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New county tax bears first fruit

Copyright © 2017 Albuquerque Journal

The grinning youngsters milled about their classroom, many girls in dresses, a few boys in buttoned-down shirts and ties, nearly all of the kids fidgeting with the pint-sized caps and gowns they had donned for the occasion.

It was graduation day at PB&J, and while some of the kids seemed more excited about playing with the toy drills and other gadgets than the ceremony about to take place on the school’s patio, the milestone wasn’t lost on parents.

“Without this program, I wouldn’t be able to get the parenting skills I need,” a tearful mom told the crowd.

“And without this program, I wouldn’t have been able to get my children back from CYFD.”

This is an art therapy room at PB&J, one of the programs benefiting from the county's behavioral health tax

This is an art therapy room at PB&J, one of the programs benefiting from the county’s behavioral health tax. PB&J uses the money to combat adverse childhood experiences. (Marla Brose/Albuquerque Journal)

Such is the work that goes on at 1101 Lopez Road in southwest Albuquerque, where the teachers – at least on this day – wore superhero capes and where job No. 1 is building up both parent and child. The organization is expanding its services, thanks to extra funding it is now receiving from Bernalillo County.

PB&J Family Services and seven other organizations are sharing $3 million a year for two years to combat adverse childhood experiences, such as abuse, neglect and other trauma. The funding is coming from Bernalillo County’s behavioral health tax, which went into effect in July 2015.

From those efforts to help at-risk children to mobile crisis teams that will soon respond to individuals experiencing nonviolent behavioral health crises, the county over the last year has started its quest to fill the gaps of New Mexico’s fragmented behavioral health system.

But the launch of services has been slow, with few programs up and running. And less than a third of the nearly $38 million that has been generated from the new gross receipts tax to date has been spent or even earmarked. Roughly 69 percent of voters supported the tax in a nonbinding ballot question in 2014.

Funding for such programs as PB&J was not among the selling points offered during the campaign for the tax. What was a main selling point was a crisis response center — a place police officers or others could take individuals with mental health issues who were committing petty crimes or disturbances in public places.

There was a call for action to assist the large number of mentally ill homeless people on Albuquerque streets, many of whom ended up in the Bernalillo County Metropolitan Detention Center, because there were no alternative places to take them.

County officials say such a center is still a priority but acknowledge the effort has stalled for several reasons.

“I still feel some frustration. I think everybody feels the frustration that we don’t have all of our services rolled out by now,” said Commissioner Maggie Hart Stebbins, a staunch advocate of the behavioral health initiative. “But there are reasons for that. It has been a very thoughtful process.

“Clearly, there is still public frustration that there are still people who are suffering in our community who have not yet gotten the services that they need, but I do believe that we have begun to roll out services.”

Help for ex-inmates

Services already launched include the community connections jail re-entry diversion program, a housing initiative for inmates with mental illness or other disorders who are coming out of jail. The first phase provided housing subsidies and intensive services to 70 men and women who were either homeless or close to being homeless.

The goal of the program is to stabilize those individuals in an effort to keep them from ending up back at the MDC.

The county kicked in $1.3 million for the program, while the city of Albuquerque contributed an additional $500,000. The second phase will expand the original program to provide at least 55 more housing vouchers along with the case management services. The price tag for Phase 2 is about $1.2 million.

The adverse childhood experiences, or ACE’s, mitigation programs that PB&J and others will administer went online in July.

Several other programs are slated to launch this year, including mobile crisis teams. Those teams will be comprised of a Crisis Intervention Unit deputy or officer and a master’s level behavioral health clinician such as a social worker or counselor.

The teams will respond to priority-one 911 calls related to nonviolent individuals experiencing behavioral health crises. If the team is unable to de-escalate the situation, the individual will be transported to a hospital, where a physician will decide whether the individual meets the criteria for admission.

The county has earmarked $1 million for the program, with the city pitching in another $456,000.

County officials are hopeful that the mobile crisis teams can be responding to calls by September, although they acknowledge that might be an optimistic estimate.

Researching programs

Katrina Hotrum, the county’s behavioral health director, said the county wants to invest in programs that work and that make a difference.

To that end, the county has contracted with the University of New Mexico’s Institute for Social Research. The institute is being paid about $246,000 a year to sift through research that has already been conducted to determine whether programs the county is thinking about investing in here have been successful elsewhere.

