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NAMI SMARTSfor

ADVOCACY

TEACHER MANUAL

Volume II

INSERT TAB: module 4 Script

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M

edication: Protecting Ch

oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac

y • Medication: Protecting Ch

oice F

acili

tato

r Scr

ipt

Page 1

© 2

015

NAM

I, In

c.

No.

of w

orks

hop

slid

es:

37

Wor

ksho

p to

tal t

ime:

90

min

utes

(at a

bris

k pa

ce)

slid

e 1

App

rox.

2 m

in

Cor

e C

once

pts

In

trodu

ctio

n an

d go

al

A

ffirm

par

ticip

ants

’re

adin

ess

to b

egin

wor

ksho

p

E

valu

atio

n fo

rm

Hel

lo e

very

one.

Wel

com

e to

the

NA

MI S

mar

ts fo

r Adv

ocac

y w

orks

hop,

M

edic

atio

n: P

rote

ctin

g C

hoic

e, p

art o

f NA

MI’s

gra

ssro

ots

advo

cacy

se

ries.

My

nam

e is

[nam

e] a

nd I

will

be fa

cilit

atin

g yo

ur le

arni

ng to

day.

A

nd h

elpi

ng u

s to

day

is [n

ame]

.

Dur

ing

this

wor

ksho

p, w

e'll

talk

abo

ut m

enta

l hea

lth m

edic

atio

ns a

s an

im

porta

nt p

art o

f man

y pe

ople

’s re

cove

ry. W

e’ll

also

dis

cuss

the

pow

er o

f yo

ur s

tory

to im

pact

a p

erso

n’s

abilit

y to

get

the

med

icat

ion

they

nee

d. A

s pa

rt of

this

wor

ksho

p, w

e'll

guid

e yo

u th

roug

h w

ritin

g yo

ur s

tory

in s

even

sh

ort s

teps

.

Med

icat

ions

may

not

hav

e w

orke

d w

ell f

or y

ou o

r you

may

not

cho

ose

to

take

them

. If t

hat’s

the

case

, you

can

stil

l use

you

r liv

ed e

xper

ienc

e—yo

ur

stor

y—to

sup

port

othe

r peo

ple

havi

ng c

hoic

es, i

nclu

ding

new

opt

ions

that

m

ay w

ork

bette

r or h

ave

few

er s

ide

effe

cts.

Whe

n yo

u co

mpl

ete

this

wor

ksho

p, o

ur g

oal i

s th

at y

ou ta

ke w

ith y

ou a

ve

rsio

n of

you

r sto

ry th

at y

ou c

an u

se to

rais

e aw

aren

ess,

insp

ire o

ther

s an

d in

fluen

ce d

ecis

ion

mak

ers.

We

hope

you

’re e

xcite

d. A

re y

ou re

ady

to s

tart

? [W

ait f

or a

resp

onse

, if

appr

opria

te] G

reat

, we’

ll ge

t sta

rted.

To b

egin

, ple

ase

take

out

you

r eva

luat

ion

form

and

fill

out t

he fi

rst

colu

mn

for q

uest

ion

one

and

two

only

. You

will

fill o

ut th

e re

st o

f the

ev

alua

tion

form

at t

he e

nd o

f the

wor

ksho

p.

[Giv

e pa

rtici

pant

s ab

out h

alf a

min

. to

fill o

ut th

e fir

st tw

o qu

estio

ns.]

Star

t the

wor

ksho

p on

tim

e

Han

dout

: Ev

alua

tion

Form

Hel

per o

r Fa

cilit

ator

:

Hel

p pa

rtici

pant

sge

t sea

ted

A

dvan

ceP

ower

Poi

nt s

lides

H

elp

parti

cipa

nts

find

eval

uatio

nfo

rm a

nd fi

ll in

first

col

umn

for

ques

tion

1 an

d 2

Cau

tion:

P

eopl

e w

ho’v

e ex

perie

nced

a

prof

ound

loss

or

even

t(s) m

ay fi

nd

that

writ

ing

thei

r st

ory

trigg

ers

grie

f or

over

whe

lms.

If th

is

happ

ens,

be

prep

ared

to a

ssis

t yo

ur p

artic

ipan

t(s) i

n sa

ving

sto

ry-w

ritin

g fo

r ano

ther

tim

e.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 2

© 2

015

NAM

I, In

c.

sl

ide

2 A

ppro

x. 1

min

C

ore

Con

cept

s

Wor

ksho

p fo

rmat

Med

icat

ion

Pro

tect

ing

Cho

ice

is fo

rmat

ted

to b

uild

on

wha

t res

earc

h sh

ows

help

s pe

ople

lear

n:

Firs

t, yo

u w

ill le

arn

why

tellin

g yo

ur s

tory

abo

ut m

edic

atio

ns is

im

porta

nt

N

ext,

you’

ll he

ar ti

ps fo

r tel

ling

your

sto

ry e

ffect

ivel

y

List

en to

an

exam

ple

D

isco

ver w

hat m

akes

a s

tory

wor

k

Writ

e yo

ur o

wn

stor

y an

d

Prac

tice

shar

ing

it.

H

ow d

oes

this

sou

nd to

you

? [W

ait f

or g

roup

to re

spon

d.]

Aga

in, t

oday

’s w

orks

hop

is fo

cuse

d on

usi

ng y

our s

tory

to h

elp

peop

le g

et

the

right

men

tal h

ealth

med

icat

ions

eas

ily.

sl

ide

3

App

rox.

1 m

in

Cor

e C

once

pt

T

urn

off e

lect

roni

c de

vice

s

P

artic

ipat

e fu

lly

H

old

ques

tions

Can

not p

rovi

de m

edic

atio

n ad

vice

This

wor

ksho

p co

vers

a lo

t of g

roun

d in

a s

hort

am

ount

of t

ime.

In

orde

r for

eve

ryon

e to

get

the

mos

t out

of t

his

sess

ion,

I’d

like

to a

sk y

ou

to a

gree

to th

e fo

llow

ing

basi

c gr

ound

rule

s:

Tu

rn o

ff yo

ur e

lect

roni

c de

vice

s un

less

abs

olut

ely

nece

ssar

y

P

artic

ipat

e fu

lly—

be w

illing

to d

o ea

ch o

f the

act

iviti

es a

nd to

sta

y fo

cuse

d

B

ecau

se o

ur ti

me

is li

mite

d, p

leas

e ke

ep q

uest

ions

and

com

men

ts

very

brie

f

Th

is is

not

“Ask

the

doct

or,”

so if

you

hav

e qu

estio

ns a

bout

spe

cific

m

edic

atio

ns, p

leas

e fo

llow

up

with

a p

resc

riber

To

kee

p us

on

time,

I’ll

be s

igna

ling

you

whe

n w

e ne

ed to

sto

p an

act

ivity

. I’l

l let

you

kno

w b

y [in

dica

te h

ow y

ou’ll

sign

al p

artic

ipan

ts—

voic

e, h

and,

ch

ime,

etc

.] P

leas

e be

willi

ng to

sto

p ev

en if

you

are

not

fini

shed

. If

you

have

que

stio

ns o

r com

men

ts th

at a

ren’

t ans

wer

ed d

urin

g th

e w

orks

hop,

feel

free

to a

sk th

em w

hen

the

wor

ksho

p is

ove

r.

Are

you

will

ing

to fo

llow

thes

e gr

ound

rule

s? [W

ait f

or re

spon

se]

Than

k yo

u!

Prep

: D

ecid

e ho

w y

ou w

ill si

gnal

par

ticip

ants

du

ring

the

wor

ksho

p (e

.g.,

by v

oice

, rai

sed

hand

, chi

me,

etc

.)

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 3

© 2

015

NAM

I, In

c.

sl

ide

4

App

rox.

3 m

in

Cor

e C

once

pts

W

hy th

is w

orks

hop?

Med

icat

ion

is a

reco

very

tool

, th

ough

not

for e

very

one

I

ndiv

idua

l res

pons

e va

ries

We’

d lik

e to

say

a w

ord

abou

t why

this

wor

ksho

p is

par

t of N

AM

I Sm

arts

fo

r Adv

ocac

y. N

AM

I see

ks to

bui

ld b

ette

r liv

es fo

r all

who

are

affe

cted

by

men

tal i

llnes

s or

men

tal h

ealth

con

ditio

ns.

We

know

that

med

icat

ion

can

be a

val

uabl

e to

ol in

a p

erso

n’s

reco

very

. W

e al

so k

now

that

not

eve

ryon

e ta

kes

med

icat

ion

as p

art o

f men

tal

heal

th tr

eatm

ent.

B

ut fo

r tho

se w

ho d

o, w

e kn

ow th

at o

ne s

ize

does

not

fit a

ll be

caus

e m

enta

l hea

lth m

edic

atio

ns a

ffect

peo

ple

in d

iffer

ent w

ays.

Med

icat

ions

th

at w

ork

for o

ne p

erso

n m

ay n

ot w

ork

for a

noth

er. A

nd, i

f sid

e ef

fect

s ca

use

prob

lem

s an

othe

r med

icat

ion,

or c

ombi

natio

n of

med

icat

ions

, may

w

ork

bette

r.

That

’s w

hy y

our l

ived

exp

erie

nce

is s

o va

luab

le to

info

rm th

e de

cisi

on

mak

ers

char

ged

with

dec

idin

g w

ho c

an g

et w

hat k

ind

of m

enta

l hea

lth

med

icat

ion.

