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IS CO State Gov't EVER GOING TO ACCEPT ITS RESPONSI-BILITIES UNDER OLMSTEAD TO PROVIDE HOUSING FOR PEOPLE WITH DISABILITIES?WITHOUT MAJOR CHANGES -- IT DOESN'T LOOK LIKE IT

6/15/2019

Any State Administration is faced with A LOT of issues. The more they have to RE-INVENT THE WHEEL the longer things are going to take, especially if they feel like they have financial and or political incentives not to do it.

    This has really been a corrupting influence on some of the nicest people in Colorado politics, including the Hickenlooper Administration.

Well, now we have the Polis Administration which is setting off on a bold & ambitious Behavioral Health Task Force that is really largely the culmination of a 10-year lawsuit against the State -- the Jail Wait Case.

THIS IS REALLY, REALLY PROMISING.

But we still have the promise of the Americans with Disabilities Act, Olmstead, subsequent caselaw and US Dept. of Justice Guidance that if States can't fully comply with legal requirements to provide services, housing, etc. to prevent unnecessary institutionalization of people with disabilities -- States need Comprehensive, Effectively Working "Olmstead Plans" with:

Measurable Goals
Reasonable Time Frames, &
Funding To Support the Plan

Is Colorado going to get to that anytime soon? Colorado's affordable housing crisis hits people with cognitive disabilities pretty much like A TON OF BRICKS.

Providers and Case Managers can't spin straw into HOUSING .

  Under Olmstead, housing for people with disabilities who are institutionalized or at great risk of institutionalization such as from homelessness is the responsibility of the STATE.

  Is that ever going to be realized without more SUPPORT & ENFORCEMENT from the FEDS for Compliance with the pre-imminent Federal Disability Civil Rights Law of this Country -- the ADA. .

  Well, maybe BUT it is probably going to take much longer without MAJOR FEDERAL ENHANCED SUPPORT & ENFORCEMENT. Further, a lot of the people who are suffering NOW will be gone if we stay on our current trajectory.

The Olmstead US Supreme Court decision was decided in 1999.

Photo Credit: atlantalegalaid.org

IRREPARABLE HARM, HOMELESS-NESS & MEDICAID REASONABLE ACCOMMODA-TIONS PENDING HOUSING

6/13/2019

WHEN THE STATE DOESN'T HAVE THE RESOURCES & PROVIDERS ARE BURNT OUT--

Maybe we wouldn't be so persistent IF we hadn't been here before --- but we have -- in a situation that was arguably much less dire than this.

Cclorado's lack of Affordable Housing and Comprehensive Mental Health Continuum of Care is AT THE ROOT of Many Crises Affecting Coloradans with Mental Illness.

So the proposed answer is often to go to the ACUTE TREATMENT UNIT. This often DOESN'T WORK to solve access to Affordable Housing or a Comprehensive Mental Health Continuum of Care.

BUT MAYBE IT COULD.

Quite frankly, Regional Accountable Entities, Intensive Case Managers don't have the MOJO to come up with HOUSING on the FLY and they are already pretty BURNT OUT.

Now, we're really in the situation with the person with a mental illness -- with the provider with burnout. We could say: YOU SHOULDN'T BE BURNT OUT. That is not going to change anything. And like most mental conditions, there are good reasons for it.

Colorado State Government under the Polis Administration is in the process of doing a major overhaul of Behavioral Health -- BUT all of that is in PROCESS.

So how could we work with the ATUs and what Colorado Medicaid currently has with "REASONABLE ACCOMMODATIONS" to buy more time to get the LEAST RESTRICTIVE ENVIRONMENT the LAW provides for.

DISCHARGE PLANNING

Acute Treatment Unit, Discharge to
Nursing Home, discharge planning arrangements to
Housing & Intensive Treatment

In many cases Nursing Homes are going to be the better choice because they have access to Medicaid Nursing Home Transition Coordinators already.

If there are no nursing homes that will take the person, Medicaid coverage of short-term hospitalization up to 45 days could also provide the necessary bridge to Housing and Intensive Treatment with enhanced discharge planning.

"RESEARCH IS EVERYBODY'S BUSINESS"

6/12/2019

A key AHSC [Academic Health Science Centre] priority is to nurture a research culture and boost numbers of Healthcare Professionals engaging in clinical academic research across all AHSC partner members. There is a growing number of healthcare professionals bringing their expertise and questioning minds to the research table and leading high quality research aligned to patient and health service priorities.

----Imperial College London

Britain like the US is facing a Mental Health Crisis straining its Economic Resources. They also recognized that it was taking 17 years for most discoveries in the lab to make it to patients.

