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Innovative partnership helps fund rides for those unable to drive

Bob and Anne Carr flank a military veteran as their company partnered with the Atlanta History Center to offer rides to veterans on Veterans Day.

World War II veteran Syd Berry (center) received a ride via Common Courtesy to the Atlanta History Center on Veterans Day.

About two years ago, semi-retired business executive Bob Carr thought he’d spend some time driving for Uber, the innovative company that allows individuals to use their own vehicles to transport paying passengers.

Little did Carr know that the journey would take him to a whole new career.

One rider told Carr that she had a doctor’s appointment and struggled with Parkinson’s disease. All she needed was to travel less than half a mile from her home, but she couldn’t manage the walk.

Bob Carr

Bob Carr

A regular taxi service had turned her down. “Too short a distance,” the dispatcher said.

The rider contacted Uber out of desperation. And Carr’s car happened to be close by.

That two-block trip confirmed Carr’s concerns about older adults who needed help. He thought there had to be thousands of people who required transportation in metro Atlanta, based on their desire to remain in their homes. Either medications or debilitating health conditions kept these people from driving, leaving them largely housebound.

Carr says he and his wife, Anne, had talked about the situation for years and became more and more determined to do something to help.

Today, the company they founded, Common Courtesy, is a grass-roots system, working in cooperation with Uber, that is helping many such people receive donated rides.

Yes, donated — either partially, or in full.


The need was obvious


One day a few years before Carr began working with Uber, he and his wife took a trip to the “Y” for exercise and noticed a woman leaving the parking lot.

uberThe woman carefully placed her walker in the trunk of her car and, with some effort, was able to get into the driver’s seat. But unfortunately, her foot hit the gas hard while the gear was set in reverse, causing the car to lurch backward at a dangerous speed.

“She nearly took out a group of people,” Carr recalls. That group consisted of people on their way out of a driving class for seniors. Ironically, the woman had also attended the class.

“Somebody needs to do something to help seniors,” Carr said to his wife that day. “That woman shouldn’t have to drive.”

The image of that woman in reverse stayed with Carr and his wife. It represented many people with limited mobility who were desperate for basic transportation — some of them desperate enough to try to operate a vehicle when they no longer could do so safely.

In 2006, Carr started the couple’s dream company with the aid of volunteers. His enthusiastic workforce was more than eager to help local seniors with transportation needs.

But soon he realized the limitations of such a project. There were only so many people who were able to volunteer their time, and most of them had limited time to give. Too often, when a driver was needed, there was simply none available.

Sadly, Carr admitted to himself that Common Courtesy couldn’t keep up with the demand and therefore couldn’t guarantee rides to people who sought them. “The system simply wasn’t sustainable,” he says today.

Given that reality, his initial start-up company took a hiatus from 2009 to 2012. But he didn’t forget the plight of the people without transportation.

During the hiatus, Carr worked with a senior independent living home and went on to serve as director of a nonprofit that served older adults with dementia. He continued to think about the growing transport needs. With this exposure, he saw it firsthand.

“Those experiences reignited my desire to help,” said Carr.

He knew the initial concept was a good one — assisting people to get from Point A to Point B. He also knew it was only going to get worse with America’s aging population. He was concerned about those who had limited sight and other debilitating health issues.

Then, along came Uber.


Two great ideas


When Uber opened its Atlanta office, it was near a building the Carrs owned. And that’s how this semi-retired executive and entrepreneur became an Uber driver.

Uber, of course, is a paid transport service. But Carr and his wife saw it as a natural piece of what he and his wife wanted to accomplish — to help people who couldn’t normally afford to ride.

As Carr gained information on Uber’s operations, he returned to his initial ideas for a specialized transport company.

“I had months of re-engineering and re-imagining how my transport ideas, based on Uber, might work,” says Carr.

Eventually, he approached Jack Reed, Uber’s Atlanta marketing manager, with some initial thoughts about cooperation.

The big hurdle for Carr and Reed in allowing such an arrangement was the method of payment.

That was mostly because Carr’s targeted demographic included a high percentage of the population who were not using smartphones.

According to a 2015 Pew Research Center report, only 27 percent of older adults (over 65) actually use smartphones or own other types of cellphones. The Uber app is a critical component of Uber’s operating system.

“One of our goals at Uber is to help provide safe, reliable transportation to everyone, everywhere,” said Keith Radford, Uber’s general manager in Atlanta.

“When Jack Reed, our marketing manager, came to me with this innovative idea, it was an easy call,” says Radford. They just needed to figure out a way to get it done.

Parkinson Disease Association


Carr reached out to the American Parkinson Disease Association (APDA) chapter in Atlanta earlier this year.

Eric Burkard, who is president of the association’s Georgia chapter, says Carr wanted “to pitch his idea for a transportation program that would specifically benefit persons with Parkinson’s disease.”

Eric Burkard (left) and honorees Lee & Laura Oakley arriving at the Atlanta Parkinson's Disease Association fundraiser in a car provided by Common Courtesy.

Eric Burkard (left) and honorees Lee and Laura Oakley arriving at an American Parkinson Disease Association fundraiser in a car provided by Common Courtesy.


According to Burkard, Carr found a sympathetic ear among the Georgia APDA’s board of directors, who fully appreciated the cost and complexities that patients with Parkinson’s disease face every day.

“They need help getting to their doctors, therapists, support groups, and exercise classes,” says Burkard. To get the program started, the Georgia Chapter issued a $3,000 grant to Common Courtesy.

“The money may reduce the cost of Uber rides by as much as 50 percent,” Burkard says. “We wanted to commend Common Courtesy for partnering with Uber, which looks like it will result in low-cost and reliable rides to those most in need,” says Burkard.