E

ven

if m

edic

atio

n is

not

par

t of t

reat

men

t for

you

rsel

f or s

omeo

ne y

ou

care

abo

ut, y

ou c

an s

uppo

rt ch

oice

for o

ther

s.

sl

ide

5

App

rox.

3 m

in

Cor

e C

once

pts

H

ow h

as m

edic

atio

n he

lped

?

W

hat d

id it

take

to g

et th

e rig

ht m

edic

atio

n?

To s

tart,

let’s

thin

k ab

out t

he ro

le m

edic

atio

n ha

s pl

ayed

in y

our r

ecov

ery

or th

e re

cove

ry o

f som

eone

you

kno

w. W

hat h

as it

take

n to

get

the

right

m

edic

atio

n? H

ave

you

had

med

icat

ions

that

did

n’t w

ork

for y

ou o

r had

pr

oble

ms

getti

ng th

e m

edic

atio

n yo

u ne

ed?

I’l

l rea

d th

e fir

st q

uest

ion,

then

the

seco

nd. I

f you

’d li

ke to

sha

re, r

aise

yo

ur h

and.

Let

’s tr

y fo

r a c

oupl

e of

resp

onse

s to

eac

h qu

estio

n.

Brie

fly, h

ow h

as m

edic

atio

n he

lped

with

you

r rec

over

y or

the

reco

very

of s

omeo

ne y

ou c

are

abou

t? [T

ake

2 br

ief r

espo

nses

) B

riefly

, wha

t did

it ta

ke to

get

the

right

med

icat

ion?

Any

cha

lleng

es?

[Tak

e 2

brie

f res

pons

es, t

hen

than

k re

spon

dent

s fo

r sha

ring]

A

s w

e st

art e

xplo

ring

wha

t can

get

in th

e w

ay o

f peo

ple

getti

ng th

e m

edic

atio

n th

ey n

eed,

thin

k ab

out t

he ro

le m

edic

atio

n pl

ays

in re

cove

ry

and

wha

t it c

an ta

ke to

get

the

right

med

icat

ion.

Not

e:

Slid

e ha

s au

tom

atio

n—qu

estio

ns w

ill fa

de in

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 4

© 2

015

NAM

I, In

c.

sl

ide

6

App

rox.

1.5

min

C

ore

Con

cept

s

Hea

lth p

lans

sho

uld

help

pe

ople

get

the

right

m

edic

atio

n

Man

y pe

ople

get

thei

r med

icat

ion

thro

ugh

a he

alth

pla

n. A

hea

lth p

lan

can

be a

:

Com

mer

cial

hea

lth in

sura

nce

plan

, lik

e B

lueC

ross

or A

etna

H

ealth

insu

ranc

e fo

r the

milit

ary,

like

TR

ICA

RE

G

over

nmen

t-fun

ded

heal

th p

lan,

like

Med

icai

d, w

hich

cov

ers

low

-in

com

e A

mer

ican

s, o

r Med

icar

e P

art D

pla

ns, w

hich

cov

er

med

icat

ions

for o

lder

Am

eric

ans

and

peop

le w

ith d

isab

ilitie

s

Thro

ugho

ut th

is w

orks

hop,

we’

ll us

e th

e te

rm h

ealth

pla

ns to

mea

n an

y ki

nd o

f priv

ate

or g

over

nmen

t hea

lth in

sura

nce

or h

ealth

cov

erag

e.

Hea

lth p

lans

hav

e to

bal

ance

…

H

ow m

uch

they

cha

rge

for a

pla

n (th

e in

sura

nce

prem

ium

) or t

he

fund

ing

they

rece

ive

with

…

W

hat i

t cos

ts to

pro

vide

qua

lity

care

, inc

ludi

ng m

edic

atio

n, fo

r the

ir m

embe

rs

A

s pa

rt of

man

agin

g bo

th c

ost a

nd q

ualit

y, N

AM

I bel

ieve

s th

at h

ealth

pl

ans

shou

ld h

elp

peop

le g

et th

e rig

ht m

edic

atio

n to

aid

in th

eir r

ecov

ery.

W

ithou

t the

righ

t med

icat

ion,

peo

ple

may

exp

erie

nce

poor

hea

lth

outc

omes

—an

d ne

ed m

ore

cost

ly c

are,

like

hos

pita

lizat

ion.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 5

© 2

015

NAM

I, In

c.

sl

ide

7

App

rox.

.5 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay m

ake

it di

fficu

lt to

get

the

right

m

edic

atio

n

Yet

eve

n th

ough

the

right

med

icat

ion

may

hel

p w

ith y

our r

ecov

ery,

hea

lth

plan

s m

ay m

ake

it di

fficu

lt to

get

the

right

med

icat

ion.

H

ealth

pla

ns tr

y to

hel

p pe

ople

reco

ver a

nd s

tay

wel

l whi

le m

anag

ing

cost

s. B

ut h

ow a

hea

lth p

lan

man

ages

ben

efits

can

affe

ct w

heth

er it

is

easy

or d

iffic

ult f

or p

eopl

e to

get

the

med

icat

ion

that

’s ri

ght f

or th

em.

sl

ide

8

App

rox.

1 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay li

mit

choi

ces

of m

edic

atio

ns o

n its

form

ular

y

One

of t

he m

ost c

omm

on w

ays

heal

th p

lans

may

mak

e it

hard

er fo

r pe

ople

to g

et th

e rig

ht m

edic

atio

n is

by

limiti

ng y

our c

hoic

e of

cov

ered

m

edic

atio

ns.

Hea

lth p

lans

als

o ty

pica

lly c

hang

e th

eir l

ist o

f cov

ered

med

icat

ions

on

e or

mor

e tim

es a

yea

r. A

hea

lth p

lan’

s lis

t of c

over

ed m

edic

atio

ns is

cal

led

a fo

rmul

ary

or a

pr

efer

red

drug

list

(PD

L).

We’

re g

oing

to m

entio

n so

me

com

mon

term

s us

ed b

y he

alth

pla

ns to

day,

bu

t you

won

’t ne

ed to

rem

embe

r the

m in

this

wor

ksho

p. W

e’ve

incl

uded

a

glos

sary

of t

he te

rms

we’

re u

sing

in y

our p

acke

t for

you

to re

ad la

ter,

if yo

u lik

e.

Han

dout

: G

loss

ary

Hel

per o

r Fa

cilit

ator

: H

old

up a

cop

y of

the

Glo

ssar

y w

hen

it’s

men

tione

d in

the

scrip

t

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 6

© 2

015

NAM

I, In

c.

sl

ide

9

App

rox.

3 m

in

Cor

e C

once

pt

P

&T

Com

mitt

ees

are

ofte

n th

e de

cisi

on-m

aker

s fo

r pl

an fo

rmul

arie

s

You

may

be

won

derin

g w

ho m

akes

the

deci

sion

s ab

out w

hat m

edic

atio

ns

your

hea

lth p

lan

cove

rs o

r wha

t you

hav

e to

do

to g

et th

em. I

n so

me

case

s, a

hea

lth p

lan’

s ph

arm

acy

dire

ctor

or p

harm

acy

bene

fit m

anag

er, a

co

mpa

ny th

at m

anag

es m

edic

atio

ns fo

r a h

ealth

pla

n, d

ecid

es w

hich

m

edic

atio

ns w

ill be

cov

ered

and

how

. S

ome

plan

s, li

ke M

edic

are

Par

t D a

nd M

edic

aid

plan

s, a

re re

quire

d to

ha

ve a

Pha

rmac

y an

d Th

erap

eutic

s C

omm

ittee

, mor

e co

mm

only

cal

led

a P

&T

Com

mitt

ee. P

&T

Com

mitt

ees

are

mad

e up

of d

octo

rs a

nd o

ther

he

alth

pro

fess

iona

ls a

nd s

omet

imes

hav

e m

embe

r or a

dvoc

ate

repr

esen

tativ

es. I

n 20

17, m

ore

com

mer

cial

hea

lth p

lans

will

be re

quire

d to

hav

e a

P&

T C

omm

ittee

, too

. P

&T

Com

mitt

ees

revi

ew s

cien

tific

evi

denc

e fo

r a m

edic

atio

n’s

effe

ctiv

enes

s, s

afet

y, s

ide

effe

cts,

dru

g in

tera

ctio

ns, c

ost a

nd o

ther

fa

ctor

s. T

he C

omm

ittee

wei

ghs

thes

e fa

ctor

s, a

long

with

sto

ries

or

test

imon

y fro

m th

e pu

blic

, and

then

mak

es a

reco

mm

enda

tion

or d

ecis

ion

for c

over

age

by th

e pl

an.

We

wan

t to

poin

t out

that

hea

lth p

lans

may

mak

e de

cisi

ons

to n

ot c

over

a

med

icat

ion

or to

rest

rict i

ts c

over

age

beca

use

the

med

icat

ion:

May

hav

e da

nger

ous

or s

erio

us s

ide

effe

cts

or in

tera

ctio

ns,

Is

n’t a

ppro

ved

for c

erta

in h

ealth

con

ditio

ns,

M

ay h

ave

limite

d ef

fect

iven

ess

or is

effe

ctiv

e on

ly u

nder

cer

tain

co

nditi

ons

or

E

ffect

iven

ess

or s

afet

y m

ay n

ot b

e w

ell-e

stab

lishe

d or

may

be

in

ques

tion.

