Shake-up in alcohol, tobacco and suicide prevention services rankles providers

There’s a major shake up in how a federal grant to help prevent suicide and the use of alcohol and tobacco will be administered in Wyoming. Some critics say it will result in significant layoffs at community-level organizations, and it could diminish some one-on-one prevention services.

Prevention officials from across the state say they were blindsided by a March 23 letter from the Wyoming Department of Health announcing that the State Prevention Enhancement Grant will be administered by a single contractor rather than administered among some 52 independent contractors as it had been for decades.

Many of the independent organizations also allege that the bidding process for the single Prevention Management Organization (PMO) contract — awarded to Community Resource Center of Johnson County in September 2011 — was mishandled, which prevented others from competing for the contract.

“It is the most unethical thing I’ve seen. It really shakes my faith in how the system works. … It’s horrible for our staff and it’s bad for our clients we serve,” said Cori Cosner-Burton, executive director of the Mercer Family Resource Center in Casper.

Cosner-Burton and others in the prevention community told WyoFile that state officials had often discussed the possibility of moving to a single PMO, but they didn’t know a decision had been made. They said most every prevention contractor in Wyoming learned about the decision for the first time when they received the state’s March 23 letter. And they were upset to discover in March that the contract for the new PMO had been finalized in September.

A request for proposal (RFP) to bid for the PMO contract went to only five organizations, and some of those were very unlikely to qualify or even want to bid on the contract. For example, the state sent the RFP to the Wyoming Student Loan Corp.

Wendy Braund, state health officer and senior administrator of the Wyoming Department of Health’s Public Health Division, said proper protocol was followed in the RFP process. She told WyoFile that if community prevention professionals were not aware of the policy change, the bidding process and the hiring of Community Resource Center of Johnson County, it was because “they weren’t paying attention.”

“This potential change has been in discussion with prevention stakeholders in the communities for quite some time. If they chose to not take part in that discussion, that’s their choice,” Braund said.

New strategy necessitated by shrinking budgets

Like other state agencies, Wyoming Department of Health has had to plan for budget cuts — 4 percent under the current budget and 4 percent for the next budget. Finding savings in suicide, alcohol- and drug-use prevention is  not an easy proposition in a state where 700 people die from smoking each year, and where alcohol- and prescription drug-related deaths and injuries are on the rise.

“We know that we’re facing budget cuts. We know we’re not getting any more dollars to go into prevention, which is of critical importance,” said Braund. “So the way to increase prevention investment in communities without more dollars is to move administrative costs … to strategies.”

According to Braund, approximately $7.7 million for the 2011-2012 biennium goes to the prevention of suicide, alcohol- and other drug-use. Of that, about $889,000 — 11 percent — goes to non-personnel administrative costs among the 52 independent organizations. That’s just the administrative cost — not the cost of actually implementing the prevention programs. Switching grant administrative duties from 52 organizations to just one could save about $339,000, which could then be redirected to implementation of prevention programs, according to Braund.

“This amount ( $889,000) would be reduced by decreasing the number of entities required to have an audit and by other administrative efficiencies,” said Braund.

Restructuring

Beginning July 1, Community Resource Center of Johnson County will manage the State Prevention Enhancement Grant for the entire state. Counties will no longer receive an equal amount of funding from the grant, as they had for many years. Instead, Community Resource Center and the Wyoming Department of Health will use two epidemiological studies to help determine how much to spend in each county based on population and need.

The change will eliminate some positions at Wyoming’s 52 local, independent organizations that have managed the grant for suicide, alcohol- and drug-use prevention programs. It requires Community Resource Center hire new managers, or to re-hire some of the professionals who had handled the administrative duties under the previous structure.

“It will probably mean three staff members out of a job for us,” said Cosner-Burton. “Every county I’ve talked to is losing people as of July 1. It’s horrible.”

Both state officials and the Community Resource Center say there will be a net loss in jobs, but warn that estimates of large layoffs are over-stated.

“Everybody who is working now will re-apply, so we will hire people back again. … Some people probably won’t want to stay on and some people will,” said Toni Cervenka, executive director of Community Resource Center.

People who stand to lose their jobs this summer because of the change are afraid to speak out, said to Cosner-Burton, because if they want to be employed under the new system they’ll have to apply to Community Resource Center — the organization at the center of the controversy.

Critics also say that restructuring under a single PMO may result in duplicative work, in some instances, and it doesn’t take into account the savings from in-kind help that local independents currently achieve through housing prevention staff with existing community service organizations. Independent providers say communities will lose local control to adapt programs to community-specific needs.