Some of the most important mental health research is going on in the US and Colorado, much is also going on in the UK and other countries.  Further, in the UK-- a conscious, concerted effort has begun to span the GAP between Researchers and Clinicians.

   Additionally, mental health research is much more broadly reported in the UK, with much credit owing to BBC Health & Science Reporter James Gallagher.  Some of the research we put on the Orchid website -- may sound really "out there" to our primary audience -- some of it might be old news in the UK -- and certainly if one is paying attention.

RIght NOW, Colorado and pretty much the rest of the US is on track to get current research understandings to Clinicians in 17 to 20 years.

Researchers don't have all the answers, but many of our Mental Health Researchers do know better than what our Clinicians are doing. That is NOT the fault of Clinicians.

   If we want to do better we need to start providing greater INTEGRATION of Research and Clinical Practice as the UK and Europe are starting to do.

BBC Health & Science Correspondent James Gallagher

BBC health reporter James Gallagher explores the increasing body of evidence that a dysfunctional immune system is responsible for the depression or psychotic illness experienced by hundreds of thousands, perhaps millions, of people in the UK.

James talks to the psychiatrists investigating this new understanding of mental illness and to people who may benefit from treatments aimed at the immune systems rather than their brain cells.

Inflammation, the Immune System & Mental Health

"The UCLPartners [Academic Health Science Centre] AHSC harnesses world-class academic and clinical specialty expertise to accelerate the development of new treatments, diagnostics and prevention strategies to transform the health of the population.

"The UCLPartners AHSC is one of six accredited AHSCs in England and is the largest in Europe. The role of AHSC – awarded in recognition of depth and breadth of clinical and academic excellence – was originally granted in 2009 and was renewed for a further five years in April 2014.

"Over this period, we have sought to set a new benchmark for what can be achieved through academic and clinical partnership, by harnessing strengths and aligning resources from across our eight partner organisations to drive world-class research, translation, care and education."

BREAKDOWN: Disability civil rights

6/11/2019

THE NEED FOR TEMPLATES & CHECKLISTS

FOR "REASONABLE ACCOMMODATIONS," "LIMITED" GUARDIANSHIPS, VARIOUS CERTIFICATIONS TO AVOID TREATMENT DENIAL, HOMELESSNESS, INCARCERATION, ETC.

So the biggest problem facing people with COGNITIVE DISABILITIES is largely LACK OF RESOURCES.
BUT we make our RESOURCE NEEDS even LARGER when we can't effectively utilize the LAWS & RESOURCES we already have.
Colorado's Cross Disability Coalition has really been on the CUTTING EDGE of this with regard to:

Limited Guardianships
& the Right to "Reasonable Accommodations" under the Americans with Disabilities Act & Section 504 of the Rehabilitation Act of 1973 for government programs such as Medicaid.*

    Are these brand new laws? No, but if you're working with a BLANK SLATE of "REASONABLE ACCOMMODATIONS" or "LIMITATIONS to GUARDIANSHIP"-- these laws can be pretty difficult to implement even with a high knowledge of the law -- which most people don't have.

   By and large most providers want to do the right thing, BUT by and large most providers are often NOT doing the right thing when it comes to their most difficult mental health patients.

   Even IF the tools already exist to deal with our most difficult situations:

If we're not aware of those tools, and/or
Don't know how to use them --

Those tools are not going to help providers or individuals. Further, there are not enough attorneys or advocates to help the THOUSANDS that need them.

These issues do impact a significant percentage of people with mental illness, they also greatly impact people with a full range and combination of cognitive disabilities.

We need government subdivisions working with inclusive groups of Stakeholders to work on these issues so that NONE OF US are left with a BLANK SLATE often rendering laws meant to protect people with disabilities MEANINGLESS.

*Section 504 of the Rehabilitation Act prohibits discrimination in federally funded programs. Title II of the Americans with Disabilities Act prohibits discrimination in Local & State Services. Medicaid is a hybrid Federal/State program.

The US Supreme Court's decision in "Olmstead" [1999] is NOT limited to Medicaid and does include HOUSING for people with disabilities to prevent unnecessary institutionalization or the great risk of institutionalization inherent in homelessness.

CCDC's Probate Power Program

Probate Power focuses exclusively on special needs planning, estate planning, and probate administration services.

These services include, but are not limited to, simple and complex wills, special needs trusts, revocable living trusts, financial power of attorney documents, uncontested guardianships/ conservatorships, ABLE accounts, and advanced medical directives.

THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

6/10/2019

So let's say, the Medicaid mental health provider of someone in a residential placement :

filed a restraining order
pursued criminal charges for "harassment"
the person with serious mental illness is now or is on the verge of becoming homeless

What kind of human resources must be allocated to avoid homelessness or incarceration @ this point: A LOT.