Cov

erag

e of

a m

edic

atio

n m

ay a

lso

be li

mite

d be

caus

e:

A

gen

eric

ver

sion

of t

he m

edic

atio

n is

ava

ilabl

e or

The

med

icat

ion

is m

ore

expe

nsiv

e th

an o

ther

med

icat

ions

use

d to

tre

at th

e sa

me

cond

ition

.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 7

© 2

015

NAM

I, In

c.

sl

ide

10

App

rox.

.5 m

in

Cor

e C

once

pt

M

edic

atio

n co

vera

ge g

ets

mor

e co

mpl

icat

ed

We’

ve m

entio

ned

that

hea

lth p

lans

can

lim

it yo

ur c

hoic

e of

cov

ered

m

edic

atio

ns a

nd c

an c

hang

e th

eir l

ist o

f cov

ered

med

icat

ions

one

or

mor

e tim

es a

yea

r. W

e al

so n

oted

that

, for

man

y pl

ans,

P&

T C

omm

ittee

s ar

e in

fluen

tial o

r dec

isio

n-m

aker

s on

cov

erag

e of

med

icat

ions

. B

ut, i

t get

s ev

en m

ore

com

plic

ated

… [P

ause

for a

mom

ent]

sl

ide

11

App

rox.

2 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay p

ut s

ome

med

icat

ions

in h

ighe

r “tie

rs”

and

char

ge h

ighe

r cos

ts

Ano

ther

way

hea

lth p

lans

may

mak

e it

hard

er fo

r you

to g

et th

e rig

ht

med

icat

ion

is b

y pu

tting

som

e m

edic

atio

ns in

a h

ighe

r “tie

r” or

leve

l on

its

list o

f cov

ered

med

icat

ions

.

Com

mer

cial

hea

lth in

sura

nce

plan

s an

d M

edic

are

Par

t D p

lans

usu

ally

ha

ve ti

ered

dru

g lis

ts. D

rugs

on

the

low

est t

ier h

ave

no o

r low

er o

ut-o

f-po

cket

cos

ts c

ompa

red

to d

rugs

on

high

er ti

ers.

O

ut-o

f-poc

ket c

osts

may

take

the

form

of c

opay

s (a

set

am

ount

you

hav

e to

pay

), co

insu

ranc

e (a

per

cent

age

of th

e to

tal d

rug

cost

) or a

de

duct

ible

(an

amou

nt y

ou h

ave

to p

ay b

efor

e co

vera

ge w

ill be

gin

or

resu

me)

. Th

e tie

r lev

el o

f a m

edic

atio

n is

ofte

n lis

ted

on a

pla

n’s

drug

list

. How

ever

, th

e lis

t mig

ht n

ot te

ll yo

u w

hat t

he o

ut-o

f-poc

ket c

ost w

ill be

for d

rugs

on

diffe

rent

tier

s.

Hav

e yo

u ev

er h

ad a

cop

ay o

r coi

nsur

ance

that

mad

e yo

ur

med

icat

ion

unaf

ford

able

? [T

ake

a qu

ick

resp

onse

or t

wo]

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 8

© 2

015

NAM

I, In

c.

sl

ide

12

App

rox.

1 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay li

st

med

icat

ions

as

“non

-pr

efer

red”

and

cha

rge

mor

e

Hea

lth p

lans

may

als

o lis

t som

e m

edic

atio

ns a

s “p

refe

rred”

and

oth

ers

as

“non

-pre

ferre

d.” P

refe

rred

med

icat

ions

are

cov

ered

by

the

plan

. Non

-pr

efer

red

med

icat

ions

may

be

avai

labl

e at

a h

ighe

r cos

t—or

may

not

be

cove

red

at a

ll.

A p

lan

may

mak

e a

med

icat

ion

“pre

ferr

ed” b

ecau

se it

is s

afer

or m

ore

effe

ctiv

e th

an a

sim

ilar m

edic

atio

n, b

ut a

med

icat

ion

may

als

o be

pr

efer

red

beca

use

it is

less

exp

ensi

ve to

the

plan

than

an

alte

rnat

ive

med

icat

ion.

H

ave

you

ever

nee

ded

a m

edic

atio

n th

at w

as “

non-

pref

erre

d” o

n yo

ur h

ealth

pla

n? [T

ake

a qu

ick

resp

onse

or t

wo]

sl

ide

13

App

rox.

1 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay re

quire

“p

rior a

utho

rizat

ion”

You

may

als

o ha

ve p

robl

ems

getti

ng th

e rig

ht m

edic

atio

n if

your

pla

n re

quire

s “p

rior a

utho

rizat

ion”

or p

rior a

ppro

val.

Prio

r aut

horiz

atio

n m

eans

th

at y

our d

octo

r mus

t con

tact

you

r hea

lth p

lan

and

requ

est c

over

age

of

the

med

icat

ion.

If

prio

r aut

horiz

atio

n, o

r “P

A,”

is g

rant

ed, y

our p

lan

will

cove

r the

dru

g, b

ut

you

may

hav

e an

out

-of-p

ocke

t cos

t. S

ome

plan

s re

quire

a n

ew p

rior

auth

oriz

atio

n ev

ery

year

or e

ven

ever

y tim

e yo

u re

fill y

our m

edic

atio

n.

If pr

ior a

utho

rizat

ion

is n

ot g

rant

ed, y

our p

lan

won

’t co

ver t

he c

ost o

f the

m

edic

atio

n. B

ut, y

ou h

ave

the

right

to a

ppea

l you

r pla

n’s

deci

sion

.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 9

© 2

015

NAM

I, In

c.

sl

ide

14

App

rox.

1 m

in

Cor

e C

once

pt

H

ealth

pla

ns m

ay re

quire

“s

tep

ther

apy”

Hea

lth p

lans

may

als

o us

e “s

tep

ther

apy”

—re

quiri

ng y

ou to

try

and

fail

on

one

or m

ore

med

icat

ions

bef

ore

they

will

appr

ove

cove

rage

for a

diff

eren

t m

edic

atio

n.

For e

xam

ple,

a p

lan

may

requ

ire y

ou to

try

a ge

neric

ant

ipsy

chot

ic fo

r se

vera

l wee

ks a

nd h

ave

your

doc

tor d

ocum

ent t

hat i

t did

not

wor

k fo

r you

be

fore

aut

horiz

ing

cove

rage

for a

diff

eren

t bra

nd n

ame

antip

sych

otic

. H

ave

you

ever

had

a b

ad e

xper

ienc

e w

ith e

ither

prio

r aut

horiz

atio

n or

ste

p th

erap

y? [T

ake

a co

uple

of b

rief r

espo

nses

]

sl

ide

15

App

rox.

.5 m

in

Cor

e C

once

pt

F

orm

ular

y re

quire

men

ts

can

keep

you

from

get

ting

the

med

icat

ion

you

need

We’

ve ju

st ta

lked

abo

ut:

Li

mite

d ch

oice

s of

med

icat

ions

on

form

ular

ies,

Tier

ed li

sts

of c

over

ed m

edic

atio

ns w

ith h

ighe

r cos

ts a

t hig

her

tiers

,

Non

-pre

ferr

ed m

edic

atio

ns th

at c

ost m

ore

or a

ren’

t cov

ered

,

Req

uire

men

ts fo

r a d

octo

r to

requ

est “

prio

r aut

horiz

atio

n” a

nd

S

tep

ther

apy

requ

irem

ents

. A

ny o

f the

se m

ay k

eep

you

from

get

ting

the

med

icat

ion

you

need

.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

0 © 2

015

NAM

I, In

c.

sl

ide

16

App

rox.

1 m

in

Cor

e C

once

pt

N

ot g

ettin

g th

e rig

ht

med

icat

ion

may

put

you

at

high

er ri

sk

Not

get

ting

the

right

med

icat

ion

may

put

you

at h

ighe

r ris

k fo

r em

erge

ncy

room

vis

its, h

ospi

taliz

atio

n or

oth

er p

oor o

utco

mes

. A

ccor

ding

to a

ten-

stat

e st

udy

of M

edic

aid

pres

crip

tion

polic

ies,

re

sear

cher

s fo

und

that

prio

r aut

horiz

atio

n of

med

icat

ions

wer

e as

soci

ated

w

ith p

eopl

e be

ing:

Mor

e th

an tw

ice

as li

kely

to b

e re

port

ed h

omel

ess

and

Thre

e tim

es m

ore

likel

y to

be

hosp

italiz

ed.

Peo

ple

who

dis

cont

inue

d or

tem

pora

rily

stop

ped

thei

r med

icat

ions

due

to

prob

lem

s ge

tting

thei

r med

icat

ions

wer

e m

ore

than

twic

e as

like

ly to

en

d up

in ja

il.

sl

ide

17

App

rox.

.5 m

in

Cor

e C

once

pt

1

out

of 1

3 E

D v

isits

in

volv

ed m

enta

l illn

ess

Let’s

look

at s

ome

num

bers

for e

mer

genc

y de

partm

ent v

isits

. Acc

ordi

ng

to h

ospi

tal d

ata,

mor

e th

an o

ne o

ut o

f eve

ry 1

3 em

erge

ncy

depa

rtm

ent

visi

ts a

mon

g ad

ults

invo

lved

men

tal i

llnes

s.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

1 © 2

015

NAM

I, In

c.

sl

ide

18

App

rox.