“Our riders complete a simple, one-time application form with Common Courtesy and then call a local number when they need a ride,” said Burkard. For the passenger, it’s that easy.

“We’re just getting started,” said Melissa LeBoeuf, who is on the all-volunteer Parkinson’s board. “And we hope this will be a positive step in the right direction.”

Carr readily admits, there were plenty of trial and error moments. “It hasn’t been a smooth ride.”

“After about 6 months of using the volunteer-driver format, we knew it wouldn’t work, says Carr. “But, once we connected with the Uber model, it still took another year of testing, vetting and implementing adaptive systems.”


A memorable ride for veterans


There are other ride services in the metro Atlanta area for older adults. Still, Common Courtesy is picking up more business.

Veterans Day at the Atlanta History Center

Veterans Day at the Atlanta History Center

In addition to working with the Parkinson Association, the company partnered with the Atlanta History Center to offer rides to military veterans on Veterans Day.

Through funding offered by an Atlanta resident’s generous donation, Common Courtesy’s Uber drivers picked up veterans and drove them to and from the History Center commemoration.

Here’s how the system works:

Funds are donated to Common Courtesy by various organizations. The funds are held in separate accounts for clients of that organization.

If the rider has a smartphone, Common Courtesy loads the Uber app with a special identity key. The key flags that rider as a Common Courtesy client. It also indicates which organization will pay for the use of the Uber service.

A rider who does not have a smartphone is given a toll-free number. The person can then call the number and request an Uber ride, which will be paid for through the rider’s specific organization, such as APDA.

Uber provides the service, using drivers in the area of the ride request. Uber then bills Common Courtesy directly.

Other donated funding, which is not restricted to ride fares, is applied to Common Courtesy’s operations,” says Carr.

“Our focus is making life more accommodating for seniors and others who may need a bit of transport help, especially those struggling with mobility-related problems,” says Carr. “We are looking at working with the Center for the Visually Impaired in Atlanta and a number of churches whose members need transport help.”

He and his wife have given countless hours and their own money to making this work for everyone concerned.

When asked if he knew how complicated forming his company would be — from obtaining a 501c3 nonprofit status, to working with the Uber brand and finally figuring out how to get “to” the people who needed help, his response was: “No, Nada, not at all, and never!”

“It’s the only answer that I can give,” shares Carr, as he races to his next meeting.

A lot of people with health problems need rides, and Carr’s a busy guy these days.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


Disabled vets take the field again — with special sports programs

6.Army veteran Jacques Swafford aims for the bullseye during an archery training session at Panola Mountain State Park

Jacques Swafford aims for the bullseye during an archery training session at Panola Mountain State Park

Sports have proved to be a lifeline for Army veteran Jacques Swafford.

Overwhelmed by depression and post-traumatic stress disorder (PTSD) after an on-duty accident in 1991, Swafford attempted suicide several times, but survived.

“I felt like my world was just coming to an end,” said Swafford, who was injured in a Humvee wreck during Army training in California, shortly before deployment to Desert Storm. It left him in a wheelchair with traumatic brain and spinal cord injuries.

He had never heard of “adaptive sports” until he was hospitalized in 1999 after a suicide attempt. As part of his treatment, he was asked to choose from a variety of sports offered by the VA.

Swafford, who lives in Atlanta, started playing basketball, wheelchair racing and archery, among other sports. Now, at 57, he says he “does it all,” and is racking up medals at different sporting events across the country.

“Sports really helped me. It takes my mind off the disabilities that I have and makes me look at the glass half-full instead of half-empty,” Swafford said after archery practice at Panola Mountain State Park in Stockbridge.

The archery program is run by BlazeSports America, which last September became one of two Georgia organizations awarded VA grants to help more veterans like Swafford forge new relationships and improve their health and well-being.

Atlanta-based BlazeSports won two grants totaling nearly $215,000, while another Georgia group, the Adaptive Golf Association, was awarded almost $125,000.

All told, the U.S. Department of Veterans Affairs distributed $8 million in adaptive sports grants to 65 organizations across the country. BlazeSports is one of only three groups that received more than one grant.

Spawned by the 1996 Olympics in Atlanta, this nonprofit organization introduces children and adults with disabilities to adaptive sports, such as archery, hand cycling, and track and field events. The VA grant provides nearly $129,000 for boccia and $86,000 to start a veteran soccer


The ‘most accessible’ game

Boccia is a ball game designed for people with motor disabilities. It is an event in the international Paralympic Games, and BlazeSports is boccia’s governing body in the United States.

“What’s cool and unique about boccia is that it is the single most accessible sport in the world,” said Sam Zapatka, who coordinates veterans’ programs for BlazeSports. “Anyone with any physical disability can play the sport of boccia.”

YouTube Preview ImageHis organization will use its new VA funding to hold three weeklong boccia and soccer training camps for veterans this year. They hope to identify talented veterans who can compete in the Paralympic Games in 2016 in Rio de Janeiro.

Officials at the Adaptive Golf Association, headquartered in Atlanta, are similarly excited about their new VA funding.

“We’re really on top of the world,” said David Windsor, director of instruction for the Adaptive Golf Association. They’re already using their grant to underwrite golf programs at eight VA hospitals in Florida, Georgia and Louisiana.

PGA and LPGA professionals are spending eight weeks teaching 15 wounded warriors to play. The program is free and includes customized clubs and balls. Specialized rigs enable people with limited use of their arms, and the pros are also working with VA therapists and caregivers to fine-tune each veteran’s training program.

All six sites in Florida already have their programs under way, and the other two hospitals are gearing up to start.

Although all the spots are filled, Windsor said interested veterans should not be discouraged. More camps are planned in the future, and will welcome vets regardless of age or injury.

