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Club Nova awaits direction on its future

BY Taylor Sisk

Staff Writer

When state Secretary of Health and Human Services Lanier Cansler addressed the 32nd annual Legislative Breakfast for Mental Health held last Saturday at the Friday Center, he reiterated his belief that mental health care reform, which state government embarked on in 2001, has failed and that an entirely new system must be built.

Karen Dunn, executive director of Carrboro’s Club Nova, agrees in principle. But the devil, she knows, is in the details. This proposed new system is only now beginning to take shape, subject to approval by the federal government, and Dunn is hopeful it will be flexible enough to encompass a full range of critical services, including those her organization provides.

“I think we are on the right track,” Cansler told Saturday morning’s audience. “Not for mental health reform. As far as I’m concerned, mental health reform is done and over.”

Rather, he said, his department is building the foundation for a system built on a new classification of organizations – critical access behavioral health agencies, or CABHAs – that will provide a comprehensive suite of services, in every region of the state, with strict medical oversight.

“We are working now to try to make certain that we have the right kind of accountability, the right kind of oversight to make sure that those organizations not only provide the necessary clinical services, but do, in fact, refer to other services, where appropriate, to make sure people receive the broad array of services that they need,” Cansler said.

It’s accommodation of those “other services” that has Dunn concerned – such as those provided at Club Nova.

The primary service Club Nova offers is psychosocial rehabilitation, which helps individuals diagnosed with mental illness live better, more productive lives within their communities, providing basic, essential coping skills.

Club Nova has no ambition of trying to meet the requirements that would allow it to become a CABHA. “I can’t make that leap,” Dunn said. “It’s just not feasible.”

CABHAs must provide four core services – case management for those with mental illness or a substance-abuse problem, comprehensive clinical assessment, medication management and outpatient therapy – and at least two additional services from a list that includes psychosocial rehabilitation.

Setting up the infrastructure to provide all those services is beyond Club Nova’s means. It would have to hire a part-time medical director to oversee the services and full-time clinical and quality management/training directors.

But beyond the costs, Dunn said, is that reshaping itself to provide all those services would “take us, philosophically, away from who we are as a clubhouse model.”

“Your diagnosis is what gets you in – the diagnosis that you have a very serious mental illness,” Dunn said. “Beyond that, when people come into Club Nova as members we look at their strengths, talents, skills and gifts. We don’t look at the diagnosis.

“It’s just a very different way of working with people.” Staff members interact with members as colleagues, “and that’s a very different relationship from if, say, you have a psychiatrist or someone who’s coming in from the medical model and providing oversight for the clubhouse. It just doesn’t work.”

It creates a new dynamic within the clubhouse. “They begin to suggest therapies,” Dunn said. And while some club members may benefit from therapy, the clubhouse is not designed as an environment in which therapy is delivered.

Dunn is thus asking how much accommodation will be made for smaller providers, such as Club Nova, that focus on a non-medical service. Club Nova would be allowed to continue to provide psychosocial rehabilitation without becoming a CABHA, but it would no longer be allowed to provide community support team services. These services are complementary to psychosocial rehabilitation and, because the reimbursement rate is so low for psychosocial rehabilitation, have helped Club Nova stay in business.

“Without a community support team, it’s within the realm of possibility that we could continue to operate, but it would be very hard,” Dunn said.

She said that leadership at the Department of Health and Human Services has expressed its support for an increase in the clubhouse reimbursement rate, but nothing is in writing.

Cansler’s department last month submitted four amendments to its CABHA proposal to the federal Centers for Medicare and Medicaid Services (which must approve the proposal or the state will lose Medicaid funding), one of which was to allow smaller providers to subcontract with CABHAs to provide specific services. Cansler has indicated that he would be open to allowing clubhouses to operate as subcontractors. That could be the answer for Club Nova.

North Carolina Speaker of the House Joe Hackney and Rep. Verla Insko, who co-chairs a legislative oversight committee on mental health, both spoke at Saturday’s legislative breakfast. Both represent Orange County, and both have expressed their support for Club Nova.

“Ultimately, we want to operate the best clubhouse we can for the citizens of Orange County,” Dunn said, “and we want to be able to assure our members, their families and our other stakeholders that this will remain a very high-quality program.”

She now awaits word from the government.

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