.5 m

in

Cor

e C

once

pt

M

ood

diso

rder

s a

top

reas

on fo

r hos

pita

l ad

mis

sion

s

For a

dults

, moo

d di

sord

ers

wer

e th

e to

p re

ason

for a

dmis

sion

to a

ho

spita

l afte

r an

emer

genc

y de

partm

ent v

isit

in 2

011.

A

nd m

ood

diso

rder

s w

ere

the

four

th m

ost c

omm

on re

ason

for

hosp

italiz

atio

n of

chi

ldre

n ag

es 0

-17

(exc

ludi

ng h

ospi

tal s

tays

for

youn

g m

oms

and

new

born

s).

sl

ide

19

App

rox.

.5 m

in

Cor

e C

once

pt

P

sych

otic

dis

orde

rs a

lso

a to

p re

ason

for h

ospi

tal

adm

issi

ons

For a

dults

, psy

chot

ic d

isor

ders

, lik

e sc

hizo

phre

nia,

wer

e th

e fo

urth

m

ost c

omm

on re

ason

for a

hos

pita

l adm

issi

on a

fter a

n em

erge

ncy

depa

rtmen

t vis

it in

201

1.

Whe

n pe

ople

don

’t ge

t the

hea

lth c

are

they

nee

d, in

clud

ing

the

right

m

edic

atio

n, th

ey’re

at h

ighe

r ris

k fo

r poo

r out

com

es li

ke e

mer

genc

y de

part

men

t vis

its a

nd h

ospi

taliz

atio

n.

As

we’

ve ju

st h

eard

, the

re a

re s

erio

us c

onse

quen

ces

whe

n pe

ople

don

’t ge

t the

hel

p th

ey n

eed.

If y

ou’d

like

to re

fer t

o th

ese

fact

s, fi

nd th

e fa

ct

shee

t inc

lude

d in

you

r pac

ket.

Han

dout

: Fa

ct S

heet

H

elpe

r or

Faci

litat

or:

Hol

d up

a c

opy

of th

e Fa

ct S

heet

whe

n it’

s m

entio

ned

in th

e sc

ript

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

2 © 2

015

NAM

I, In

c.

sl

ide

20

App

rox.

1 m

in

Cor

e C

once

pt

A

med

icat

ion

that

wor

ks fo

r on

e pe

rson

may

not

wor

k w

ell f

or a

noth

er

This

quo

te fr

om th

e N

atio

nal I

nstit

ute

of M

enta

l Hea

lth s

ums

up w

hat

man

y pe

ople

hav

e ex

perie

nced

: “A

med

icat

ion

that

wor

ks w

ell f

or o

ne

pers

on w

ith s

chiz

ophr

enia

ofte

n do

esn’

t wor

k w

ell f

or a

noth

er.

Gen

etic

var

iatio

ns a

re th

ough

t to

play

a k

ey ro

le in

this

diff

eren

ce in

re

spon

se. W

hile

pat

ient

s se

arch

for t

he ri

ght m

edic

atio

ns, t

heir

illne

sses

may

wor

sen.

” Th

is is

not

just

true

for s

chiz

ophr

enia

. Man

y pe

ople

with

oth

er m

enta

l illn

esse

s, li

ke b

ipol

ar d

isor

der,

also

find

that

a m

edic

atio

n th

at w

orks

wel

l fo

r oth

ers

does

n’t w

ork

wel

l for

them

. D

o yo

u kn

ow s

omeo

ne th

at h

as d

one

wel

l on

a m

edic

atio

n th

at

does

n’t w

ork

for y

ou o

r oth

ers,

eve

n th

ough

you

hav

e th

e sa

me

diag

nosi

s? [T

ake

a qu

ick

resp

onse

]

sl

ide

21

App

rox.

.5 m

in

Cor

e C

once

pt

Y

our s

tory

let’s

peo

ple

know

how

the

right

m

edic

atio

n he

lps

We

know

that

it is

n’t a

lway

s ea

sy to

get

the

right

med

icat

ion

and

we

know

w

hat c

an h

appe

n w

hen

peop

le d

on’t

get t

he m

edic

atio

n th

ey n

eed.

Tha

t’s

why

it’s

impo

rtant

to s

peak

up.

You

r sto

ry is

a w

ay to

let p

eopl

e kn

ow

how

the

right

med

icat

ion

mak

es a

big

diff

eren

ce in

not

just

you

r re

cove

ry o

r tha

t of s

omeo

ne y

ou lo

ve, b

ut a

lso

the

reco

very

of o

ther

pe

ople

who

live

with

men

tal i

llnes

s.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

3 © 2

015

NAM

I, In

c.

sl

ide

22

App

rox.

1 m

in

Cor

e C

once

pts

Y

our s

tory

is a

lway

s rig

ht

Y

our l

ived

exp

erie

nce

has

valu

e an

d m

eani

ng

Y

ou d

on’t

have

to h

ave

all

the

answ

ers—

just

a c

lear

“a

sk”

Res

earc

h sh

ows

that

sto

ries

that

evo

ke e

mot

ion

and

empa

thy

are

far

mor

e po

wer

ful t

han

fact

s an

d fig

ures

in s

hapi

ng th

e op

inio

ns o

f oth

ers.

H

earin

g re

al s

torie

s is

one

of t

he b

est w

ays

to c

hang

e ho

w h

ealth

pla

ns

cove

r med

icat

ions

for p

eopl

e liv

ing

with

men

tal i

llnes

s.

Bes

t of a

ll: [P

ause

slig

htly

afte

r eac

h of

thes

e co

ncep

ts to

let p

eopl

e pr

oces

s]

1. Y

our s

tory

is a

lway

s rig

ht

2. Y

our l

ived

exp

erie

nce

has

valu

e an

d m

eani

ng

3. Y

ou d

on't

have

to h

ave

all t

he a

nsw

ers-

-just

a c

lear

"as

k" o

f yo

ur li

sten

ers

If yo

u th

ink

abou

t it,

this

is v

ery

empo

wer

ing

to re

aliz

e.

sl

ide

23

App

rox.

.5 m

in

Cor

e C

once

pt

H

ow y

ou te

ll yo

ur s

tory

can

af

fect

you

r im

pact

How

ever

, whi

le y

our l

ived

exp

erie

nce

is m

eani

ngfu

l, ho

w y

ou te

ll yo

ur

stor

y af

fect

s yo

ur im

pact

. You

wan

t to

mak

e an

impa

ct, s

o w

e’ll

give

you

so

me

tips

for t

ellin

g yo

ur s

tory

abo

ut y

our e

xper

ienc

e w

ith m

edic

atio

n.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

4 © 2

015

NAM

I, In

c.

sl

ide

24

App

rox.

1 m

in

Cor

e C

once

pts

K

eep

your

sto

ry b

rief

A

im fo

r abo

ut 9

0 se

cond

s;

thin

k of

a m

ovie

trai

ler

The

1st ti

p is

to k

eep

your

sto

ry b

rief.

W

e co

uld

all t

ell v

olum

es a

bout

wha

t has

hap

pene

d to

us.

But

, you

’ll lo

se

your

list

ener

s if

you

spen

d to

o m

uch

time

and

give

too

man

y de

tails

.

Rem

embe

r, w

e liv

e in

a w

orld

of s

ound

bite

s an

d Tw

itter

feed

s. K

eep

your

sto

ry s

hort.

Aim

for a

bout

90

seco

nds.

Th

ink

abou

t a m

ovie

trai

ler—

in 3

0 se

c. y

ou g

et th

e hi

ghlig

hts

and

wan

t to

see

mor

e. T

hat i

s w

hat y

ou w

ant t

o ac

hiev

e w

ith y

our s

tory

—gi

ve ju

st th

e hi

ghlig

hts

abou

t how

med

icat

ion

has

mad

e a

diffe

renc

e in

you

r rec

over

y an

d le

ave

your

list

ener

s ea

ger t

o kn

ow m

ore.

sl

ide

25

App

rox.

1 m

in

Cor

e C

once

pt

H

ope

is a

pow

erfu

l m

otiv

ator

T

hink

abo

ut h

ow g

ettin

g th

e rig

ht m

edic

atio

n he

lped

or

wou

ld h

elp

with

you

r re

cove

ry

Our

2nd

tip

is to

mot

ivat

e yo

ur li

sten

er b

y us

ing

posi

tive

conc

epts

like

ho

pe a

nd re

cove

ry w

hene

ver p

ossi

ble.

H

ope

is a

pow

erfu

l mot

ivat

or fo

r dec

isio

n m

aker

s. P

eopl

e lik

e to

root

for

thos

e w

ho m

ake

it th

roug

h ad

vers

ity—

use

this

to y

our a

dvan

tage

. If

you

stru

ggle

to th

ink

of y

our s

tory

as

hope

ful,

thin

k ab

out w

hat y

ou

hope

for o

r how

get

ting

the

right

med

icat

ion

wou

ld h

elp

with

you

r re

cove

ry o

r wou

ld h

elp

othe

rs in

thei

r rec

over

y.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

5 © 2

015

NAM

I, In

c.

sl

ide

26

App

rox.

