1. What Keeps You Up at Night?

2.  How do I know what I don’t know? (e.g. regulations, statutes, etc.)  How does the LGU keep abreast of the numerous state initiatives, keep up with all of the changes, know which to pay closest attention too, keep providers informed, support them thru the changes and balance our own projects and remain sane?  Medicaid audit and possible tragic ending to someone that I decided didn't meet criteria for MH pick up order. What Keeps You Up at Night?

3.  Need for specialized housing for forensic clients discharged from state psychiatric hospitals given the reluctance of housing providers to accept these individuals  Lack of a regional approach for inpatient services unit to treat developmentally disabled clients with behavioral health issues.  Folks from my generation will remember School House Rock and "How a Bill Becomes a Law" - but I don't remember the Episode on How CMS interacts with OMH, interacts with Department of Budget, etc. What’s a State Plan, what’s a State Plan Amendment, How do we go about getting these things, What is a Waiver, How are rates really set, etc. How a Bill Becomes a Law What Keeps You Up at Night?

4.  Treatment resistant individuals with multiple health, mental health, developmental, criminal justice, chronic homelessness, and addiction issues. We seem to have a growing population that is not adequately served in any system - and I consider us a "service rich" community.  The rapid departure of knowledgeable, caring, seasoned behavioral health professionals (baby boomers) with clinical skills that are either not being replaced or are replaced with individuals from somewhat or not at all related fields.  The challenge of how to serve individuals in the least restrictive settings vs. the protection and safety of clients and others.  The eroding of local control/influence in the behavioral health system with the emergence of large managed care organizations (think David and Goliath except no one will help me find my sling). What Keeps You Up at Night?

5.  Specialized services for clients with autism  I am just beginning to think I understand the role of the LGU - but how are the System Changes (PPS/DSRIP, MCOs, Value Based Payments, HH, Children's HH) impacting this role? Do we still have system oversight? Balance between oversight and facilitating/creating new programs? (So, Back in the Day when Brian first started - the LGU did "This"....now, we are really needing to do "This".  "Data, data, data" - what Data related to outcomes is available to LGUs? What information is available and through which systems? What do we need to do to access these systems? How can we use this information for planning and for service provider/system oversight. (I am hearing about PSYCKES, OMH BHO portal, CLMHD Dashboard, Salient, MAPP, etc. but don't really know what each does and what permissions we may need to access this - I could research each one myself, but wow, I hope someone might have an overview?) What Keeps You Up at Night?

6.  Treatment programs and resources for sex- offender  Related to the above and related to confidentiality - What Individual specific information am I entitled to as the DCS and under what circumstances?  Not really a DCS question, but more a Management question - what the heck to do with a long term employee who is a Supervisor who significantly under performs in a job that is difficult to quantify? What Keeps You Up at Night?