Cottonwood plan may include privatization

Plans have been set in motion to privatize Cottonwood Residential Treatment Center.

The future of the 32-bed facility has remained uncertain since its funding was depleted in a round of budget cuts by Gov. Jay Nixon in June. It was slated for closure, but hopes remained it could be saved when Nixon released nearly half the funding for the facility last week.

Since that time, the Missouri Department of Mental Health has been working on a plan to keep Cottonwood in operation but in a more efficient manner, said director Keith Schafer.

The new Cottonwood treatment system includes a 16-bed "community psychiatric rehabilitation inpatient diversion children's residential treatment center" operated by the Community Counseling Center. The new system cuts the number of beds available for children with severe emotional and mental needs in half.

The Community Counselling Center is a private, charitable, not-for-profit behavioral health organization that serves five counties in Southeast Missouri. It's nationally accredited by the Commission on Accreditation of Rehabilitation Facilities and is funded in part by the Missouri Department of Mental Health, service fees, grants and the Cape Girardeau, Perry and Ste. Genevieve county mental health boards.

The transition also will include a combined total of six treatment-family and professional-parent homes. A treatment-family home features a homelike setting that provides intensive therapeutic interventions and can serve as many as three children at a time. A professional-parenting home provides intensive mental health interventions and serves one child at a time.

Schafer said the decision to integrate Cottonwood into the Community Counseling Center was twofold.

"First, there is a belief -- and it is a legitimate belief -- that if decisions can be made more locally and closer to the kids that the program is going to be better," he said. "Second, state law indicates that if we are to provide community-based services in the state of Missouri that are not state-operated, then they have to be ... administered through a comprehensive array of community mental health centers in the state.

"The Community Counseling Center is one of those administrative agent community mental health centers that has been designated," Schafer said, "so if we were going to make this change and act reasonably quickly and do it through the statutory system that's been established for the community, we needed to work through [the center's] program."

Privatization was not among the plans floated to save Cottonwood from its closing date of Dec. 31. State Reps. Kathy Swan and Donna Lichtenegger created a financial plan for the facility, which they submitted in August to the Missouri House Appropriations Committee and the state mental health department for review. The plan was well-received by many members of the appropriations committee who also expressed interest in seeing the facility remain in operation.

The plan laid out by the lawmakers proposed increasing revenue at the facility by adjusting restrictive eligibility requirements for admission and increasing the per diem rate. The plan also called for adding acute-care beds and services for youths between the ages of 17 and 21 that are not available. To reduce expenses, they recommended reviewing the lease agreement with Southeast Missouri State University and its food service options and restructuring human resources.

Restrictions made in the referral process about three years ago took a toll on Cottonwood's census, meaning it was consistently below full capacity. Swan indicated taking steps to increase the census and the per diem rate would help boost revenue to where the facility was self-sustaining.

The state mental health department indicated in a presentation to Cottonwood staff earlier this week that the transition to the Community Counseling Center was the best move because it provides broader treatment options and "significantly less risk of future state budget reductions."

The transition still offers programs only for those between the ages of 6 and 17, but Schafer said the six treatment homes have the potential to serve children in new ways.

"The advantage of having [those treatment homes] will be that children who may no longer need residential care in that more intensive residential care setting could then graduate to the professional parenting home or to the treatment family home," he said. "The other advantage is the kid may be able to start there. My hope is that particularly the young children ages 6 to 7 to 8 could actually start in those homes as opposed to starting in the residential treatment side."

Cottonwood staff in good standing will be given preference for available positions in the treatment homes and the residential program. Cottonwood state employees in good standing will be given first priority for vacant positions at the Southeast Missouri Mental Health Center and Sex Offender Rehabilitation and Treatment Services at Farmington, Missouri. Staff receive second priority after state Division of Developmental Disabilities employees being laid off at the Poplar Bluff Regional Office -- also closed because of state budget cuts -- for positions in Southeast Missouri developmental disabilities programs in Sikeston, Missouri, and Poplar Bluff.

Since work began on the transition last weekend and state mental health officials shared the plan with Cottonwood staff Monday, the freeze on admissions has been lifted to allow admissions up to 16 beds. Schafer said 15 children were receiving services from Cottonwood as of Monday.

How quickly Cottonwood and the Community Counseling Center will complete the transition to privatization depends on several factors. For example, the center must determine the number and type of staff needed to operate with the new program. Schafer said that process could be completed before the end of the 2015 fiscal year, but no timeline has been set.

One factor the Community Counseling Center won't need to worry about is location. Schafer said Cottonwood will remain at its location at Southeast Missouri State University, and opportunities for student internships will continue. The relationship between the two entities has been mutually beneficial, he said.

"I'm very excited about the possibility of continuing to work in partnership with Southeast Missouri [State University]," Schafer said. "We think kids benefit, we think students benefit and that's something we want to continue."

srinehart@semissourian.com

388-3641

Pertinent address:

1025 N. Sprigg St., Cape Girardeau, Mo.