1 m

in

Cor

e C

once

pts

M

ake

an “a

sk”

Her

e's

our l

ast t

ip:

Mak

e an

“as

k” o

f you

r lis

tene

r. Th

is is

ofte

n fo

rgot

ten

whe

n pe

ople

tell

thei

r sto

ries.

But

as

the

sayi

ng g

oes,

“If y

ou d

on’t

ask,

yo

u do

n’t g

et.”

Bes

ides

, dec

isio

n m

aker

s w

ant t

o kn

ow w

hat y

ou w

ant t

hem

to d

o, e

ven

if th

ey d

isag

ree.

If y

ou a

re ta

lkin

g to

dec

isio

n m

aker

s, le

t the

m k

now

wha

t w

ould

hel

p yo

u or

oth

ers

get (

or k

eep

getti

ng) t

he ri

ght m

edic

atio

n to

su

ppor

t rec

over

y.

You

've

just

hea

rd o

ur th

ree

tips.

Wha

t was

the

mos

t mea

ning

ful t

hing

yo

u've

hea

rd s

o fa

r? [

Take

two

quic

k re

spon

ses]

sl

ide

27

App

rox.

5 m

in

Cor

e C

once

pts

S

hare

a s

ampl

e st

ory

S

tory

form

at is

ada

ptab

le

L

iste

n an

d no

tice

your

re

actio

ns

Now

that

we’

ve g

one

thro

ugh

our t

ips,

I'm

goi

ng to

sha

re a

sam

ple

stor

y fr

om th

e pe

rspe

ctiv

e of

[cho

ose

the

sam

ple

stor

y yo

u w

ill re

ad].

You

r m

ater

ials

incl

ude

two

sam

ple

stor

ies—

one

from

the

poin

t of v

iew

of a

pe

er a

nd o

ne fr

om th

e po

int o

f vie

w o

f a fa

mily

mem

ber.

You

r ow

n pe

rspe

ctiv

e is

uni

que

and

you

may

or m

ay n

ot re

late

to th

ese

sam

ple

stor

ies.

Th

is s

tory

is b

eing

told

as

if th

e pe

rson

wer

e ta

lkin

g to

a P

harm

acy

&

Ther

apeu

tics

(P&

T) C

omm

ittee

. How

ever

, thi

s st

ory

form

at is

like

a b

asic

re

cipe

; it c

an b

e ea

sily

ada

pted

to fi

t oth

er s

ituat

ions

or a

udie

nces

. Fo

r now

, I’d

like

you

to k

eep

an o

pen

min

d an

d no

tice

your

reac

tions

an

d w

hat m

oves

you

or h

as im

pact

for y

ou.

R

ead

the

sam

ple

stor

y w

ith e

xpre

ssio

n [y

ou o

r, id

eally

, you

r Hel

per]

W

hat h

ad im

pact

for y

ou o

r cau

ght y

our a

ttent

ion?

[Tak

e tw

o to

four

re

spon

ses]

Prep

: D

ecid

e w

hich

sam

ple

stor

y yo

u w

ill us

e be

fore

the

wor

ksho

p H

elpe

r or

Faci

litat

or:

Prac

tice

the

sam

ple

stor

y ou

t lou

d se

vera

l tim

es b

efor

e th

e w

orks

hop

until

yo

u ca

n re

ad it

sm

ooth

ly a

nd w

ith

expr

essi

on

Han

dout

: Sa

mpl

e St

orie

s

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

6 © 2

015

NAM

I, In

c.

sl

ide

28

App

rox.

15

min

C

ore

Con

cept

Com

pare

Sev

en S

teps

C

heck

list t

o sa

mpl

e st

ory

Now

that

you

've

liste

ned

to o

ur s

ampl

e st

ory

and

notic

ed it

s im

pact

, you

'll ne

ed y

our S

ampl

e St

orie

s (p

ages

3-4

), yo

ur S

even

Ste

ps C

heck

list

(pag

e 5)

and

you

r Sto

ry P

ract

ice

Shee

ts (p

ages

7-8

).

The

Che

cklis

t lis

ts th

e el

emen

ts o

f a b

rief,

effe

ctiv

e st

ory.

We'

re g

oing

to

revi

ew th

ese

seve

n el

emen

ts, o

r ste

ps, a

nd c

ompa

re th

em w

ith th

e sa

mpl

e st

ory

you

just

hea

rd. T

hen,

you

'll us

e th

ese

step

s to

writ

e yo

ur

own

stor

y.

Not

e: M

ark

the

sent

ence

s in

you

r sam

ple

stor

y th

at y

ou w

ant p

eopl

e to

m

entio

n w

hen

answ

erin

g th

e qu

estio

ns.

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Stor

y Pr

actic

e Sh

eets

H

elpe

r: H

elp

peop

le

find

wor

kshe

ets

as

need

ed

Dis

cuss

1st

ste

p

Int

rodu

ce w

ho y

ou a

re a

nd

whe

re y

ou’re

from

S

hare

how

you

are

affe

cted

by

men

tal i

llnes

s

Sta

te y

our p

urpo

se—

wha

t ac

tion

or d

ecis

ion

you

wan

t

The

1st s

tep

of a

n ef

fect

ive

stor

y is

to in

trodu

ce y

ours

elf a

nd w

hy y

ou

are

spea

king

or w

ritin

g.

1.

You

r int

rodu

ctio

n sh

ould

beg

in b

y le

tting

you

r aud

ienc

e kn

ow y

our

nam

e an

d w

hat c

ity o

r tow

n yo

u liv

e in

. 2.

S

hare

how

you

are

affe

cted

by

men

tal i

llnes

s, w

heth

er y

ou li

ve w

ith

men

tal i

llnes

s, a

re a

fam

ily m

embe

r, ca

regi

ver,

frien

d or

pro

fess

iona

l. Th

is e

stab

lishe

s yo

ur c

redi

bilit

y th

roug

h liv

ed e

xper

ienc

e.

3.

Last

ly, l

et y

our l

iste

ner k

now

that

you

wou

ld li

ke to

sha

re y

our s

tory

an

d st

ate

your

pur

pose

—w

hat a

ctio

n or

dec

isio

n yo

u w

ant f

rom

them

. Th

is h

elps

you

r aud

ienc

e fo

cus

and

be m

ore

resp

onsi

ve.

Tak

e a

mom

ent t

o m

ark

the

phra

se in

the

sam

ple

stor

y th

at le

ts y

ou

know

the

purp

ose

of th

e sp

eake

r's s

tory

. W

ho w

ould

like

to re

ad th

e ph

rase

that

lets

list

ener

s kn

ow th

e sp

eake

r’s p

urpo

se?

[Pic

k a

volu

ntee

r and

ask

them

to re

ad th

e ph

rase

th

ey th

ink

answ

ers

the

ques

tion]

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

7 © 2

015

NAM

I, In

c.

Dis

cuss

2nd

ste

p

Wha

t hap

pene

d be

fore

you

re

ceiv

ed h

elp?

S

houl

d be

brie

f, bu

t viv

id

The

2nd s

tep

of a

n ef

fect

ive

stor

y is

to d

escr

ibe

wha

t hap

pene

d be

fore

yo

u go

t the

righ

t med

icat

ion

(or w

hat y

ou a

re g

oing

thro

ugh

now

).

Kee

p th

is v

ery

brie

f--th

ink

abou

t the

mai

n hi

ghlig

hts

or m

ost i

mpo

rtant

th

ing

your

list

ener

sho

uld

know

abo

ut y

our s

ituat

ion.

V

ivid

lang

uage

in th

is d

escr

iptio

n he

lps

your

aud

ienc

e un

ders

tand

wha

t yo

u w

ent t

hrou

gh (o

r are

goi

ng th

roug

h).

T

ake

a m

omen

t to

mar

k a

line

or w

ords

in th

e sa

mpl

e st

ory

that

m

oved

you

or h

elpe

d yo

u un

ders

tand

wha

t hap

pene

d to

the

spea

ker.

Who

wou

ld li

ke to

read

a li

ne in

the

seco

nd s

ectio

n th

at m

oved

you

or

hel

ped

you

unde

rsta

nd w

hat h

appe

ned?

[Pic

k a

volu

ntee

r to

read

th

e ph

rase

they

thin

k an

swer

s th

e qu

estio

n]

Did

som

eone

els

e m

ark

a di

ffere

nt p

hras

e? [P

ick

a vo

lunt

eer t

o re

ad a

ph

rase

] Y

our l

iste

ners

will

vary

in w

hat m

oves

them

. And

, diff

eren

t sto

ries

will

mov

e di

ffere

nt p

eopl

e. T

his

is w

hy it

hel

ps fo

r mul

tiple

peo

ple

to s

hare

th

eir s

torie

s.

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Dis

cuss

3rd

ste

p

Wha

t hel

ped

in y

our

reco

very

or w

hat w

ould

he

lp?

T

ells

the

liste

ner w

hat

mak

es a

diff

eren

ce

The

3rd s

tep

is to

des

crib

e w

hat h

elpe

d in

you

r rec

over

y (o

r for

so

meo

ne y

ou c

are

abou

t) or

wha

t wou

ld h

elp.

By

focu

sing

on

help

ed o

r w

hat w

ould

hel

p yo

u or

oth

ers,

you

cre

ate

a se

nse

of h

ope

and

help

you

r lis

tene

r kno

w w

hat m

akes

a d

iffer

ence

.