“We want them to be able to live their life to the fullest, enjoy this game, learn it, and use it to their advantage,” Windsor said. “There are really no barriers.”

BlazeSports has specific criteria in mind for its soccer and boccia programs. For boccia, it is recruiting quadriplegic veterans; for soccer, it is seeking veterans with stroke damage or traumatic brain injuries.

Boccia and soccer camps will be held in Atlanta, and each will enroll 12 veterans. Veterans are being recruited for the soccer camps that are going to be held this month, and in April and August. The boccia camps are planned to start in April, May and July. Airfare and accommodations are included.

“Everything is 100 percent funded and provided for them,” Zapatka said. “So, all they’ve got to do is show up.”


A life-changer

Zapatka has worked with veterans for nearly two years, and he has become a believer in the power of adaptive sports to change lives.

“It’s been an unbelievable change − spirit, mind and body,” Zapatka said. He teaches archery, discus and hand cycling, as well as other sports, to veterans with disabilities.

Sam Zapatka helps a veteran with his bow during archery practice at Panola Mountain State Park

Sam Zapatka helps a veteran with his bow during archery practice at Panola Mountain State Park

When the injured veterans come together, Zapatka said, they talk more and gain more confidence.

“I think it’s really good for them to see veterans with the same disability, and seeing things that they can also do,” he said. “Because it gives them that little hope [to say], “I can do that, too.’ ”

Swafford feels the same way. While his symptoms of PTSD and depression have not disappeared, he said, they have become more manageable.

“When I’m competing or practicing, it makes me forget the things that I cannot do,” he said. “It makes me look at the things that I can do and achieve.”

Last year, Zapatka trained Swafford and others for the National Wheelchair Games in Philadelphia and the U.S. Paralympic Track and Field Championships in San Mateo, California.

“He is one of our top athletes,” Zapatka said. “[Coaching] was unbelievable. It was awesome to see his hard work pay off.”

He came home from Philadelphia with gold medals in shot put, archery, discus and javelin; plus a silver medal in weightlifting. He also earned silver medals in shot put and discus in San Mateo.

Swafford is going to try out for the U.S. Paralympic Track and Field team in April during the Southeastern Regional Games in North Myrtle Beach, S.C.

“[Winning] gave me hope and a lot of joy,” Swafford said. “And knowing that being an athlete in high school and in the military, it brought back the competitive spirit that I had.”


Hyacinth Empinado is a freelance journalist in Athens. She is currently pursuing a master’s degree in health and medical journalism at the University of Georgia.


For more information about BlazeSports’ boccia and soccer camps, contact Sam Zapatka at For more information about the adaptive golf program, contact David Windsor at or call at (941) 650-5750.


Big change in psychiatric hospitals: What the commissioner has to say

Last week, the state Department of Behavioral Health and Developmental Disabilities announced that its psychiatric hospital in Thomasville will close Dec. 31.

The closing of the Southwestern State Hospital continues the restructuring of the state’s services for people with mental illness and developmental disabilities in the wake of Georgia’s landmark 2010 agreement with the U.S. Department of Justice.

The DOJ accord — hailed by consumer advocates as a model for other states — aims to increase community services across the state, including housing, crisis teams and stabilization units, so people with disabilities can avoid the need for hospitalization. Hundreds of people with developmental disabilities have been moved from hospitals to community settings.

Frank BerryFrank Berry, who  took over as commissioner of DBHDD nine months ago, is presiding over this rapid transition of state services. GHN last week interviewed Berry about the upcoming Thomasville closure, problems with past hospital closings, and what he sees as the future of services for people with behavioral health problems and developmental disabilities.


Q: Is closing the Thomasville hospital your biggest challenge so far?

A: It certainly is one of the top challenges, to make certain that we taken the lessons we learned with the closure of Rome and Central State [in Milledgeville], and that we do a better job of building communities while we are in the process of closing a hospital.

Another challenge is the settlement agreement overall, and then you’ve got building capacity around the state to serve people with developmental disabilities.


Q: Why close the Thomasville hospital?

A:  Two main points. One is building communities so that people can receive their services closer to home. Once they get discharged from a facility, it’s better if they are closer to home, so services can be connected prior to discharge, instead of moving people far distances to go to a hospital.

The data showed that large numbers were being admitted to Southwestern State Hospital who were coming from surrounding areas, not just Thomasville. [Places such as] Valdosta and Albany. We want those people to receive services closer to home.

The other piece of it had to do with the dollars and cents. As we move out people with developmental disabilities from the state institutions, as part of the settlement agreement with the Department of Justice, it leaves fewer and fewer people in these large institutions.

Right now there are 100 to 120 people at that hospital. There are about 50 of them with developmental disabilities. When you move them out,  . . . federal dollars [for their care] follow them into the community. The hospital would cost $27 million a year to operate, to serve a little over 50 people. From a dollars-and-cents standpoint, you cannot sustain that on an ongoing basis. Those dollars can be much better spent serving people closer to home.

Q: How do you avoid the transition problems that plagued the hospital closings in Rome and Milledgeville?

A: A couple of the new services are tied to the settlement agreement. A new service that’s being developed in that area [is the operation of] crisis service centers, which are a little more intensive than even a crisis stabilization unit. They are emergency receiving facilities for law enforcement to bring people to drop them off. The services are navigated for that person from that location.

Law enforcement will have easier points to drop [people] off. The doctor-and-nursing coverage is a little more enhanced than a crisis stabilization unit. There is also going to be capacity for 23-hour observation beds, so that people who have historically come in and out [of a hospital], now . . . can get there and be transitioned quickly to the next level of care they need.