“We believe that solutions to our health and prevention (efforts) comes from the community. That’s gone now. Projects will be decided by (Community Resource Center of) Johnson County. Thats a big move backward for us,” said Annmarie McMahill, prevention and wellness office manager at West Park Hospital in Cody.

“Some of those community-driven (prevention efforts), those will not be community-driven anymore. … We know what works in our community and what doesn’t,” said Jennifer Dyer, chairwoman of the Natrona County Prevention Coalition.

The state is using a separate $373,000 federal grant to restructure the state’s prevention program. Braund said the change is among several reforms at the Wyoming Department of Health. Last year, Tom Forslund accepted the Wyoming Department of Health director position after serving as Casper city manager for 22 years.

Braund said shifting to a single PMO not only saves administrative costs, but allows the department to focus more on “evidence-based,” or measurable outcomes, and “environmental” strategies, which include public media campaigns such as billboards and television ads. Those differ from programs in which a prevention specialist works directly with a small group of juveniles in diversion programs, for example, or one-on-one parenting classes.

Braund said the changes in strategy do come from concern that prevention resources were not well-managed in some communities, and results did not meet expectations in some cases.

“There was a lot of variability about what was being done in various communities, much of which was not evidence-based or prevention … Sometimes money was re-purposed,” said Braund.

Braund declined to provide any specific examples.

Cosner-Burton said the Mercer Family Resource Center serves more than 1,000 individuals each year on a one-on-one basis. She said a media campaign may reach 40,000 people, but there’s always a need to balance those “environmental” strategies with strong local one-on-one programs.

“We value both, and we’ve been fortunate to do everything. And now this threatens our ability to make connections with people one-on-one and with youth and families,” said Cosner-Burton.

Selection process

Critics say the manner in which the state handled the PMO bidding process doesn’t pass the smell test. Funding for the PMO comes from a Federal Enhancement Grant, and is awarded as a “900 series” grant. Any contractor, or vendor, who feels they are reasonably qualified can ask the Wyoming Administration and Information division to be placed on the vendors list for 900 series grants

But that was never necessary for any of the 52 independent providers that had received State Prevention Enhancement Grant monies, according to Sarah Mikesell-Growney, an independent contractor in Cody.

There were very few names on the state’s vendors list for 900 series grants. In fact, Community Resource Center of Johnson County was not on the list at the beginning of the selection process, either. Because there were so few vendors listed, the Department of Health was asked to invite more organizations to consider the RFP.

The department invited;

• Community Resource Center of Johnson County
• University of Wyoming, WYSAC
• Wyoming Citizen Review Panel
• Wyoming Student Loan Corporation

Only one application was received. The PMO was awarded to Community Resource Center, the contracts were signed in September, and then the rest of the prevention community seemed to be completely unaware of the events until the Department of Health issued its March 23 letter.

In the meantime, Community Resource Center had already made some key hires, which further raised concerns that the whole process was either mishandled or, worse, purposefully kept low-key.

“If the state really wants to have the best services possible, that would be another argument for opening up the RFP process,” Mikesell-Growney told WyoFile. Moreover, the positions that Community Resource Center filled are good-paying jobs, said Mikesell-Growney, yet it doesn’t appear that many prevention professionals around Wyoming were aware of the job openings.

If all of these changes are meant to save money and improve the quality of administration and services, “It would seem they would want to open up the applicant pool as well,” Mikesell-Growney said.

Several conference calls have already taken place between Department of Health officials and community providers who are upset over the process. Braund maintains that the RFP process was legal and open. Department officials admit they only invited four organizations to apply and did not make a general notification or announcement statewide. Part of the reason was because department officials didn’t believe any organizations outside the four they recommended could meet the criteria required. A qualifying bidder must have an existing statewide presence with properly accredited experts and have demonstrated a capacity to manage prevention services statewide.

“We could have sent it to everyone, and probably should have,” Wyoming Department of Health prevention unit manager Marilyn Patton told WyoFile.  “People who are disgruntled with the communications, I can understand that.”

“There’s always opportunities to improve our communication with our stakeholders,” said Braund. “I understand this is the end-all-be-all for these folks, but we are spending an inordinate amount of time addressing this issue. … This is all in efforts to make sure we provide good prevention (services) to the citizens of Wyoming.”

— Contact Dustin Bleizeffer at 307-577-6069 or dustin@wyofile.com.

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