T

ake

a m

omen

t to

mar

k a

line

in th

e sa

mpl

e st

ory

that

hel

ped

you

real

ize

wha

t hel

ped.

W

ho w

ould

like

to s

hare

the

line

that

str

uck

you

in th

e th

ird s

tep?

[P

ick

a vo

lunt

eer t

o re

ad w

hat h

elpe

d]

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

8 © 2

015

NAM

I, In

c.

Dis

cuss

4th

ste

p

How

are

you

diff

eren

t to

day?

S

hare

pos

itive

not

e ab

out

reco

very

The

four

th s

tep

is to

des

crib

e ho

w y

ou a

re d

iffer

ent t

oday

. S

hare

w

hat i

s go

ing

right

in y

our l

ife (o

r in

the

life

of s

omeo

ne y

ou c

are

abou

t) or

ho

w y

ou a

re e

xper

ienc

ing

reco

very

. Thi

s is

how

you

r sto

ry in

spire

s.

Wha

t lan

guag

e in

the

four

th s

tep

of th

e st

ory

left

you

feel

ing

hope

ful

or in

spire

d? [

Ask

a v

olun

teer

to re

ad th

e ph

rase

in th

e fo

urth

sec

tion

of

the

stor

y th

at m

entio

ns h

ow th

e w

riter

is d

iffer

ent t

oday

.]

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Dis

cuss

5th

and

6th

ste

p

Wha

t will

help

oth

ers?

T

rans

ition

s fro

m p

erso

nal

to o

ther

s

H

elps

dec

isio

n m

aker

s m

ake

polic

ies

that

affe

ct

man

y pe

ople

In th

e 5th

and

6th

ste

ps, d

escr

ibe

wha

t is

the

need

or p

robl

em a

nd

wha

t will

hel

p ot

hers

. In

step

five

, tra

nsiti

on a

way

from

you

r ow

n co

ncer

n to

wha

t oth

er p

eopl

e ne

ed o

r the

cha

lleng

e th

ey fa

ce th

at is

si

mila

r to

your

ow

n.

In s

tep

six,

des

crib

e w

hat w

ill he

lp o

r cou

ld h

elp

othe

rs. T

his

shou

ld b

e w

hat y

ou w

ant a

dec

isio

n m

aker

to d

o or

dec

ide.

Th

ese

step

s ta

ke y

ou fr

om y

our p

erso

nal s

tory

to a

mes

sage

that

abo

ut

othe

r peo

ple.

Thi

s he

lps

deci

sion

mak

ers

who

will

take

act

ions

or d

ecid

e on

pol

icie

s th

at w

ill af

fect

man

y pe

ople

. W

ho w

ould

like

to s

hare

the

line

that

hel

ped

you

sens

e th

e tr

ansi

tion?

[P

ick

a vo

lunt

eer t

o sh

are

the

line

they

mar

ked.

]

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Dis

cuss

7th

ste

p

Mak

e yo

ur “a

sk”

D

on’t

take

no

or

nonc

omm

ittal

resp

onse

pe

rson

ally

In th

e 7th

and

last

ste

p, m

ake

your

"as

k."

Thi

s is

a c

ritic

al s

tep

that

m

any

advo

cate

s he

sita

te o

r for

get t

o do

. Tha

nk y

our a

udie

nce

for

liste

ning

. The

n, le

t the

m k

now

wha

t act

ion

or d

ecis

ion

you

wan

t the

m to

m

ake

on y

our i

ssue

. If

your

aud

ienc

e gi

ves

you

a po

sitiv

e re

spon

se, t

hank

them

for t

heir

supp

ort.

If

your

aud

ienc

e gi

ves

you

a ne

gativ

e or

non

com

mitt

al re

spon

se, d

on’t

take

it p

erso

nally

. Tha

nk th

em, a

gain

, and

let t

hem

kno

w y

ou’d

like

to

serv

e as

a re

sour

ce o

n m

enta

l illn

ess.

Tak

e a

mom

ent t

o m

ark

a lin

e in

the

sam

ple

stor

y th

at m

ade

an a

sk.

Wha

t str

ikes

you

abo

ut th

e "a

sk"

in th

e sa

mpl

e st

ory?

W

hat d

o yo

u fin

d he

lpfu

l abo

ut th

e ch

eckl

ist?

[Tak

e 1

to 2

resp

onse

s]

Han

dout

s:

Sam

ple

Stor

ies

Se

ven

Step

s C

heck

list

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 1

9 © 2

015

NAM

I, In

c.

s

lide

29

App

rox.

19

min

C

ore

Con

cept

s

Writ

e yo

ur s

tory

usi

ng

prac

tice

shee

ts

1

5 m

in to

writ

e

War

n w

hen

5 m

in le

ft

W

arn

whe

n 2

min

left

Now

that

you

’ve

hear

d a

sam

ple

stor

y an

d co

mpa

red

it to

the

Sev

en

Ste

ps C

heck

list,

you'

re re

ady

to fi

nd y

our S

tory

Pra

ctic

e Sh

eets

(pag

es

7-8)

and

sta

rt w

ritin

g yo

ur o

wn

stor

y.

For h

elp,

use

you

r Sev

en S

teps

Che

cklis

t and

the

sam

ple

stor

y—or

ask

a

ques

tion.

Rem

embe

r, th

e be

st p

repa

ratio

n fo

r tel

ling

an e

ffect

ive

stor

y is

to

kno

w y

our p

urpo

se a

nd y

our “

ask.

”

Her

e’s

the

scen

ario

to u

se fo

r you

r sto

ry. P

leas

e pr

eten

d yo

u ar

e te

lling

your

sto

ry to

urg

e de

cisi

on m

aker

s to

mak

e it

easi

er fo

r peo

ple

to g

et th

e rig

ht m

edic

atio

n, ju

st li

ke in

our

sam

ple

stor

ies.

You

r “as

k” c

an b

e th

e sa

me

as in

a s

ampl

e st

ory

or y

ou c

an u

se y

our o

wn

wor

ds.

You'

ll ha

ve a

bout

15

min

utes

to w

rite

your

sto

ry o

n yo

ur p

ract

ice

shee

t. I’

ll le

t you

kno

w w

hen

you

have

a fe

w m

in. l

eft t

o fin

ish

up.

If yo

u do

n’t f

inis

h, d

on’t

wor

ry. T

his

is ju

st a

pra

ctic

e. Y

ou c

an fi

nish

it o

n yo

ur o

wn

time

or m

ake

edits

late

r. If

it’s

eas

ier f

or y

ou, f

eel f

ree

to w

rite

your

sto

ry in

“bul

let p

oint

s” in

stea

d of

full

sent

ence

s.

If yo

u fin

ish

early

, pra

ctic

e re

adin

g yo

ur s

tory

sile

ntly

.

C

ircul

ate:

Whi

le p

artic

ipan

ts a

re w

ritin

g, w

alk

arou

nd th

e ro

om.

If pa

rtici

pant

s fin

ish

early

, ask

if th

ey a

re w

illing

to le

t you

read

thei

r sto

ry

sile

ntly

. Le

t the

m k

now

wha

t phr

ases

are

stro

ng. K

eep

in m

ind

part

icip

ants

who

hav

e st

rong

sto

ries.

W

arn

part

icip

ants

5 m

in. b

efor

e en

d an

d 2

min

. bef

ore

time

is u

p.

[Use

you

r chi

me,

bel

l or o

ther

pre

arra

nged

sig

nal]

Stop

par

ticip

ants

afte

r 15

min

. If

you

didn

't fin

ish

your

sto

ry, f

eel f

ree

to fi

nish

in y

our f

ree

time.

Wha

t did

yo

u le

arn

abou

t writ

ing

your

sto

ry?

[Tak

e on

e or

two

resp

onse

s]

Han

dout

s:

Stor

y Pr

actic

e Sh

eets

Sev

en S

teps

C

heck

list

Hel

per:

Hel

p pe

ople

fin

d w

orks

heet

s an

d pa

rtici

pant

s w

ith

ques

tions

or

stru

ggle

s (th

is w

ill fre

e up

Fa

cilit

ator

to c

ircul

ate

and

man

age

time)

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 2

0 © 2

015

NAM

I, In

c.

sl

ide

30

App

rox.

15

min

C

ore

Con

cept

s

P

ract

ice

tellin

g yo

ur s

tory

in

unde

r tw

o m

in w

ith a

pa

rtner

Fee

dbac

k fo

r thr

ee m

in

L

iste

ner—

use

Con

stru

ctiv

e Fe

edba

ck F

orm

and

kee

p tim

e

You

all

have

a g

ood

star

t on

your

sto

ry. N

ow, w

e’ll

prac

tice

shar

ing

and

givi

ng c

onst

ruct

ive

feed

back

. H

old

onto

you

r sto

ry a

nd ta

ke o

ut y

our C

onst

ruct

ive

Feed

back

For

m.

The

form

has

a s

cale

, fro

m o

ne to

five

, for

eac

h st

ep o

f a s

tory

. A “

one”

in

dica

tes

an a

rea

that

cou

ld b

e st

reng

then

ed; “

thre

e” in

dica

tes

an

area

that

wor

ks fi

ne a

nd a

“fiv

e” in

dica

tes

an a

rea

that

is p

artic

ular

ly

stro

ng o

r im

pact

ful.

