WASHTENAW COUNTY COMMUNITY MENTAL HEALTH BOARD

Michigan Office of the
Auditor General
Thomas H. McTavish, C.P.A.
Auditor General

EXECUTIVE DIGEST #3950898
WASHTENAW COUNTY COMMUNITY MENTAL HEALTH BOARD

INTRODUCTION
This report, issued in June 1999, contains the results of our performance audit of the Washtenaw County Community Mental Health Board, an agency under contract with the Department of Community Health.

AUDIT PURPOSE
This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND
The Board was established in 1965 and operates under the provisions of the Mental Health Code, being Sections 330.1001 - 330.2106 of the Michigan Compiled Laws.

The Board's mission is to promote and enhance quality of life; to provide, with dignity and respect, community-based mental health services for individuals in Washtenaw County and their families and supports; and to identify appropriate resources for anyone in need who cannot be directly served.

The Board operates and/or contracts for mental health services including inpatient, outpatient, day program, residential, case management, respite, crisis, and prevention services for mentally ill (MI) and developmentally disabled (DD) individuals.

The Board's Access Unit serves as the single entry point for Washtenaw County residents seeking mental health services. The Board is also the designated Substance Abuse Coordinating Agency for both Washtenaw and Livingston Counties, established in accordance with Act 368, P.A. 1978.

Board operations generally are funded by approximately 90% State and federal funds and 10% local funds. Total expenditures for the fiscal year ended September 30, 1998 were approximately $38.5 million. As of September 30, 1998, the Board had 283 full-time equated employees and was serving 3,046 consumers.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS
Audit Objective: To assess the Board's effectiveness and efficiency related to the delivery of services.

Conclusion: The Board was generally effective and efficient in the delivery of services. However, we noted reportable conditions related to the Board's management information system, person-centered planning, day program case records, and ability-to-pay determinations (Findings 1 through 4).

Noteworthy Accomplishments: The Board implemented a Program Evaluation and Quality Improvement System which provides a systematic, coordinated mechanism for the ongoing evaluation, assessment, and improvement of services to Board consumers. Quarterly quality improvement reports are submitted to the Board's governing body for review and analysis of aggregate data on consumer satisfaction and service effectiveness and efficiency. Also, in February 1998, the Board received a three-year accreditation from the Rehabilitation Accreditation Commission (CARF).

Audit Objective: To assess the Board's effectiveness in administering and monitoring contracts with mental health service providers.

Conclusion: The Board was generally effective in administering and monitoring contracts with mental health service providers. However, we noted reportable conditions related to pharmaceutical contract controls, substance abuse contracts, residential service provider inventories, quarterly maintenance inspections, and residential contract administration (Findings 5 through 9).

AUDIT SCOPE AND METHODOLOGY
Our audit scope was to examine the program and other records of the Washtenaw County Community Mental Health Board. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances.

To accomplish our objectives, we examined Board records and activities for the period October 1, 1995 through November 30, 1998. We interviewed Board and contractual staff; reviewed applicable statutes, rules, policies, and procedures; assessed the effectiveness of applicable areas of the internal control structure; and analyzed applicable program, financial, and clinical records. Also, we surveyed consumers and referral sources (survey summaries are presented as supplemental information). In addition, we analyzed contracts with mental health service providers and tested compliance with the contracts. Further, we conducted site visits of contract providers and examined provider expenses reported to the Board.

AGENCY RESPONSES
Our audit report includes 9 findings and 11 corresponding recommendations. The Board's preliminary response indicated that it generally agreed with our recommendations and has taken steps to implement them.

Full Audit Report - #3950898 - WASHTENAW COUNTY COMMUNITY MENTAL HEALTH BOARD

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This page was created on 06/01/99.


INTRODUCTION This report, issued in June 1999, contains the results of our performance audit of the Washtenaw County Community Mental Health Board, an agency under contract with the Department of Community Health.

AUDIT PURPOSE This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND The Board was established in 1965 and operates under the provisions of the Mental Health Code, being Sections 330.1001 - 330.2106 of the Michigan Compiled Laws. The Board's mission is to promote and enhance quality of life; to provide, with dignity and respect, community-based mental health services for individuals in Washtenaw County and their families and supports; and to identify appropriate resources for anyone in need who cannot be directly served. The Board operates and/or contracts for mental health services including inpatient, outpatient, day program, residential, case management, respite, crisis, and prevention services for mentally ill (MI) and developmentally disabled (DD) individuals. The Board's Access Unit serves as the single entry point for Washtenaw County residents seeking mental health services. The Board is also the designated Substance Abuse Coordinating Agency for both Washtenaw and Livingston Counties, established in accordance with Act 368, P.A. 1978. Board operations generally are funded by approximately 90% State and federal funds and 10% local funds. Total expenditures for the fiscal year ended September 30, 1998 were approximately $38.5 million. As of September 30, 1998, the Board had 283 full-time equated employees and was serving 3,046 consumers.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS Audit Objective: To assess the Board's effectiveness and efficiency related to the delivery of services. Conclusion: The Board was generally effective and efficient in the delivery of services. However, we noted reportable conditions related to the Board's management information system, person-centered planning, day program case records, and ability-to-pay determinations (Findings 1 through 4). Noteworthy Accomplishments: The Board implemented a Program Evaluation and Quality Improvement System which provides a systematic, coordinated mechanism for the ongoing evaluation, assessment, and improvement of services to Board consumers. Quarterly quality improvement reports are submitted to the Board's governing body for review and analysis of aggregate data on consumer satisfaction and service effectiveness and efficiency. Also, in February 1998, the Board received a three-year accreditation from the Rehabilitation Accreditation Commission (CARF). Audit Objective: To assess the Board's effectiveness in administering and monitoring contracts with mental health service providers. Conclusion: The Board was generally effective in administering and monitoring contracts with mental health service providers. However, we noted reportable conditions related to pharmaceutical contract controls, substance abuse contracts, residential service provider inventories, quarterly maintenance inspections, and residential contract administration (Findings 5 through 9).

AUDIT SCOPE AND METHODOLOGY Our audit scope was to examine the program and other records of the Washtenaw County Community Mental Health Board. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances. To accomplish our objectives, we examined Board records and activities for the period October 1, 1995 through November 30, 1998. We interviewed Board and contractual staff; reviewed applicable statutes, rules, policies, and procedures; assessed the effectiveness of applicable areas of the internal control structure; and analyzed applicable program, financial, and clinical records. Also, we surveyed consumers and referral sources (survey summaries are presented as supplemental information). In addition, we analyzed contracts with mental health service providers and tested compliance with the contracts. Further, we conducted site visits of contract providers and examined provider expenses reported to the Board.

AGENCY RESPONSES Our audit report includes 9 findings and 11 corresponding recommendations. The Board's preliminary response indicated that it generally agreed with our recommendations and has taken steps to implement them.