009;
2) To document process and outcomes in the implementation of Guam’s Comprehensive Strategic Prevention Framework Plan and the collaborative work accomplished with Guam’s Community Coalitions for Prevention and Early Intervention;
3) To maintain and update the Prevention and Training Branch website: www.peaceguam.org as well as an annual Mass Media Educational Campaign on Prevention;
4) To develop and implement evidence-based prevention programs for Guam’s targeted communities that are based on established datadriven, substance use priorities (tobacco and alcohol), cultural appropriateness and relevant strategies;
5) To implement Guam’s Comprehensive Plan for Youth Suicide Prevention and Early Intervention, entitled “Focus on
6) To strengthen Guam’s workforce in the public and private sector and in particular to increase and sustain a pool of Certified Prevention Specialists, Tobacco Cessation Program facilitators and trainers for Applied Suicide Intervention Skills Training (ASlST);
7) To strengthen program components for evaluating process and outcomes and to utilize these findings to improve and sustain prevention and training branch services; and
8) To establish MOUs with key public and private sector partners in an effort to leverage available resources and to sustain positive outcomes as a result of established prevention programs, policies and practices implementation.
Accomplishments to Date:
*Substance Abuse Prevention Skills Training
> 1 training hosted
> 19 individuals completed a 5-day training
*Youth for Youth LIVE! Guam Annual Conference
* Attended by approximately 60 youth leaders and 400 participants (middle and high school students) from Guam, CNMI, and Native American tribes
*Substance Abuse Prevention Mini-Conference
* Hosted 1 miniconference, in partnership with Jose Rios Middle School
*Attended by at least 10 youth leaders and 53 student participants
*SYNAR Tobacco Compliance Inspection
*98.3% of establishments licensed to sell tobacco were covered in the inspection; that is 328 or 337 total establishments
*93.1% were found in compliance to tobacco retail laws
*22 on-site citation issued and fines assessed, in partnership with the Alcoholic Beverage Control at the Dept. of Revenue and Taxation
*One Nation Liberation Day Parade
*31 families pledged to host panies/tents at the parade route
*29 families of the 31 were confirmed to be in compliance
*Responsible Beverage Skills Training
*7 individuals participated in a 2-day training of trainers, 3 of them represented the Prevention and Training branch of DMHSA
*Other outreach presentation and display
*Participated/Hosted 11 outreach presentations at schools, through non-profit organizations, and in partnership with other government agencies
*Includes town hall meetings on underage drinking hosted by non-profit organizations such as Astumbo Middle School Parent-Teacher Organization, *UOG Student Services Office, Christian Life Center, St. Jude Confirmation Class.
*Had a total audience of 789 youth and adults
*Youth Summer Water Safety Instruction Program
*35 youth leaders (age 12 through 18) and 201 youth participants (age 5 through 15) completed this 6-week summer program
*Non-Communicable Diseases Consortium
*The department was well-represented in two committees of the NCD Consortium – Alcohol Abuse
*Prevention and Tobacco Abuse Prevention
*Stress Management Workshops
*Hosted 2 Stress Management workshop in partnership with the Dept. of Administration
*Trained a total of 86 individuals
Continued to produce and implement media campaigns and youth-oriented talk shows:
o Youth Talk Today! (in partnership with Sorensen Media Group)
o One Nation, Alcohol-Free campaign
o Focus on Life Suicide Prevention campaign
FDA State Tobacco Enforcement
Goal: To enforce FDA’s new regulation that prohibits retailers from selling cigarettes and smokeless tobacco products to children under 18,
Synectics – State Epidemiological Outcomes Workgroug iSEOW)
To promote the strategic use and dissemination of data for informing and guiding Guam’s substance abuse prevention and behavioral health promotion policy and program development, decision-making, resource allocation and capacity building.
1.Systematically collate and analyze relevant data (including but not limited to consumption and consequences of alcohol, tobacco, and other drug (ATOD) use, and risk and protective factors for mental health) to delineate and better understand the magnitude and nature of substance abuse and
mental illness on Guam and to effectively and efficiently utilize resources for substance abuse prevention and behavioral health promotion
2. Promote data driven decision making across all stages of the Strategic Prevention Framework throughout the State substance use prevention and mental health system
3. Strengthen and build capacity and data infrastructure for effective data utilization for substance abuse prevention and behavioral health promotion
4. Facilitate inter-agency and community collaboration to optimize the exchange, access, and utilization of data across organizations and stakeholders working on substance abuse prevention, mental health promotion and other related fields
5. Provide technical support to key health policy and program leaders, and community stakeholders to promote cross-systems planning, program integration, implementation and monitoring for substance abuse prevention and mental health promotion.
Development of Guam’s SEOW Charter and continued partnerships with SEOW members in the annual updates, production and distribution of Guam’s 2011 Epi-Profile on substance abuse and suicide.
I Famagu’on-ta Child Adolescent Services Division 2012 Highlights
To establish a unified System of Care across all of Guam’s child serving agencies which includes a broadly supported, sustainable array of home and community-based services that enables children and youth to achieve their maximum potential building on the strengths of Guam’s diverse families, provided by skilled providers trained with System of Care values, principles and best practices.
1.Raise awareness of Guam’s child and adolescent mental health needs.
2. Reduce the stigma of mental illness and increase referral of mental health services.
3. Promote systems of care and wraparound for positive child/youth development, recovery and resilience.
1 January-February, 2012. Hired four personnel for the System of Care Expansion Planning Grant, a $500,000 federal grant award to develop strategic plan unifying and expanding Guam System of Care for children/youth with mental health challenges and their families.