Another lesson was building the community prior to the closure of the hospital. For instance, Valdosta, which has been sending its people to Thomasville, will have a 24-bed crisis service center plus six temporary observation beds. Albany is going from 30 to 36, with six beds being temporary. Thomasville will have a crisis service center as well.

You’re putting the crisis, deep-end services where people have historically been going into a hospital at more of a local level. This will be short-term stays, for the most part.

The people in the forensic unit in Thomasville will be going to the Columbus hospital.

[For] the ones who are chronic long-term, we will build in the capacity to purchase some limited-capacity, private psychiatric beds. There will also be capacity in our existing state hospitals.


Q:  Are the services sufficient in those areas to handle the load?

A: The settlement agreement also brings in ACT teams, intensive case management, case management. Mobile crisis is ramping up, so the capacity in that community will be built up by the time the hospital closes.

Q: How many [psychiatric] hospitals will the state have after Southwestern State Hospital closes?

A: After this closure, we will have Savannah, Central East Georgia, Atlanta, Columbus, and the forensic unit at Central State. The number of hospital beds will have shrunk, and the number of crisis service center and crisis stabilization beds will have increased.


 Q:  Will the state save money with the closure?

A: Ultimately, there will be [savings]. But it takes a little while to realize those savings, because you’re closing at midyear. [The fiscal year runs from July through June, so the Dec. 31 closing will fall at its midpoint.] You still have to staff it to serve the people who are there. There’s a bond on the facility, a $10.5 million bond. That issue will ultimately be addressed.

The goal by 2015 is that some portion of hospital dollars where we have closed hospitals will go to sustain all the settlement agreement services.

Q: Will there still be any staffers or activity on the grounds at Southwestern State?

A: Because of the location and the heat and humidity down there, there will be a core group of probably 10 to 15 people to maintain the campus. All the utilities will be maintained year-round. If you don’t, there will be mold and mildew in those buildings. There is some discussion of some local community behavioral health providers using some parts of the campus for their community programs.

Q: Will the state try to sell the property?

A: We would welcome that opportunity, if that could happen. It’s a beautiful campus, 240 acres. The buildings are in good shape. If there was the right partner interested in using it, we would certainly entertain selling it or partnering with other state agencies or giving it to another agency.

Q: Does the state still own the Rome hospital property?

A: Rome is owned by the state and being well maintained. There are constantly ideas floated around of how to use it from a community standpoint. We’re always interested in talking with other state agencies and state properties authority on how that campus can be re-purposed.


Q:  What was the response of employees to news of the closure?

A: Certainly there is disappointment from the employees. I would say there’s hope for the future by both employees and legislators, because we are building the communities at the same time. I have asked the employees to focus on [the fact] that we need them to continue to serve people, just not at a hospital, but in a community setting.

As we’ve laid that out, I’ve asked providers to give our employees preference for interviews and strong consideration [for hiring]. They have come out publicly and agreed to do that. There’s hope employees will be able to follow some of the clients on the developmental disabilities and mental health sides in some of the crisis service centers and crisis stabilization units.

Q:  Will there be a number of people who will lose employment?

A: There will be some. There are a little over 600 employees there now. There’s a community need for 400 jobs from private providers, on the mental health and developmental disabilities side. Certainly there will be a significant decrease in state employment, but the hope is they will transition to some of the private providers.

Q:  What has been the response of the business community?

A: Certainly they’re concerned about the loss of jobs. However, the buildup of the crisis service centers and crisis stabilization units demonstrates that we have thought about the economic development that comes with the construction of these facilities along with job creation. Group homes on the developmental disability side, which serve four people [each], take 20 to 24 people to staff. There will be purchasing of homes that have been on the market for a while, and renovating them. There is opportunity that it can be a nice win for the local community.

Q:  You’ve talked before about the difficulty of talking to parents of disabled people who don’t want them to leave the institutions.

A:  From now through 2015, we have probably 275 people who will be leaving state institutions and moving into the community. I believe it’s the right thing to do. I’ve seen tremendous success stories, of people who had spent a majority of their lives in institutions, and are now living in their own homes and doing things that you and I do in the community. The challenge is showcasing those success stories to some of the parents who are getting older and are very concerned about a change for their loved one. They feel the state institutions have provided great care.

I think over the last few years, the quality of care in the institutions has been much better than it had been previously. But I believe the quality of care will ultimately be better for them when they’re living in their own homes.


Q:  Is law enforcement buying into the changes? They have been major critics of how the Rome and Milledgeville closings played out.

A:  Rather than trying to sell them a bill of goods, we’re trying to show them in different ways. These three facilities will follow the emergency receiving facility guidelines in a much more stringent manner. The goal is for law enforcement to see that this will make their lives easier, because it will be a dropoff point for people with behavioral health problems. The goal with these three new ones [is that law enforcement] can bring them straight there. This is an opportunity to show them this is a better model. The best way to do that is by demonstrating its success. We have kept law enforcement informed of the decision, so the hope is over the next six to eight months, they’ll become part of the biggest cheerleading group for this type of initiative.

Q:  What’s the Department of Justice’s reaction to the upcoming closure?

A: As we move from a facility-based model of care to a community-based model of care — which is what the settlement agreement is all about — this is another strong demonstration of our commitment, so they’re pleased.

Q: How are the consumer advocacy groups responding to the closing? Are they pleased?

A: Many of them are. We’re bringing services out to them. They have been pushing us to develop more community-based services. Part of the advocacy groups serving people with developmental disabilities . . . have been more vocal in their concern about moving their loved ones out. We are trying to show them that these can be successful transitions. There are two different sides of the story.

Q:  What have been some problems related to moving people with developmental disabilities out of hospitals?