Even if the Medicaid provider or Regional Accountable Entity finally steps up to do the right thing, they are often NOT prepared for the HEAVY LIFTING that is required. -- and the CLOCK IS TICKING.

This week we will start work on a Draft Application for Emergency Order and post on the website focusing largely on a Medicaid mental health recipient who is facing lack of treatment and homelessness due to State inaction or action. The Mental Health Center and the Regional Accountable Entity will also likely be included as Defendants.

If the situation in question is resolved QUICKLY -- our Application may not be necessary. Unfortunately, this is NOT an isolated incident.

While it is true much work is going on @ the state level on Behavioral Health -- Medicaid recipients with serious mental illness & their families need EMERGENCY RULE MAKING to address their concerns.

In some situations, it may be appropriate for the State to provide Hotel Vouchers until permanent housing can be obtained and the Mental Health Center and Regional Accountable Entity can arrange intensive services, including Assertive Community Treatment if appropriate.

Getting the situation out of the EMERGENCY category reduces the Stress on EVERYONE and increases the likelihood of cooperation and better decisions going forward.

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

6/8/2019

The "Horcrux" of the problem in Criminal Justice is NOT that we're concerned about SAFETY. It is that our concern for PUNISHMENT is preventing us from realizing our SAFETY objectives.
It has also created one of the most inefficient, ineffective & unjust systems in American Society & largely the Western World -- the American Criminal Justice System.
Those long criminal dockets are pretty darn unnecessary.
There are some cases in which everything is @ issue. That's not most cases.
The primary issue in most cases is the PUNISHMENT.
Well, the Criminal Justice System has been trying to include TREATMENT in its range of options for decades. The advent of Medicaid Managed Care has not made that easy. Of course, it wasn't easy to begin with.
Further, the Criminal Justice System is going to determine homelessness, discrimination, poverty, substance issues, & disability largely IRRELEVANT to their determinations, except in very narrowly prescribed circumstances.
SO we can never reduce the CRIMINAL JUSTICE DOCKETS because we can't, we think we can't or we won't deal with underlying ROOT CAUSES.

The DUE PROCESS people need is not in trips to the Courthouse for Arraignment and the many court dates set after that for DISPOSITION -- because the range of alternatives is INSUFFICIENT and can be HORRIFIC.

There are cases that DO NEED a lot of attention in order to DETERMINE THE FACTS -- but those cases/people can't get it because the SYSTEM is so overrun with cases that don't need to be there.

Further, if we try to work with people rather than against them we may find that in some cases it is THEY not US who are arguing for a HIGHER LEVEL of TREATMENT & PLACEMENT.

The more we base treatment & placement decisions on objective health & social determinant of health data and on an inclusive set of considerations rather than an exclusive set of considerations-- the more COMMON GROUND we'll find.

J.K. Rowling

A Horcrux is an object formed by dark magic that is used by a wizard or witch in the Harry Potter series. Horcruxes are created to achieve immortality by splitting a dark wizard's soul into separate pieces.

--dictionary.com

Legal Reform: How to Cut Criminal Justice Dockets in half or more?

6/7/2019

Photo Credit: US Chamber Institute for Legal Reform. Of course, people and organizations have different opinions on what constitutes "reform."

"[I]t will take a combination of technological improvements, procedural simplifications and maybe even 'breaking down the lawyer cartel' for the access to justice problem to be mitigated."

---LAW360, Access to Justice

The Access to Justice article referenced above is about DIVORCE -- but it could also be about -- GASP! -- CRIMINAL JUSTICE.

What drives Criminal Justice Dockets is failure to provide appropriate and humane placements & services over the long term.

Our Society does NEED the skills lawyers & judges possess -- but those skills are often being wasted in not only grossly inefficient legal systems but also grossly ineffective legal systems as well.

Part I: Get Rid of Probation, Jail & Prison -- Provide for Weaknesses & Strengths

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

PART I: HOW COULD WE CUT CRIMINAL DOCKETS IN HALF OR MORE? GET RID OF PROBATION, JAIL & PRISON-- PROVIDE FOR WEAKNESSES & STRENGTHS

6/6/2019

[The policy prescriptions below may not sound very much in the "middle" -- BUT from our perspective they really are]

Provide a menu of individualized services & housing, placements that are available based on demonstrated need, including:

Supported Employment
Vocational Rehabilitation, including access to educational supports
Placement determinations in which victims, if any, do have a voice
Access to appropriate level of treatment and/or placements for:
- Brain Injury
- Mental Illness
- Developmental Disability, including HIGH IQ ADHD or Autism
- Substance Use Issues
- Sex Offending Behavior
Strength-Based Development of talents, abilities, hopes, aspirations & goals.

