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First in a series.

For 25 years, each of Iowa’s 99 counties have been asked by the state Legislature to provide mental health services for the thousands of adults who have mental health needs.

The burden was shared somewhat in 2013 when the regionalization system was implemented, and Bremer County joined Benton, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn counties to create the East Central Region (ECR) for Mental Health and Disability Services.

However, the Legislature passed an amendment to Chapter 25 of the Human Services Department code that would create children’s behavioral health services last year. Now, each of the regions, including ECR, have to submit a plan for at least half of the necessary services by April 1 to be implemented on July 1, with the remainder to be done so by July 1, 2021.

Mae Hingtgen, the CEO of the ECR, told Waverly Newspapers by phone that there are 11 services that need to be enacted. The regions need to implement eligibility assessment and evaluation, outpatient therapy, education, medication prescribing and management, and prevention measures this year, while inpatient treatment, community-based and residential crisis stabilization services, early identification, early intervention and mobile response elements need to be in place the following summer.

“We have this period here where we have the ability to be mindful about our planning, to ensure that we are incorporating all of those services that fit in the state law,” Hingtgen said, “and provide access to those services for children in our region.”

The document that includes all of the requirements for the regions to implement can be found at

Hingtgen said one of the first steps the representatives of the nine counties need to do before submitting the plans to the Iowa Department of Human Services is to amend the 28E Agreement, or a “Joint Exercise of Governmental Powers,” between them. They need to incorporate language to include the children’s behavioral health services.

Next, the counties are going to be soliciting input from all of the stakeholders across the region.

“The stakeholders are everybody from Department of Human Services to providers of children’s services to parents, to educators, to other government officials — for example law enforcement, Department of Public Health — kind of casting a really wide net seeking input on what our stakeholders are interested in seeing as the implementation of children’s services,” Hingtgen said.

“Once we have that in really wide net of input, we’re going to dig a little bit deeper and ask some more specific questions with our stakeholder groups to try to get some really good input about what needs to happen, how we need to determine eligibility, how all of those processes need to take shape in order for us to provide the best support that we can for children with severe emotional disturbances (SED), so that the requirement in the law that children who are eligible for services are those who meet the SED criteria.”

Hingtgen added once that input is gathered, the ECR board will write and submit its plan.

“This is obviously impacting our budget for the region,” she said. “We’re including services for children… we’re including planning for that in the budget.”

The next meeting of the board will be at 1:30 p.m. Jan. 23 at the Jean Oxley Linn County Public Service Center, 935 Second St. SW, Cedar Rapids. During that meeting, Hingtgen said the board will see a first draft during that time, and then work on it further during the February meeting before having it certified by March 31.

Following that process, the board will spend the next three months preparing to implement the plans. Included is the establishment of an advisory board for children’s services.

“We’ll be working on gathering folks together who would be interested in serving on the advisory board to provide some structure to the input and the plans for the implementation of those children’s services,” Hingtgen said.

When asked what ideas have been brought about for the proposals, Hingtgen said that is still on the drawing board.

“We’re trying to get a lot of input on that right now,” she said. “The input from our stakeholders and the people who are really interested are often passionate about children’s services and are really important to us. We want to get their input before we really start planning.

“I can plan in isolation, but that wouldn’t be the best interest of the children, the providers, the parents, the families in our nine counties. We really want to have their input first.”

She said prevention and education are two required goals to have in place this summer.

“We’d like to be creative; we’d like to be innovative on prevention,” Hingtgen said. “We’re providing prevention, providing early intervention when children are suffering from, perhaps, trauma, or children are experiencing the beginning stages of mental illness in order to help them from becoming further impacted by the mental illness and really try to focus on the whole child and the well-being of the child. We can help them grow into healthy and successful adults.”

She said the new law requires the regions to focus on serious emotional disturbances for children, but she added what that means is a bit of a gray area.

“We’re working with state input and oversight helping us to narrow down what that definition is, the criteria, the eligibility,” she said. “That is the minimum requirement, and the East Central Iowa Region, we may consider providing services to children who maybe don’t fall under that category of ‘serious emotional disturbance.’ That will be part of our budgeting process as we look at what’s available. Can we afford with our regional budget to provide the above-and-beyond services than what’s required in the minimum in the code?”

Jan Heidemann, Bremer County case manager, said the new system will help with the coordination of the county’s services throughout the lifespan of clients.

“It’s important that in Bremer County — especially working with Bremwood and Lutheran Services in Iowa — that will be an easier transition for the youth that are using those services to be able to transition right into adult services, and if they choose to stay in Bremer County,” Heidemann said.

Hingtgen said one of the challenges the ECR has with the process to implement the children’s behavioral health services is that it’s a mandate from Des Moines without any appropriations.

“We are actively working with our state legislators in order for them to prioritize this year in the legislative session (which began Monday) a mechanism for them to identify additional funding that can come to regions to help us to pay for these services that they’re asking us to provide,” she said.

Heidemann, in Bremer County, doesn’t anticipate a huge fiscal impact here, because of how the legislation was worded.

“The funding piece won’t cover a substantial about of kids,” she said. “Most kids in Iowa have either HAWK-I, which is Medicaid for kids, or their covered through some private insurance of their parents. The actual funding piece, I don’t think, will be substantial for Bremer County, or the region for that matter, but the piece that is going to be larger is going to be coordination.”

Once implemented, Hingtgen hopes the region’s providers can help alleviate the impact of SEDs on children and focus on their well-being and support any child in the nine counties.

“They can grow up to be healthy, successful, contributing adults,” she said. “Along with that, (we can) alleviate some of the distress on families when a family has a child that’s suffering from a severe emotional disturbance that’s hard on the family financially as well as stress and a lot of pressure on the whole family system.

“If we can help to treat children, we can support children in a way that they become more healthy, then that alleviates some of the stress on the family unit as well.”