A:  Ensuring continuity of care as people move from a hospital to a community placement, when they have known their doctor and nursing teams for so long. We are addressing that by making a commitment to keep on staff some of the doctor-and-nursing teams that will follow them into the community.

I think the other issue of moving people out is you have large providers and smaller providers. Making sure the quality is consistent among all of them. So it’s oversight.

Q:  You have recently put a freeze on placing developmentally disabled patients in the community.

A: In 45 days, we’ll begin to move people from the institutions into the community. The population we’re now starting to focus on has more complex medical needs than people moved out previously. I wanted to make certain that the level of oversight and quality of placements was in place prior to their moving out, rather than trying to do something after the fact.

Q:  What will the public system look like in five years?

A:  In the next several years, we’ll have a comprehensive system of care in the community, where people can access a variety of housing and clinical treatment options that will meet their needs. I think the reliance on state hospitals will decrease.

The goal is get away from our system focusing on the deep end and be able to serve people before they need the deep-end services. The state will continue to provide some long-term chronic mental health beds and continue to be in the forensic business. The goal is to have robust local systems of care so people can have easy access to high- quality services, and they can lead a life of recovery and independence.

Q: Will the state close other hospitals?

A: We are constantly looking at what our bed capacity needs will be as the settlement agreement services get ramped up. I don’t want to make that decision until we see what the system looks like as we continue to build up communities.

 Q: A major criticism of Georgia’s settlement agreement is that it does not include services for children. What can be done about improving this care?

A:  One of the opportunities that has presented itself, with the juvenile justice reform and rewrite, that many state agencies are now going to be forced into looking at children’s issues in a much more comprehensive way, and work together on them.

Over the next six months, the governor will be pulling together the agencies, and asking for a comprehensive approach [toward care of] children. It will be breaking down some of the historical silos. I do agree we need to do something big with children, and I think this will be the opportunity to do that.


‘Whole person’ treatment: New approach combines physical, mental care

Whole Person Treatment

Sharon Hix, along with Stephen Schweitzer (left) and John King, attend a Dalton mental health program. Consumers soon will get medical care, too, in the same building.

Sharon Hix and Brenda Jeffers regularly come to a Dalton day program for people with mental illness.

Each has medical problems in addition to mental health issues. Hix, 65, is pre-diabetic, has high cholesterol and a thyroid problem. Jeffers, 52, is battling a cholesterol problem and attempting to beat her smoking habit. Both women are trying to exercise more and eat healthier.

Their mental health services are delivered in a building that will soon offer medical care as well. Hix and Jeffers, and others like them, will be able to get both kinds of care under one roof. Ideally, that will mean overall care that is better coordinated.

Their Dalton mental health service organization, and a local community health center, are among 93 programs nationally that have won a federal grant intended to improve the “whole health’’ of a person with behavioral health problems.

The trend to merge care for the brain and for the rest of the body has taken off in Georgia, thanks to collaborations between two segments of the safety net: community service boards and community health centers.

Under this integrated model, people with mental illness, who often let their physical ailments go untended, get immediate access to primary care. And many patients who enter the system with medical complaints are diagnosed and treated for depression and other behavioral health problems.

Some behavioral health patients have not seen a primary care doctor in 10 years, says Frank Berry, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities.

Before being chosen as commissioner, Berry ran a community service board in suburban Atlanta, which created sites in Lawrenceville and Conyers that combined mental and physical health care.

This type of mental/physical health collaboration “is going to provide better outcomes,’’ Berry says. And it will reduce costs by addressing a patient’s needs earlier.

This integration of services seeks to address a longstanding problem: Individuals with severe and persistent mental illness die 25 years earlier than the general population.

These deaths are often the result of largely preventable physical problems — such as tobacco addiction and related illnesses, as well as obesity and diabetes. People with serious mental illness often “don’t exercise, have very unhealthy lifestyles,’’ says Dr. John Bartlett of the Carter Center’s Mental Health Program.

Psychotropic drugs often lead to weight gain, experts say.

Highland Rivers Health, the public behavioral health provider in Dalton, and the local federally qualified health center, Georgia Mountains Health, were recently awarded a four-year, $1.6 million federal grant to improve the care of adults with mental illness who also have diabetes, cardiovascular disease or hypertension.

The money from the Substance Abuse and Mental Health Services Administration (SAMHSA) will help “bring together the mind and the body,’’ says Jason Bearden, CEO of Highland Rivers. The grant will also allow mobile care in vans that will reach nearby rural areas Murray, Gilmer and Fannin counties.

Bearden says of those with serious mental illness at Highland Rivers, up to 90 percent have significant physical issues as well, including high rates of obesity, diabetes, and smoking.

Poverty is a problem for large numbers of people with mental illness. Many don’t get medical help, says Natalie Davis of Dalton, who has fought major depression and now works as a certified peer specialist, trained to assist people with mental illness in their recovery. Many people with mental illness “can’t afford the healthy foods,’’ she adds.

Hope in a hard-hit area

Integration of care will start in early 2013 in Dalton, the northwest Georgia city that’s called the “Carpet Capital of the World’’ but has fallen on hard times since the economic downturn began.

The housing and building slump cut carpet sales drastically, and Dalton suffered the third-worst employment drop of America’s 372 metro areas in 2011, according to government figures.

Dalton’s unemployment rate in October of this year was 11.2 percent, much higher than the state average.

The area has a large homeless population, says Steven Miracle, executive director of Georgia Mountains Health.

People here with mental illness tend to cycle in and out of emergency rooms, jails and homeless shelters. Prescription drug abuse and methamphetamine use are major problems, Miracle says.

The new Dalton program will be a one-stop shop. A primary care physician will be posted at a Highland Rivers behavioral health location. The community health center will do preliminary mental health screenings of its medical patients. Children and teenagers with mental health issues will eventually come to the same center that houses the health clinic.

