Agency to operate under county State's guidelines are more cumbersome

November 14, 1997|By Jackie Powder | Jackie Powder,SUN STAFF

When the County Commissioners decided last month to designate Carroll's Core Service Agency as part of the Health Department, local mental health advocates felt shut out.

Members of the county's Mental Health Advisory Board -- who had been working for six years to establish the agency to coordinate mental health services -- had developed a state-approved blueprint for the Core Services Agency to operate as a separate and private, nonprofit entity.

Despite their differences, the commissioners and board members are trying to work toward the common goal of starting Carroll's Core Service Agency without further delays.

To that end, the commissioners agreed yesterday to allow the Core Services Agency to operate under the county's purchasing policies, instead of the state's more cumbersome guidelines.

"That's encouraging," said Spencer Gear, a member of a committee established by the Mental Health Advisory Board to develop a model for the CSA. "Now that the decision's been made to move the thing [the CSA] to the Health Department, there were certain obstacles that had to be overcome to make it workable at all."

State procurement guidelines cover everything from buying office equipment to contracting with providers for mental health services. The CSA committee argued that state policies were too time-consuming and inflexible. They said the more streamlined county process would better serve the CSA's needs.

"One of our concerns was that it not become a mindless state agency," said Gear, director of Granite House, a Westminster agency that provides housing and rehabilitation services to psychiatric patients.

The CSA committee is working to revise its proposal to operate out of the Health Department. If the plan is approved by the commissioners and the Mental Hygiene Administration, Carroll's CSA will receive $150,000 to $175,000 in state money for salary and operating expenses.

The commissioners' decision to put the Core Services Agency in the county Health Department was the latest twist in the long and complicated struggle to establish the agency in Carroll.

The process has run into repeated delays as proposals developed by the CSA committee were written, submitted to the state Mental Hygiene Administration and returned to the board with questions.

Last summer, the board was leaning toward placing the CSA under the management of Human Services Programs, a nonprofit agency that serves the county's low-income population through various programs.

The announcement that the CSA was to be shifted to the Health Department was a surprise to many involved in its development.

"It all happened out of the clear blue sky," said Larry L. Leitch, county health officer. "The [CSA] committee, rightly so, was annoyed or disconcerted over the decision."

Commissioner Donald I. Dell noted lack of space at Human Services Programs as one reason for moving the CSA to the Health Department.

"It makes logical sense that the Health Department handle health issues," Dell said.

Members of the CSA committee didn't see it that way. In addition to the procurement issues, board members also had concerns about hiring policies, accountability and potential conflicts of interest.

"I have been working with the committee on a number of issues to get this back on track," Leitch said.

Committee members were worried that the executive director of the CSA would be protected under the state's merit system, and if problems arose it would be difficult to hire a replacement.

Helen Choma, president of the Mental Health Advisory Board, said she is confident that a CSA oversight board would allow the agency to operate with autonomy.

"Larry [Leitch] has no desire to micromanage this thing at all," Choma said.

In cases where the CSA must award contracts to providers -- which may include Health Department addictions services -- Gear said the agency can minimize a conflict of interest problem by ensuring that the contract review panel does not include individuals directly involved in providing services.

The CSA concept was approved by the General Assembly in 1991 as a way to improve the delivery of publicly funded mental health services by putting funding and policy-making decisions in the hands of local administrators.

Besides Carroll, the only counties without CSAs are Garrett, Wicomico and Somerset.

Pub Date: 11/14/97

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