The department held a meeting in the Sleep Inn & Suites to discuss changes occurring with programs of the department as well as county social services, which are now funded by the state.

“Nothing is going to be revolutionary. This is all evolutionary,” said Christopher Jones, executive director for the department.

“We need to provide the services consistently across the state of North Dakota. That doesn’t mean we’re always going to provide them the exact same way. We know there’s differences by community,” he said. “But we do need to use best practices in how we deliver services across the state.”

Gaining efficiencies might not translate to reduced cost because there will always be more needs than resources, he said.

Jill Schramm/MDN North Central District Judge Doug Mattson, right, visits with Christopher Jones, executive director of the North Dakota Department of Human Services, following a community meeting regarding state behavioral health and social services in Minot Friday.

“We really need to be focusing on the return on investment of the programs and services that we have. They need to be constantly re-evaluated to see if we’re getting the outcomes that we want, as relates to delivering quality services,” Jones said.

The department representatives cited an imbalance of investment in state human service programs currently.

“We right now put the majority of our funding into the highest and most expensive area, which is treatment. Treatment is vital for those that need it, but we cannot only fund treatment,” said Pamela Sagness, director of the Behavioral Health Division. “When we start talking about prevention, treatment people get nervous their dollars are going away. When we talk about home- and community-based services, people that run facilities say that’s not fair. We are actually fighting against each other, and we’re all one system, and we’re all necessary.

“We need every single piece of this continuum if we’re going to be effective,” she added. “If we’re missing any piece of the puzzle, we will not have a comprehensive or robust behavioral health system. We won’t be able to meet the needs.

“The first area of the continuum is prevention and promotion, and this is probably one that’s missed the most, because this is the area where they’re not yet a client. This is the work that we do in our communities to build resiliency. It’s a protective factor. It’s focused on good policy and resiliency and healthy communities,” she said.

“The second thing is we need to increase community-based services close to people, where they live. And lastly, we need to stop using the criminal justice system as a behavioral health system,” Sagness said. “It doesn’t mean people in the criminal justice system don’t deserve those same behavioral health services. They do. But it shouldn’t be the only way to get a service.”

A bill approved by the 2019 Legislature makes it easier for people to receive substance abuse treatment closer to home. The Legislature also approved a grant program to start recovery homes and provided funding to expand crisis services across the state. Peer support specialists will be able to be certified and paid through Medicaid. The Free Through Recovery program will be expanded to individuals not in the criminal justice system. Opioid treatment programs in the Minot, Bismarck and Fargo areas will be able to create medication units in other communities to reduce the travel time for clients.

Along with putting more money toward youth prevention programs, the Legislature directed school districts to establish behavioral health resource coordinators and is making $1.5 million available to schools to address behavioral health.

Numerous other improvements were adopted, but Sagness said the state could see the biggest change with a Medicaid amendment that will provide payment for services not currently covered for behavioral health clients, such as housing and employment supports, respite, education supports and nonmedical transportation.

“This creates the funding opportunity. It does not create the providers,” she said of the Medicaid amendment. “Part of my ask to you today is to know that this is coming, and to really talk with your community providers about what role they potentially will play in this. How will they engage and provide services, and can they expand the services and reach people, because this is what’s going to begin starting July 1 of 2020.”

Sara Stolt, transformation manager with the department, outlined changes coming to county social services next year. After Jan. 1, the county offices will be replaced by 19 human service zones.

“Those 19 zones are really about coming together administratively so that we can shift the duplicated administrative dollars to programs and services to better help clients,” Stolt said. “We truly believe we can put the client at the center and see stronger outcomes, greater efficiency, higher quality for the people that we’re serving.

“We have child protection workers who are spending 80% of their time behind the computer filling out paperwork,” she said. “So we had to redesign the work to be more client focused, so that worker was spending face-to-face time with the family, and reduce the administrative work without sacrificing the quality or the expectations of the children and the family that we’re serving.”

In addition to zone employees, there will be four specialty teams with state-employed workers for childcare licensing, home- and community-based case management, long-term care eligibility determination and quality control for child welfare. Stolt explained the specialization will ensure better service within those complex programs.

Positive changes already are happening with the redesign, Stolt said. As an example, the time required for background checks for child-care workers fell from an average of 25 days to between six and eight days. Another redesign project greatly reduced the time spent completing assessments in child protection cases.

The process has just started, though, Stolt noted.

“This is going to be an ongoing process to increase efficiency and improve quality outcomes for the people that we serve,” she said.