This integration of care is part of the movement toward what are known as patient-centered medical homes.

A medical home is a single practice or facility that provides as much of a patient’s overall care as possible. “We’re trying to take care of every issue they have,’’ says Duane Kavka, executive director of the Georgia Association for Primary Health Care, which represents community health centers.

Georgia, he says, “is a little ahead of the curve’’ nationally in the move toward integrated care.

The effort in Georgia got a jump start through the Carter Center’s Mental Health Program, which brought together community service boards and health centers from the same geographic areas in a series of meetings beginning two years ago.

The goal was to help facilitate new relationships between safety net providers of physical health and behavioral health, says Bartlett of the Carter Center, who hosted the meetings. He says there are now 20 such partnerships across the state.

The coordination can improve care no matter where the patient enters the system, either from the physical or mental health side, Bartlett says.

He also points out that many people visiting a doctor for physical health needs often have their behavioral health needs unrecognized in the rush of a 15-minute medical appointment. “It’s not a setting that’s designed to address behavioral health.’’ Bartlett says.

And he adds, ”people who are depressed and/or have problem drinking or drugging have worse clinical and financial outcomes for their medical conditions.’’

Integration aims to reinvent primary care to address the whole person through a team approach, he says.

Trend felt in several parts of state

In coastal Georgia, where the Gateway community service board partnered with a health center, behavioral services and medical care are delivered together at three Savannah sites.

“What we’re trying to do is provide treatment for the whole person,’’ says Frank Bonati, CEO of Gateway. State funding has helped in this effort, Bonati adds.

Berry, the commissioner of Behavioral Health and Developmental Disabilities, told GHN that he is working with his counterpart at Community Health, David Cook, on getting technical assistance on these integration efforts from the National Council for Behavioral Health.

Dalton is the third area in the state to get a SAMHSA grant, after Columbus and Cobb/Douglas.

The Cobb and Douglas community services boards, through a four-year, $2 million grant with West End Medical Centers, has installed nurse practitioners and nurses in an outpatient mental health centers in Austell. Patients have access to fitness experts and peer specialists as well.

The collaborative has seen more than 600 patients, and has more than 430 active clients. Peer specialists encourage people with mental illness to get medical care and adopt wellness practices, such as exercise and weight loss.

The Cobb/Douglas and West End program is helping Felton Keyes, 54, who has fought mental illness and substance abuse. He lives at a Marietta residential program run by the community board, and during the day goes to the organization’s Austell clinic for group therapy and other services. He receives medical care at the same location, and help for his high blood pressure.

He even gets his exercise there. “I stay on the treadmill,’’ he says.

Keyes is impressed with the concept of the program. It treats the “biological, emotional and psychological,’’  he says.

Tod Citron, CEO of the Cobb/Douglas community services boards, says 78 percent of patients there have no insurance. The Affordable Care Act could help sustain this project financially by insuring more of them, he says.

Bearden of Highland Rivers says the collaboratives ‘‘are going to be a model of the future.’’

“Reimbursement is going to shift,’’ he says. Government programs and insurers “will want to pay for these types of services.’


Breaking ground on mental health: An interview with Dr. Frank Shelp

Two years ago, Georgia reached a landmark agreement with the U.S. Justice Department to revamp its system of care for people with mental illness and developmental disabilities.

The Justice Department involvement followed articles in the AJC that reported more than 100 suspicious deaths of patients occurred in Georgia’s mental hospitals during a five-year period.

Dr. Frank Shelp was a key player in forging that agreement with the feds. And, as the first commissioner of the Department of Behavioral Health and Developmental Disabilities when it was created in 2009, Shelp had the task of carrying out the overhaul.

Before becoming a psychiatrist, Shelp dealt with these issues in his personal life.

His mother battled mental health problems, and he became her caregiver. In addition, a cousin was killed by a drunken driver while walking home from school, and another cousin with developmental disabilities choked to death, Shelp told GHN.

At DBHDD, Shelp has been credited with helping to turn around a failing system. He has also received criticism for some of his actions as commissioner.

The new Georgia system isn’t without problems,  from jails housing many people with mental illness to failures of  community teams formed to help people with mental illness.

Still, many mental health advocates say Georgia’s system has improved during Shelp’s tenure. He stepped down from his post in August.

In this wide-ranging interview, Shelp talks about terminating whole shifts of hospital staff, the negotiations leading to the DOJ agreement, and what he now wishes he had done differently.

Q: How did you come to be the agency’s first commissioner in 2009?

A: At the time, I had taken a temporary contract to be the clinical director at the state hospital in Savannah, with the goal of closing the hospital. . . . By March, there were a number of concerns about closing the hospital. I expressed some of those concerns to some of the people in DHR. . . . The idea of a new department was beginning to move through the Legislature. . . . I was invited to be part of the private discussions around how the new agency should look. Out of that came the invitation to meet with Governor [Sonny] Perdue. I went in to meet with him to talk to him about the mental health system in Georgia. What came out of that was this invitation to be the first commissioner.

Q: Where was Georgia at that time in terms of working with the Department of Justice, which had been investigating Georgia’s mental health system?

A: A settlement had been reached with the Department of Justice the last day of the Bush administration [in January 2009]. There were preparations being made to address that settlement. . . . But there were still many problems. In mid-April, there was an actual murder at Central State Hospital [in Milledgeville]. A patient managed to kill another patient while on one-to-one observation.

Q: How did the agreement with the DOJ come about?