P

leas

e fin

d a

partn

er a

nd w

ait f

or o

ur p

ract

ice

inst

ruct

ions

. [W

ait f

or

partn

ers

to fo

rm]

Her

e ar

e th

e in

stru

ctio

ns. I

n th

e ne

xt te

n m

inut

es, w

e’ll

have

two

five-

min

ute

roun

ds o

f sto

ry-s

harin

g. A

s a

rem

inde

r, I’l

l let

you

kno

w w

hen

five

min

utes

has

pas

sed

with

[Ind

icat

e ch

ime,

bel

l or o

ther

sig

nal].

Dur

ing

each

roun

d:

O

ne p

erso

n w

ill sh

are

thei

r sto

ry in

two

min

utes

or l

ess.

O

ne p

erso

n w

ill ke

ep ti

me

and

stop

the

stor

ytel

ler a

fter t

wo

min

utes

. U

se a

sto

pwat

ch fu

nctio

n on

a c

ell p

hone

, if a

vaila

ble.

Ti

mek

eepe

r sho

uld

also

list

en a

ttent

ivel

y an

d, if

pos

sibl

e, fi

ll ou

t the

C

onst

ruct

ive

Feed

back

For

m to

reco

rd im

pres

sion

s.

A

fter t

he s

tory

telle

r’s tw

o m

inut

es is

up,

pro

vide

con

stru

ctiv

e fe

edba

ck—

spec

ific

info

rmat

ion

abou

t wha

t wor

ked

wel

l or w

orke

d fin

e an

d w

hat c

ould

be

stre

ngth

ened

and

how

. R

emem

ber t

hat

cons

truct

ive

feed

back

is n

ot in

tend

ed to

be

judg

men

tal—

it is

inte

nded

to

hel

p yo

u se

e th

e st

reng

ths

of y

our s

tory

and

how

you

cou

ld m

ake

it ev

en m

ore

impa

ctfu

l. Pl

ease

beg

in.

Sign

al e

nd o

f rou

nd 1

afte

r 5 m

in.

It’s

time

to tr

ade

role

s if

you

have

n’t a

lread

y.

Sign

al e

nd o

f rou

nd 2

afte

r 5 m

in.

How

’d th

at g

o fo

r eve

ryon

e? W

hat d

id y

ou le

arn

abou

t tel

ling

your

st

ory?

[Tak

e 2

to 3

qui

ck re

spon

ses]

Han

dout

s:

Stor

y Pr

actic

e Sh

eets

C

onst

ruct

ive

Feed

back

For

m

Hel

per a

nd

Faci

litat

or: H

elp

peop

le fi

nd a

par

tner

(m

ay b

e on

e tri

o or

H

elpe

r may

fill

in a

s a

partn

er)

Hel

per:

Hel

p gr

oups

yo

u ne

ed a

ssis

tanc

e or

hav

e qu

estio

ns

Faci

litat

or: C

ircul

ate

and

liste

n fo

r in

divi

dual

s w

ith

stro

ng s

torie

s

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 2

1 © 2

015

NAM

I, In

c.

sl

ide

31

App

rox.

5 m

in

Cor

e C

once

pts

B

asic

sto

ry is

writ

ten

and

can

serv

e as

bas

is o

f ad

voca

cy

S

tory

can

be

mod

ified

to

use

with

diff

eren

t au

dien

ces

and

issu

es

A

sk fo

r a v

olun

teer

to s

hare

thei

r sto

ry.

Cal

l on

a pe

rson

who

m y

ou

thin

k m

ay h

ave

a go

od s

tory

bas

ed o

n w

hat y

ou h

eard

or r

ead

earli

er.

Than

k yo

u so

muc

h fo

r sha

ring

your

sto

ry.

Now

, as

liste

ners

, wha

t w

as e

ffect

ive

for y

ou a

nd w

hy?

[Tak

e tw

o or

thre

e re

spon

ses]

N

ote:

You

may

ask

for a

noth

er v

olun

teer

if y

ou li

ke.

You

hav

e al

l acc

ompl

ishe

d a

lot i

n ju

st a

sho

rt tim

e. Y

ou’v

e w

ritte

n yo

ur

stor

y an

d pr

actic

ed it

. Now

, you

can

use

you

r sto

ry to

hel

p m

ake

posi

tive

chan

ges

for p

eopl

e liv

ing

with

men

tal i

llnes

s.

Bes

t of a

ll, th

e st

ory

you

wro

te is

bas

ed o

n a

basi

c st

ruct

ure,

or r

ecip

e.

That

mea

ns y

ou c

an m

ake

just

a fe

w c

hang

es in

det

ails

and

the

purp

ose

and

“ask

” and

use

it fo

r man

y di

ffere

nt is

sues

and

aud

ienc

es.

Let’s

lear

n to

geth

er—

wha

t mak

es a

sto

ry re

ally

effe

ctiv

e?

Wha

t was

mos

t hel

pful

or i

mpa

ctfu

l for

you

?

[Tak

e a

coup

le re

spon

ses

to e

ach

ques

tion]

sl

ide

32

App

rox.

.5 m

in

Cor

e C

once

pt

Y

our s

tory

and

act

ions

can

m

ake

a di

ffere

nce

This

quo

te, “

Act

as

if w

hat y

ou d

o m

akes

a d

iffer

ence

. It d

oes.

” is

a re

min

der t

hat y

our s

tory

can

—an

d do

es—

influ

ence

oth

ers.

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 2

2 © 2

015

NAM

I, In

c.

sl

ide

33

App

rox.

.5 m

in

Cor

e C

once

pt

Y

our s

tory

can

hel

p pr

otec

t ch

oice

of m

edic

atio

ns

Your

sto

ry c

an m

ake

a re

al d

iffer

ence

. It c

an h

elp

prot

ect c

hoic

e of

m

edic

atio

ns.

sl

ide

34

App

rox.

1 m

in

Cor

e C

once

pt

S

hare

you

r sto

ry w

ith P

&T

Com

mitt

ees,

pha

rmac

y di

rect

ors,

Med

icai

d an

d in

sura

nce

agen

cies

and

el

ecte

d of

ficia

ls

One

way

to m

ake

an im

pact

is to

sha

re y

our s

tory

with

peo

ple

who

can

influ

ence

m

edic

atio

n ch

oice

s, s

uch

as:

H

ealth

pla

n P

harm

acy

& T

hera

peut

ics

(P&

T) C

omm

ittee

s

Hea

lth p

lan

phar

mac

y di

rect

ors

S

tate

Med

icai

d ag

enci

es

S

tate

insu

ranc

e ag

enci

es

S

tate

and

Fed

eral

ele

cted

offi

cial

s Y

ou c

an u

se y

our s

tory

to w

rite

a le

tter o

r mak

e a

call

or, f

or th

e m

ost i

mpa

ct,

mee

t in

pers

on w

ith a

P&

T C

omm

ittee

or o

ther

s w

ho a

re d

ecid

ing

on c

over

age

of m

edic

atio

ns. Y

our s

torie

s w

ill h

elp

deci

sion

-mak

ers

unde

rsta

nd th

e re

al li

fe

impa

cts

of m

edic

atio

ns a

nd h

ow th

ey a

re c

over

ed.

NA

MI w

ill h

elp

keep

you

info

rmed

of o

ppor

tuni

ties

to u

se y

our s

tory

—an

d w

e ho

pe y

ou’ll

thin

k of

you

r ow

n op

portu

nitie

s, a

s w

ell.

[O

ptio

nal:

If ho

st k

now

s of

an

oppo

rtuni

ty, m

entio

n B

e H

eard

! han

dout

and

any

in

stru

ctio

ns]

Prep

: If t

here

is a

n op

portu

nity

to te

stify

or

shar

e st

orie

s, fi

ll ou

t Be

Hea

rd! h

ando

ut in

ad

vanc

e, p

rint a

nd

incl

ude

in p

artic

ipan

t pa

cket

H

ando

ut:

Be

Hea

rd! (

optio

nal)

Not

e: If

ther

e ar

e pa

rtici

pant

s w

ith

rele

vant

and

co

mpe

lling

sto

ries,

ask

if

they

’d b

e w

illin

g to

te

stify

(sha

re th

eir

stor

y) a

t an

upco

min

g op

portu

nity

Faci

litat

or S

crip

t for N

AMI S

mar

ts fo

r Adv

ocac

y, M


oice

Dec. 2

016

NAM

I Sm

arts fo

r Adv

ocac


oice F

acili

tato

r Scr

ipt

Page 2

3 © 2

015

NAM

I, In

c.

sl

ide

35

App

rox.

.5 m

in

W

hat m

ade

an im

pact

?

Wha

t did

you

take

aw

ay fr

om th

is e

xper

ienc

e to

day?

Wha

t mad

e an

im

pact

on

you?

[Tak

e th

ree

resp

onse

s]

Hel

per a

nd

Faci

litat

or:

If po

ssib

le, b

ring

a po

rtabl

e co

pier

or

scan

ner a

nd

scan

/cop

y st

orie

s of

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INSERT TAB: Module 4 worksheets

NAMI Smarts for Advocacy Medication: Protecting Choice

NAMI Smarts for Advocacy • Medication: Protecting Choice Page 1 © 2015 NAMI, Inc.