2. March, May and September, 2012. Held 3 planning summits to accomplish the development of a Guam, unified and expanded system of care for children and youth with mental health challenges and their families. This will bring /Famagu’onta and Project Karínu together as a unified system of care for children from birth to 18 years of age.
3. October, 2012: The Guam strategic system of care expansion plan was finalized pending printing for distribution.
4. October, 2012: lnitiation of the Saturday column on children mental health and related topics in the Pacific Daily News.
5. November 8, 2012. Governor Eddie Baza Calvo signed the Executive Order No.2012-16 establishing the Governor’s Executive Committee For System of Care. This will be publicly presented when the Guam Strategic Pian on System of Care Expansion booklet is ready for distribution. Anticipated date is February 2013.
6. December 4, 2012. The artwork on “System of Care Through the Eyes of Children”, a 5 large mural was completed and exhibited at the Guam Council of the Arts and Humanities Gallery in Hagatna. This is the work of young people with the guidance of their art teachers. This project was
funded through a CAHA grant awarded to lFamagu’onta.
7. SERENITY Horne, a step down/transition and respite home for adolescent with mental health challenges successfully transitioned one of the residents into a therapeutic foster care placement. Altogether, DMHSA has 3 therapeutic foster care homes for our special needs children/youth.
8. December 26, 2012. /Famagu’onta Children Adolescent Services Division Fee Schedule was signed into law. This fee schedule allows for the Medicaid billing of system of care type of services as well as private insurance billing.
9. December 28, 2012: Celebrated our 13th annual Christmas Cheer for our children/youth and their families at /Famagu’on-ta Office. Over 190 children/youth and their families attended. Donations from numerous businesses were used for this event.
Goals and Events for 2013
1. To publicly announce the creation of the Governor Executive Committee for system of care.
2. To Launch a new website for children’s services at www.icareguam.org
3. Conduct 2 presentations at the NASW Social Work Conference on: (1) The System of Care Expansion Plan, and (2) Training on the Core Content of the Crisis Counseling Program (CCP).
4. To continue the implementation of the Guam SOC Expansion Plan
5. To hold the 13th annual Art of Healing Project artwork display of students from K-12 grade during mid April and mid May. April is the Young Child Month and Child Abuse Prevention Month and early May is Children Mental Health Week. The artwork will be on display at the Agana shopping center.
6. To reclassify the 10 I Famagu’onta personnel that are still unclassified employees to ensure the sustainability of system of care and wraparound.
7. MAY 2013. Children Mental Health Awareness Week. Some of the events for the week is the 2nd annual School Personnel System of Care Ambassador Award, Open House at I Famagu’on-ta, and the Big Awareness Wave.
8. Summer Blast (Late enrolled children and youth, 4-6 weeks of Summer activities to keep them busy , productive and safe during nonschoo| days.
9. Organizing the 6th Annual System of Care Conference and Training Institute on Mental Health First Aid, training of trainers.
Healing Hreats Crisis Center 2012 Highlights
Mission: The Healing Hearts Crisis Center incorporates a holistic approach for individuals who may have experienced a sexual assault. Regardless of when the assault occurred or the age, race or sex of the victim, Healing Hearts offers a supportive, healing atmosphere with caring people to assist them in regaining feelings of safety, control, trust, autonomy and self esteem.
1) To improve the collection of evidence in sexual assault cases, which will assist with the successful prosecution of criminal sexual assault cases; improve the use of the Multi-Disciplinary Team.
2) To ensure that survivors of sexual assault are provided with the necessary support/resources to report and participate in the investigation and prosecution of criminal sexual conduct cases.
1) Recruitment of the HHCC Program Manager and Social Worker III.
2) Participation in the Task Force on the Prevention of Sexual Abuse of Children within the Child Protective Act.
3) HHCC Nurse Examiner achieved certification as a Pediatric Sexual Assault Nurse Examiner (SANEP).
4) A memorandum of Understanding between HHCC and the Guam Sexual Assault and Abuse Resource Center Association (SAARCA) was signed and approved by the Governor of Guam to promote cooperation in the fulfillment of the mutual interest and objectives between the two organizations and implement programs and services, diversify funding and decrease sexual violence.
5) Preliminary work began to establish a Sexual Assault Survivors Support Group.
6) HHCC was chosen as DMHSA’s nomination for unit of the year for MagPro Awards.
7) HHCC Nurse Examiner received the National Sexual Violence Resource Centers 2012 Visionary Voice Award and the National Recognition Citation for MagPro.
8) Staff training included: Social Worker ll attended the 26Ih Annual San Diego International Conference on Child and Family Maltreatment in San Diego, California , On-Call Medical Examiner attended “Forensic Investigations: From Scene to Courtroom in Kansas City, Missouri, all HHCC attended “Heart of Healing: Secondary Stress” on Guam, Program Manager attended the National Sexual Assault Conference in Chicago, Illinois, Social Worker lll attended the American Professional Society on the Abuse of Children’s Child Forensic Interview Clinic in Seattle, Washington
HHCC Nurse Examiner attended the 20lh Annual Scientific Assembly sponsored by the International Association of Forensic Nurses in San Juan, Puerto Rico.
9) 2 peer reviews were conducted in calendar year 2012.
10) Red Flag/ Green Flag presentations were conducted at 9 local elementary schools reaching out to over 2.800 students, teachers, librarians, school aides, school nurses and counselors.
11) Statistics: 156 clients were served in calendar year 2012; 56 medical examinations were conducted; 8 multi-disciplinary team interviews were conducted; 30 Guam Police Department Sexual Assault kits collected.