A: In May 2009, the governor signed [the bill setting up the new department] and announced me as the first commissioner. Four days later, I met the Department of Justice for the first time in Augusta. . . . Those discussions were ongoing. We were meeting at the Carter Center with the [mental health] advocates. The argument that Justice was bringing was that hospital conditions could not be looked at in isolation, that re-hospitalization is primarily a failure of follow-up in the community after a hospital discharge.

I had agreed with that principle at the time. Dr. Bill McDonald and I personally visited all seven hospitals and walked their campuses. But the DOJ returned to Milledgeville to follow up on that murder, and they reported back to me that there was no [state] follow-up. It looked to the Justice Department like business as usual, that nothing had happened. I was two months into our administration.

I brought Dr. Karen Bailey-Smith and put her over that hospital, and gave her total authority. She ended up staying there a year. She showed up [on] all three shifts, [did] spot checks, walked around. She discovered a patient assaulted by a staff person. There was involvement of a whole shift. We made a decision to terminate the entire shift. It was a strong action, because the hospital was allegedly understaffed. . . . We started to see our hospital census go down, and incidents go down.

And during that time, the Justice Department was back at Central State. They delivered another fairly scathing report. . . . I again had to take some specific action. I put Central State on indefinite diversion, which means no new admissions would come. The census [patient population] went down. After four months, the Legislature was back in session. There were a lot of questions about what was going to happen. At that point, we made a decision not to reopen the Powell Building.

Q: But the state and the Justice Department were still far apart?

A: At the end of 2009, we were taking pretty strong actions in the hospitals. We were terminating individuals. We terminated a whole shift in Atlanta. They were found asleep at night. . . . But the Department of Justice was emphasizing the efforts in hospitals were not going to remedy the situation as long as the hospital was almost the exclusive resource for people with mental illness.

The re-hospitalization rate was north of 20 percent — one in five were coming back to the hospital within 30 days.

At end of  ’09, there was a meeting with Assistant U.S. Attorney General Thomas Perez, Governor Perdue and myself. Perez informed the governor he was going to initiate a new litigation. He acknowledged [our progress on hospitals], but said he was directing his staff to draft those papers. So we were looking at a court date for somewhere in March. We were still having some discussions with the Justice Department and the amici [friends of the court]. Somewhere in late February, pretty much at the last hour before court, the Justice Department asked us whether we would be interested in a settlement. We started a negotiation. Judge Pannell asked that the amici be heard, participate in some way.

Q: What were your goals?

A: I was becoming more firm around a couple of points. That the department maintain its autonomy and integrity and ability to run a system and be accountable for it. . . . The other piece was that it needed to be a reasonable plan that would not be seen as so onerous by the Legislature and others that as soon as it was over, it would be taken apart. I had seen that happen in other states. . . . But most of all it would have durability. It would be able to be done without so much sacrifice and so much intrusion that there would be a buildup of resentment.

Q: And eventually the agreement was reached?

A: It was reached, but not easily.

Q: What made it happen?

A: We agreed to agree to disagree at the end of June. . . . Justice mustered together another review team to go after the hospitals one more time, in early September. The hospitals were now very different places. It had now been a year and a half. Things had substantially changed. . . . In the midst of that review, Justice asked if we were still interested in negotiating further. . . . We did meet for about three days. We came to a settlement . . . Governor Perdue actually was very much in favor of signing it. Perdue is a strong individual, but he had a real sense that this area had not been attended to.

Q: He came around on this issue.

A: He came around to understand the problems. . . . In the end, he was ready to go to stand with me. When I assured him that this had a level of third-party validation without a monitor or court master . . . and the cost would not be so excessive . . . we all felt genuinely good about it.

Q: As you look at the settlement now, what have been its main accomplishments?

A: We have reduced our re-hospitalization rate from the 20 percent range. The national average is between 9 and 10 percent. We’re now in 5 to 6 percent, significantly under the national average. Our overall hospitalization rate had been higher than the national average. Now it’s lower.

When I started, developmental disabilities was the overwhelming majority of our census, nearly 50 percent statewide. Forensics [patients who were in the criminal justice system] was 35 percent. Adult mental health was about 20 percent. Now forensics is our largest line of business. Developmental disabilities went from 850 to about 350 now. They’ve been largely moved into host homes and group homes in community settings.

The adult civil [mental health] census has gone from close to 600 to around 330. We’ve now been below 300 several times, as low as 290s. We’ve cut that in half.

In January 2011, we announced we would close the hospital in Rome.

Q: That sparked a lot of local consternation, correct?

A: Yes. The Rome hospital was closed for a number of reasons. For one, it was in fact the most expensive. But it wasn’t just cost alone.

[The closing] met with a lot of hostility. I met with the Chamber of Commerce. I had people yelling at me in the men’s room.

The emphasis was that we were not just shutting down a hospital. We were going to build a continuum of services across that region. Acute hospitalization would be provided by general hospitals. WellStar was our first hospital, in Cobb County. Then we added some more hospitals. Now there are probably close to a dozen.

Q: And there are more community services, correct?

A: We’ve added [assertive community treatment] teams, we’ve built two extra Crisis Stabilization Units, we’ve added peer support services, peer wellness centers. There’s now actually more access. We’ve admitted 80 percent more unique individuals in acute hospitals on the same money. The length of hospital stay average [in state hospitals] was 18 days, and in our community hospitals, it’s less than five days. They’re being moved into a community continuum at a pretty good rate.

The sheriffs are now reporting they travel shorter distances in the northern region, have less time waiting for evaluations, and now they’re getting more support from safety-net providers and community service boards. We have a much broader continuum of options. We also put in place supportive housing and some supported employment.

Q: What about the rest of the state?

A: I originally thought it would be region by region, over more time. . . . In a recent tour around the state, there’s not a single private hospital right now that isn’t ready to sign and be part of the process. It has happened as far south as Columbus.