One of the places we really get into trouble is we UNDER-ESTIMATE the level of difficulty of RE-INTEGRATING somebody SAFELY back into SOCIETY -- both for the person and for the Society.

So we're NOT for:

Understating the Risk or Difficulty the situation presents, BUT
We're NOT for overstating the Risk or Difficulty either.

Some people may be truly dangerous, SOME people are EMOTIONALLY OVEREXCITABLE --- & when that EMOTIONAL OVEREXCITABILITY is MISINTERPRETED -- Some [maybe most] of those People become even more EMOTIONALLY OVEREXCITABLE.

Well, now we're really OFF TO THE RACES. We think this "overexcitability" is really @ the heart of what the "GIFTED" Community is complaining about with regard to "misdiagnosis." The problem-- it appears these "overexcitabilities" can damage the immune system and ultimately the brain.

Our Society is going through some growing pains with regard to the NATURE of Intelligence. It is pretty clearly NOT what we thought it was. In fact, the disconnect between what we "thought" and "reality" has become so pronounced that the industry that has grown up around "Emotional Intelligence" is BOOMING.

Well, unfortunately many of the people the "emotional intelligent" people would label as TOXIC are in fact "gifted" people with "overexcitabilities" that the "emotionally intelligent" people don't like.

AND that is one of the reasons it is so important to NOT only provide accommodations for weaknesses, BUT also provide access to opportunities to develop strengths & talents.

High IQ & Psycho-Neuro-Immunology

The "Epidemic" of "Misdiagnosis" in the "Gifted" Community

Bringing "Giftedness" Down To Earth So We Could Recognize It In Unlikely Places

When We Don't Tackle Complex System Issues like Guns & Mental Health -- We Almost Always SCAPEGOAT Individuals

6/6/2019

The mishandling of the Arapahoe High School Shooting was every bit as bad as that of Parkland.

But the problem wasn't with security it was with administration officials -- including the firing of security officers for TELLING THE TRUTH.

The Arapahoe High School Community is STILL dealing with the fallout, BUT it recently rejected a bid to SCAPEGOAT Principal Pramenko even though some of the actions of Pramenko & Littleton Public School District officials were pretty bad.

If we are NOT for SCAPEGOATING -- & we're NOT -- what are we for -- dealing with the TOUGH SYSTEMIC PROBLEMS these TRAGEDIES EXPOSE -- the BAD JUDGMENT CALLS are CLUES.

SCAPEGOATS, SACRIFICIAL LAMBS &

AMERICAN
CRIMINAL JUSTICE

America's Justice Problems are NOT limited to the Criminal Justice System -- BUT they are worse there than anywhere else.
There are some pretty FUNDAMENTAL, STRUCTURAL Problems that are driving this:

The US Bill of Rights includes some pretty BROAD protections that are meant to protect Individuals and Minorities.
However, the American Judiciary has never quite lived up to its promise of being an INDEPENDENT CO-EQUAL BRANCH of Government. Yes, it will on highly selected occasions declare something unconstitutional or illegal -- but there are A LOT of POLITICAL CALCULATIONS that go into that.
Long Time ideas of CAUSATION going back to English Common Law -- and before that ---govern HIGHLY COMPLEX HUMAN BEHAVIOR in HIGHLY COMPLEX SOCIAL ORDERS. Do we need to know who did it? -- Yeah, BUT we need to know A LOT more, too.
Much of what is most critical to know: the Justice System will determine as IRRELEVANT.
So the ROOT CAUSES of our problems OFTEN don't get SOLVED -- BUT if we PUNISH somebody-- we call it GOOD.
IT'S NOT GOOD and it has led to the replacement of the US as the protector of AMERICAN VALUES. Remember those values are IDEAS and some countries are implementing those IDEAS much better than we are.