The institute is also helping the county establish accountability measures to determine whether programs are working. The institute will do the external evaluations on those new programs and pilots to determine whether they have been effective, Hotrum said.

The county has also brought in a behavioral health consultant — Pam Hyde and Associates — to help with its internal structure and to help develop a permanent governance structure. Hyde is a former secretary of the New Mexico Human Services Department and a former administrator of the U.S. Substance Abuse and Mental Health Services Administration.

Her firm, which is being paid $140,000, will also help the county prioritize spending of the behavioral health funding not yet earmarked.

“Seventeen million dollars goes fast,” Hotrum said, referring to the revenue generated by the tax each year. “So they’re going to help us prioritize.”

The tax, which is one-eighth of 1 percent, or 12.5 cents on every $100 purchase, brought in $16.5 million in fiscal year 2016, $20.2 million the following year and $1.1 million so far this fiscal year, which began July 1.

Bernalillo County Commissioner Wayne Johnson, a mayoral candidate, said during a recent mayoral forum that while he opposed the tax when it came before the commission, he has been helping to create a governance structure to ensure that the money generated is spent wisely.

“We have a fragmented system, and part of what we’re doing … is trying to create a system that addresses behavioral health, a system that addresses addiction, because these are important things in our community that must be addressed,” he said.

Johnson said the work will impact crime in Albuquerque.

“But,” he said, “it’s not the panacea that some would make it out to be.”

Debbie O’Malley, chairwoman of the Bernalillo County Commission, said the county has spent a significant amount of time looking at unmet needs in the community.

“It’s really important that we address those gaps in services,” she said. “That’s where we’re seeing people fall through the cracks. We’re certainly doing our best to leverage funds.”

Model in Tucson

One program county officials would like to roll out at some point — but haven’t quite figured out how to pull off — is a crisis response center similar to the one in Tucson. That center offers short-term treatment for adults and children with mental health and substance abuse emergencies.

A delegation from Albuquerque visited the facility in 2015 and found that it offered an alternative to jails and hospital emergency rooms, which are often the places where people with substance abuse problems and behavioral health disorders end up.

But the delegation also found that a solid, effective provider network needs to be in place for such a center to be effective.

“Part of the challenge is that the state is supposed to promulgate regulations on crisis centers, and they have not done that yet,” Hotrum said. “And so, at this point, we’re still reliant on the emergency room system in order to provide that level of support and stabilization while we have been focusing on how then to step that individual down into service and care.”

Hotrum was referring to rules relating to the licensure of crisis triage centers and rules establishing reimbursement rates for qualifying centers.

Hart Stebbins said a crisis response center is still a priority, but key pieces need to fall into place, including state regulations for Medicaid reimbursement for such a facility.

PB&J expands services

Meanwhile, at PB&J, the extra $580,000 it is receiving from behavioral health tax dollars will be used to bolster services to its existing clients and to provide services to 100 more families.

Researchers have found that childhood trauma increases the likelihood of incarceration, violent crime, psychological disorders and premature death.

Francesca Duran-Lopez, PB&J's home visiting program manager, discusses the childhood trauma she suffered and how PB&J helped her get her life together

Francesca Duran-Lopez, PB&J’s home visiting program manager, discusses the childhood trauma she suffered and how PB&J helped her get her life together. She said her current position allows her to provide support to other families. (Marla Brose/Albuquerque Journal)

Francesca Duran-Lopez, PB&J’s home visiting program manager, knows those statistics firsthand.

She said she had a rough childhood, experiencing some of the same traumas as many of the clients she works with today.

Duran-Lopez was incarcerated at a juvenile facility at the age of 13. She had her first child at 16, when she was locked up, and that’s when PB&J came into her life.

The organization worked with her in the facility where she was being held and helped her bond with her infant son, who was being cared for by her mother.

“They never gave up on me,” Duran-Lopez said, noting that PB&J built her up, taught her how to be a good parent and helped her to see that she could do something with her life and should go to school.

She earned her associate degree in early childhood development from Central New Mexico Community College and is working on her bachelor of arts degree. She is the first person in her family to graduate from college.

“These things we experience at such a young age always stay with us,” she said. “Experiences, whether good or bad, stay with us.”

Duran-Lopez said PB&J changed the course of her life, and she’s thrilled that she is now able to help other families.

“My healing began here,” she said.