Vera Kalkwarf is the Social Services &Mental Health Program Manager for Grays Harbor County Public Health and Social Services Department.
Could you describe a bit about what you do in your position as the social services manager for Grays Harbor County?
With the help of an extraordinary team of co-workers we build resources ensuring community members with mental illness, substance use disorders, homelessness and adults with developmental disabilities have access to different types of treatment and support services.
We work with state, federal and local agencies, schools, treatment centers, housing, law enforcement, medical services and jails to serve approximately 850 adults and youth each month.
Our focus is on improving services through strategic planning and partnerships. Specifically we are working to integrate mental health and chemical dependency services with a “triple aim” to offer rapid access, intensive case management and expanded housing supports. Several projects are in development while others are in different stages of implementation.
One such program that demonstrates a new collaboration between Social Services and the criminal justice system is the Prosecuting Attorney’s Diversion program. The purpose of the program is to divert first time felony drug offenders from the court system, provide intensive treatment, case management and supervision. It’s a rigorous program where clients are closely supervised and required to become employed, enroll in school and submit to random UAs.
Local behavioral health services are provided by BHR, Catholic Community Services, SeaMar and True North/ESD 113. Services include outpatient for youth and adults, Wraparound for families and Crisis intervention, stabilization and ITA services are available 24-hours a day. Elma Homecare provides support to 20 individuals with significant mental health disabilities.
Grays Harbor County works with CCAP, Morningside, high school Transition programs, DVR, WorkSource Center, local businesses and case managers to provide supportive employment services to 80 adults with developmental disabilities. Employment provides access to the community and the opportunity to live more independently.
In January of 2014, our department accepted a new challenge to manage the homeless housing resources. The first month was spent developing new contracts with local agencies to provide shelter and rent assistance. Our next steps are to convene a coalition of community stakeholders to develop a shared vision that addresses individual and family homelessness.
How long have you been in the position and what have you done prior in your career?
I’ve worked for Grays Harbor County Public Health &Social Services for almost 24 years. The position is different today as a result of funding, policies and needs of the community. It’s changing now in response to healthcare reform, Medicaid expansion, budget cuts and an emphasis on “value based services” for the purpose of reducing health care costs while improving outcomes.
I interned with Grays Harbor County Adult Probation while in college. It was there that I realized the importance of early intervention to redirect the pathway some individuals were traveling.
After graduation I worked 10 years for a nonprofit agency that has since closed. In many ways that agency was ahead of its time serving youth and their parents through a multi-disciplinary approach to addressing problems. A small group of new graduates dedicated to solving complex problems implemented programs that now resemble “best practices.”
Why did you decide to get into such a field and what are some of your personal beliefs on the need for such services?
I think the work of social services is a calling for many of us. I believe the fact that I was the 2nd child in a family of 8 kids (all starting with the letter “V” and a dog named Vaughn) who experienced good and bad times had an influence on my career choice.
I personally believe that everyone wants to be well. Individuals often become ill through various diseases, injuries or traumas. Research from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates mental health and substance use disorders have a biological, environmental and or social basis. Mental illness and drug substance use disorder are often associated with a genetic predisposition or as a result of childhood trauma.
Substance use disorders are similar to other diseases. It disrupts healthy functioning, is progressive and has serious consequences if left untreated. Like other chronic diseases substance use disorder often include periods of relapse and remission. It’s not uncommon to become frustrated when we don’t understand how to help our family or friend — especially when we can’t see past their behaviors. It’s important to know treatment works and transforms lives.
Grays Harbor struggles with significant problems. We are fortunate to live in a community where partners pull together to address the day to day challenges and in times of emergencies. We are a hurting and a hardy community impacted by long term unemployment, poverty and lack the infrastructure to leverage opportunities that exists in other communities.
Describe some of the biggest issues and challenges related to mental health on the Harbor and some of the goals you have set to face them.
Based on the 2013 County Health Rankings, Grays Harbor’s health status is the worst among the state’s 39 counties. This status reflects the challenges of an under resourced health care system and its impacts.
The health of our community impacts our mental health. Thirteen percent of adults in Grays Harbor reported having poor mental health for 14 days or more during the previous month. This is the third highest percentage in the State of Washington. The 2012 Healthy Youth Survey indicates our 12th grade students report experiencing depressive feelings over the past year at a higher rate than the state average.
Co-occurring mental illness and substance use disorders are common. Funding for services is unequal and categorical making seamless access to care difficult.
We work with True North and BHR to better serve youth in need of behavioral health services on campus of area high schools.
In response to the serious opioid problem in Grays Harbor we worked with Evergreen Treatment Services, the state, the City of Hoquiam and other stakeholders to open a clinic in Hoquiam (starting in April) to offer medication assisted treatment. Patients will have access to treatment without the daily burden of traveling to Olympia.
Plans are underway to develop sub-acute detoxification services as part of an integrated behavioral health crisis system. Currently our 10 bed Crisis Clinic provides mental health stabilization but will expand to support co-occurring in order to improve health interventions.
Many individuals are involved with the criminal justice system. Based on the Department of Corrections, 18 percent of persons incarcerated have a serious mental illness diagnosis, 63 percent with a substance use disorder, and one-third have both.
Two new services are offered in the County Jail. Inmates requiring stabilization receive a psychiatric evaluation in coordination with primary care. Services are expanding to the Aberdeen and Hoquiam jails. A Community Connections program was recently established to assist releasing inmates access to treatment. All services in jail are intended to break the cycle of recidivism. Mental health services are available for youth in detention.
We recently received a grant to develop High Intensity Case Management supports for complex mental health patients resistant to treatment services.
Individuals with behavioral health problems are frequently homeless which interferes with providing treatment and stabilization services.
A new Transitional Housing support with 24-hour supervision for individuals with significant mental illness who otherwise would be at-risk for inpatient hospitalization, homelessness, and/or incarceration will be provided by Catholic Community Services beginning in March 2014.
The lack of psychiatric inpatient treatment is inhumane. The state eliminated beds from Western State Hospital but failed to create local capacity for in-patient care or an adequate community alternative. People are “boarded” in hospitals without adequate care or a payment mechanism. Our jails and hospitals have become de facto mental health institutions.
The lack of inpatient chemical dependency treatment beds leaves individuals in a crisis waiting 6 to 12 weeks for treatment.
How is the county working with BHR to help eradicate their current financial issues?
I’m not sure we can eradicate their financial issues but we are committed to helping the agency. Treatment providers are challenged to keep pace with increasing costs while the amount and type of money that pays for services declines.
BHR operates in Thurston and Grays Harbor counties. The services they provide are critical to us. We are working to understand their costs, the challenges to deliver services in our rural community and determine the most responsible way in which to reimburse them while following the rules that govern the funding. We’re confident that we’ll find a solution.
What have been some of your personal most challenging and most rewarding moments in your position with the county?
There have been numerous challenges and I anticipate more with the implementation of health care reform but what continues to challenge me the most is when our system fails. On the opposite end there have been many rewarding moments. The work has been both a challenge and a privilege. I’ve worked with amazing people and state leaders but I am very grateful for the opportunity to work under two incredible women, Maryann Welch and Joan Brewster.