Image Credit: economictimes.indiatimes.com

Organizations need scapegoats to take responsibility for failures

THE VERY LARGE INTERSECTION BETWEEN PERSON-CENTERED, STRENGTH-BASED CARE AND SAFETY

6/5/2019

   Throughout most of human history including modern history, we've generally thought we needed to get the community's CONSENSUS to HATE on BAD PEOPLE to protect ourselves.
I remember one of the GREAT attorneys I knew, and I have known many, was fond of saying:  "Well, the DEATH PENALTY will deter this person."
   We're generally pretty far past the "BLOOD FEUD" -- although some gang violence looks a lot like it.
  Far from being complicit in most horrible crimes, today it's concerned family members and friends who may be contacting law enforcement.
   If you're a social worker, or a public interest attorney or in public health--you probably already know, that when SOCIETY washes its hands of people-- people tend to get worse.
   On the other hand, we can't ask the Community or Providers or Law Enforcement to be in unsafe or perceived unsafe situations.
Now, sometimes folks, including providers, will say: THE PERSON WON'T ACCEPT TREATMENT.
This is where the skills of creative lawyers & advocates can really be of great use. BUT the truth is we DON"T need & there aren't enough lawyers & advocates for every person who needs to NEGOTIATE "TREATMENT."
    Some people might consider our good friend, colleague, psychiatric survivor and nationally known mental advocate Amy Smith as a "radical" mental heath advocate -- BUT even she would tell you that people are "begging for help" and they can't get it.
  Well, what are those skills of creative lawyers and advocates that we could probably transfer into an interactive questionnaire -- @ least to begin with:

finely parsing the treatment options that are available: CBT [Cognitive Behavioral Therapy] , DBT [Dialectical Behavioral Therapy], EDMR [Eye Movement Desensitization and Reprocessing], nutritional support, exercise, dog therapy, equine therapy, cooking therapy, horticulture therapy, etc.
what's available for -- medication, etc.
- what types of medication
- has the person already tried some types of medication, what was the experience -- good/bad/side effects
- would genetic testing be appropriate
- would advice of a neuro-pharmacologist be appropriate
- are there relevant clinical trials that the person might be interested in participating in or monitoring.
what "reasonable accommodations" -might be made to treatment options --are there ways of thinking about those "reasonable accommodations" in general "categories."
an opportunity for the person to propose an accommodation
an opportunity for the person to propose what they would see as most helpful -- again -- are there ways of thinking about this in general "categories" --
it's very hard to get information if people are provided a blank piece of paper or a blank screen -- but if people are given relevant prompts -- we generally get a lot of information. Also, if we just say "treatment" that's a whole lot of things and if someone has had a BAD EXPERIENCE -- there may be a BLANKET REFUSAL.
Where appropriate ask about the persons feelings about institutionalization & various forms of it --- many people are adamantly opposed some people aren't. --WHAT MAKES PEOPLE FEEL BETTER IS AGENCY, NOT NECESSARILY THE FORM OF THE TREATMENT. If there is a CHOICE to be made, be sure the person gets to make it where possible.
Good lawyers and advocates are generally trying to find that INTERSECTION between the person's wants and needs and that of AUTHORITY FIGURES. That intersection is actually much bigger than what we think -- in fact we think it is HUGE.

Venn Diagram

Lateral Thinking/Problem Solving (Disregarding "Implied" Rules)-- BTW Politicians Do This All The Time
[politicians also sometimes disregard actual LAWS ---we don't want that]

I want to thank Scott Durairaj PGC, MBA with the NHS (National Health Service) England for posting this on Linkedin.

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Val's Blog

IS CO State Gov't EVER GOING TO ACCEPT ITS RESPONSI-BILITIES UNDER OLMSTEAD TO PROVIDE HOUSING FOR PEOPLE WITH DISABILITIES?WITHOUT MAJOR CHANGES -- IT DOESN'T LOOK LIKE IT

IRREPARABLE HARM, HOMELESS-NESS & MEDICAID REASONABLE ACCOMMODA-TIONS PENDING HOUSING

WHEN THE STATE DOESN'T HAVE THE RESOURCES & PROVIDERS ARE BURNT OUT--

"RESEARCH IS EVERYBODY'S BUSINESS"

BREAKDOWN: Disability civil rights

THE CLOCK IS TICKING . . . INDIVIDUALS WITH SERIOUS MENTAL ILLNESS & THEIR FAMILY MEMBERS NEED EMERGENCY RULE MAKING to address medicaid Provider resort to criminal Justice System

PART II: HOW COULD WE CUT CRIMINAL JUSTICE DOCKETS IN HALF OR MORE? THE "HORCRUX" OF THE PROBLEM IN CRIMINAL JUSTICE

Legal Reform: How to Cut Criminal Justice Dockets in half or more?

PART I: HOW COULD WE CUT CRIMINAL DOCKETS IN HALF OR MORE? GET RID OF PROBATION, JAIL & PRISON-- PROVIDE FOR WEAKNESSES & STRENGTHS

When We Don't Tackle Complex System Issues like Guns & Mental Health -- We Almost Always SCAPEGOAT Individuals

THE VERY LARGE INTERSECTION BETWEEN PERSON-CENTERED, STRENGTH-BASED CARE AND SAFETY

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