Q: How about the Atlanta region?

A: Grady Hospital is a much bigger component there.

What we did at Grady, we worked with Dr. David Satcher, we did partnerships with all our medical schools, Morehouse, Emory, GHSU, Mercer. With Bill McDonald now at Grady, the department has basically funded two positions under Morehouse. They have been specifically put in place to deliver more aggressive, more complete services in the Grady emergency room, and integrate the services better with the community clinics. They have effectively transformed the situation at Grady. We’re actually seeing a decline in census at Atlanta Regional.

Q: So Atlanta and Middle Georgia are on their way?

A: We have a really good partnership with Emory and Grady and Morehouse. We’ve become full partners with David Satcher’s Health Care Leadership Institute. We’ve had fellows in our department who have done real research. So those collaborations are starting to yield results on the ground. . . . We joined the Savannah hospital partnership with Memorial and the Mercer Medical School in Savannah. . . . We’re moving toward a merger of the Augusta hospital and GHSU.

The whole state is not done. There’s a lot be done. The tenor has been changed. This is evidenced by the recent closure in Milledgeville; we closed the last of our developmental disabilities units back in June. That had been the largest census when I started. Now adults [with mental illness] and developmental disabilities are gone from that facility.

Q: The community was critical of these changes in Milledgeville.

A: It was largely about jobs. Central State Hospital had been an economic engine for a long time. . . . In my entire history, I’ve heard of all kinds of things. Completed suicides, assaults. I had never heard of an actual homicide while on one-to-one observation. That is a complete breakdown [of care].

Q: In late August, the state requested and received a delay of a scheduled review, explaining that the assertive community treatment (ACT) teams were either disbanded or inadequate. Is this problem something you were aware of?

A: Many ACT providers struggled, and the department provided technical assistance and imposed corrective action plans. But over the course of a few months, we came to the conclusion that several of the providers were not up to the task and we would re-procure the ACT teams with an opportunity to both increase expectations from the department side and allow for vendors to make new cost proposals.

We reviewed all these issues and actions in real time as they occurred with Elizabeth Jones, our independent reviewer, and together we decided to speak to the DOJ about revising the ACT team assessments. . . . There had been provider failure beyond our control, and we were already initiating the most appropriate measures to provide for these services in the most thorough and expedient way.

Q: What didn’t get done in your tenure that you regret?

A: I think on the developmental disabilities side, it took me longer than I would have liked to have personally understood some of the nuances in the waiver process and how that side of the house operationally delivers those services . . .

In reality, it was more bureaucratic and redundant than it needed to be. In the last few months, I initiated a reform in that. But I wish I had taken more direct action in that area a year earlier.

Q: What are your current concerns?

A: My concern from the very beginning is durability, that this must be sustainable in the future. This project comes out of a very personal motivation. I have learned about mental illness in very difficult ways. . . . There needs to be continued growth.

Q: Adolescents and children were left out of the DOJ settlement. So how are they doing?

A: Mental health for children and adolescents around the country [generally] falls to Medicaid.

I’ve talked with many of the children’s advocates, and they’ve got many concerns. What I have asked for but have not been able to find is some concrete measures. For adults, you could see homelessness and people in jail. . . . For children and adolescents, the numbers are more slippery. Truancy, involvement with the Juvenile Justice are harder indicators. So I don’t personally know with confidence that the system is adequate or inadequate. The management is largely going to fall to the Department of Community Health and the CMOs and Medicaid. . . .  I think there’s a big question mark there. It wouldn’t surprise me if it needed work.

Q: You have heard a lot of criticism of yourself –- on employee bonuses, meals from lobbyists, etc. How do you respond to that?

A: The reality is, in closing the hospital in Rome, we had to offer some retention compensation for staff to stay till the end. You can’t close a health care facility without [doing that]. You have a responsibility to patients. So, what were called bonuses were a retention plan, involving over 100 employees, [getting] a couple thousand dollars apiece.

Lobbyists? Stan Jones [an attorney cited in an AJC article] is a man of known stature in the mental health community. He sits on the coordinating council of the department, he’s a voting member.

So criticisms around this, unfortunately, I understand the source. It goes with the territory.

Q: Any mistakes that you made?

A: Well, from Day One, I had said publicly that we would have to make mistakes, that no one likes to watch a basketball game where there are no fouls. A game with no fouls is slow and low-scoring and uninteresting.

We didn’t have room to foul out; the bench wasn’t that deep. At the same time, if we were going to move the needle, we could not be second-guessing every single move along the way. . . . We did not think about being flawless.

I didn’t expect my team to be flawless. I said, ‘If you’re not making some mistakes, I would have to question how hard you’re trying. [But] I don’t want you to be reckless.’ I promised I would not embarrass anyone in public. . . . I made all the department’s apologies myself.

Could I have done some things better? Absolutely. . . . In retrospect, I could go back and fine-tune the pieces.

Q: Why did you leave?

A: In the very beginning, I said publicly that this would take two to three years to turn around. . . . So what’s happened has happened exactly on that time frame. I thought in January that we’d accomplished pretty much what I set out to accomplish.

Q: Were you asked to resign?

A: No. I had met with the chief operating officer for the governor [earlier this year]. I told him that I was tired. . . . I was concerned as well that this project could not be allowed to become about me, that it needed to have durability for the future, . . . to be sustainable. So I gave them two months’ notice. Frank Berry [the new commissioner] I think is the right person.

Q: What are the biggest challenges for Commissioner Berry?

A: The biggest threat right now is a sense of resting on the accomplishments to date. . . . There will be a threat of compromise, and settling for arrangements, that will be the biggest challenge to overcome. [State officials should] maintain momentum, and anticipate and resist forces for a return to the status quo.

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