Evaluation FormFacilitator’s name: _______________________________________ Date: ____________

Location of workshop (City & State): ____________________________________________

My name (optional, but preferred): ____________________________________________

1. Overall, my knowledge and skill level in telling my story about medications is...

Before the training: (Circle your rating) After the training: (Circle your rating)

1 2 3 4 5 6 7 8 9 10

None Some Good Excellent 1 2 3 4 5 6 7 8 9 10

None Some Good Excellent

2. Overall, my level of confidence in telling my story is...


1 2 3 4 5 6 7 8 9 10

None Some Good Excellent 1 2 3 4 5 6 7 8 9 10

None Some Good Excellent

3. What did you learn that was most meaningful or helpful to you today?

4. Where do you plan to use your medication story?

5. What comments, if any, do you have about this workshop?

6. NAMI seeks to support the entire community.To help us track how we are doing,please check all that apply. I am:

American Indian or Alaska Native Asian American Black or African American Hispanic or Latino Native Hawaiian, Pacific Islander White Multiracial Other: _____________________

Person living with a mental illness Family of adult living with a mental illness Parent or guardian of minor child living with a mental

illness Mental health provider, including peer provider Other mental health advocate Military service member, veteran or military family

member Other: ________________________



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Sample Family Member Medication Story 1. My introduction

Hello, I’m Keith Jones from Amity. I’m a member of NAMI Springville, part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.

I have a 25‐year old son who lives with schizophrenia and my family’s experience leads me here to urge you to make all mental health medications easily available.

2. What happened

I can tell you that the right medication can change lives.

When my son was young, he was bright, loving and happy. But as he grew, schizophrenia took away his joy. Despite mental health services, he ended up in and out of psychiatric hospitals and group homes—and even on the streets. I worried about him every day and wondered if he would ever experience a life without fear again.

3. Getting the right medication

Several months ago, Kevin’s doctor finally got approval for him to try a new antipsychotic. It took weeks to start taking effect, but the difference was amazing. It’s the first medication that has really worked for him.

4. How he/she is different today

For the first time in years, Kevin is living without terror. He’s even moved into his own apartment. He has a peer mentor and wants to become one himself. And for the first time in years, we both have hope.

5. What’s keeping people from getting the right medication

My son is proof that the right medication can change a life. But many people don’t get the right medication because it’s not covered or it’s out of reach. 6. What will help people get the right medication

Making all mental health medications readily available will help more people experience a recovery like Kevin’s and avoid hospital stays and living with unimaginable symptoms.

7. My "ask"

Thank you for listening. I hope I can count on you to protect choice of medications—and the hope of recovery for families like mine.



Sample Peer Medication Story 1. My introduction

Hello, I’m Cynthia Wood from Bothell. I’m a member of NAMI Springville, part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.

I live with major depression and the right medication is critical to my recovery. I’d like to share my story and ask that you protect choice of medications for people living with mental illness.

2. What happened

I’m a family physician, I’m married and I have two beautiful children. I also live with major depression. When I was first diagnosed in my twenties, I was devastated. I thought I wouldn’t make it through medical school, enjoy a career or raise a family.


I wanted to get better, but my depression was stubborn. Nothing seemed to work. Finally, my doctor and I found the one medication that works for me. It’s expensive, but with it, I made it through med school, became a successful physician, married and started a family.

4. How I'm different today

My depression is under control and I’m able to take good care of my family and my patients. And knowing about my success helps my patients feel like they can recover, too.


I want my patients to have what works for them, but as a doctor, I know that when people can’t get the medication they need easily, they often give up—or suffer serious setbacks.

6. What will help people get the right medication

Having choices helps people get the right help at the right time. More choices of medications mean more opportunities for people, like me, to realize their dreams.

7. My "ask"

Thank you. For everyone who lives with mental illness, please protect choice today.



Seven Steps to Telling Your Story about Medication The following seven steps will help you craft a succinct and powerful story.

1. Introduce yourself

Give your name and city or town. Include your organization. We encourage you to describe yourself as “a member of [NAMI State Org or NAMI Affiliate], part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.”

Share how you are affected by mental illness. Are you living with mental illness, a family member, a caregiver? This gives you credibility.

State the position or action you want your listener(s) to take.

2. What happened?

What happened before you received the medication you needed? Keep this brief‐‐think about the most important thing you’d like your listener to know.


Describe how you got the right medication. Keep this brief—and add how medication helped in your recovery (or would have helped). If you had problems getting the right medication, share the challenges and the effect on you.

4. How are you different today?

Share what is going right in your life or how you are experiencing recovery. Inspire your audience by sharing the gains you’ve made or what your goals are.

5. What’s keeping people from getting the right medication?

Mention the challenges that keep people from getting the right medication. Think about your listeners and focus on the challenges that are within their influence, like a health plan’s list of covered drugs.

6. What will help people get the right medication?

Talk about what will help people get the right medication. It’s helpful to add why it’s important for people to get the medication they need.

7. Make your "ask"

Ask your listener(s) to take the position or action you want. Thank your audience for listening, then make your “ask.” Feel free to be direct and specific



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Story Practice Sheet Please refer to your Seven Steps Checklist for additional information.

1. My introduction Include your name and city and organization, if applicable. Add how you are affected by mental illness and the position or action you want your listener(s) to take.

2. What happened Aim for 3‐5 sentences. Briefly describe the most important and compelling thing(s) about your situation.


Aim for 2‐4 sentences. Briefly describe how you got the right medication and how it helped in your recovery. If you had problems getting the right medication, share the challenges and the effect on you.




Aim for 1‐3 sentences. Share what is going right in your life or how you are experiencing recovery. Inspire by sharing the gains you’ve made or what your goals are.


Aim for 1‐3 sentences. Mention the challenges that keep people from getting the right medication. Focus on challenges within the influence of your listeners.

6. What will help people get the right medication

Aim for 1‐2 sentences. Talk about what will help people get the right medication. It’s helpful to add why it’s important for people to get the medication they need.

7. My "ask"

Aim for 1‐2 sentences. Thank your listener for listening to you. Then, ask your listener(s) to take the position or action you want. Feel free to be direct and specific.



Constructive Feedback Form In the space below each scale, identify where the story was strong or impactful or what would strengthen the story.

Introduction

1 2 3 4 5 Would benefit from strengthening Works fine Very strong

What happened?


Getting the right medication


How are you different today?


What’s keeping people from getting the right medication?


What will help people get the right medication?


Make your "ask"




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Glossary

KEY TYPES OF HEALTH PLANS

COMMERCIAL OR PRIVATE INSURANCE/HEALTH PLAN: Coverage for certain health care costs in exchange for premiums paid for by you, your family or an employer.

MEDICAID: A health care coverage program for low‐income families, children, pregnant women, seniors and people with disabilities. Medicaid typically covers a wider range of benefits and has lower out‐of‐pocket costs than Medicare or commercial health insurance.

MEDICARE: A federal health insurance program for people who are 65 or older and for younger people with disabilities who receive Supplemental Security Disability Income (SSDI). Medicare Part A and Part B cover hospital and outpatient care.

MEDICARE PART D: Part D is Medicare coverage for medications. BRAND NAME DRUG: A medication developed by a pharmaceutical company and sold under a brand name. When a brand name drug’s patent expires, generic versions of the medication may be sold.

COINSURANCE: A percentage you must pay of the cost of your medication or health care (for example, your plan may pay 80 percent and you pay 20 percent coinsurance).

COPAYMENT OR COPAY: A fixed amount (for example, $20) you pay for covered medication or health care.

COST SHARING OR OUT‐OF‐POCKET (OOP) COSTS: Costs that aren’t covered by your health plan, such as premiums, deductibles, coinsurance, copayments and non‐covered services and supplies.

DEDUCTIBLE: The amount you pay in a year before your plan covers costs. For example, if you have a $1,000 deductible, you will pay $1,000 for health care before your plan begins covering any costs in one year.

EXCEPTION FOR PSYCHIATRIC MEDICATIONS: An instance when a health plan approves a member or doctor’s request to provide or cover a medication in a different way than is typical for the plan. Some sample requests are to:

Cover a drug that is not covered on the plan’s formulary or PDL Waive prior authorization or step therapy requirements for a drug that works for you Provide a higher‐tier drug at a lower tier cost because lower tier drugs do not work for you

EXEMPTION FOR PSYCHIATRIC MEDICATIONS: A freedom from requirements, such as prior authorization, step therapy, generic substitution, for one or more types of mental health medications.

FORMULARY: A list of generic and brand name medications covered by your health plan (may also be called a Preferred Drug List or PDL).



GENERIC DRUG: A medication with the same active ingredients and in the same amounts as a brand name counterpart. Generics are usually less expensive than a brand name drug, but may have different fillers, additives or different timing of the release of active ingredients.

NON‐PREFERRED: A medication that a health plan may not cover or that has higher cost‐sharing or other requirements.

PHARMACY BENEFITS MANAGER (PBM): A managed care organization that specializes in providing medications through mail order and/or a network of pharmacies for Medicaid and other health plans.

PREFERRED DRUG LIST (PDL): A list of generic and brand name medications covered by your health plan (may also be called a Preferred Drug List or PDL).

PRIOR AUTHORIZATION: A requirement by your health plan to review a medication request before approving or denying. Your plan may require prior authorization because a medication has dangerous side effects, may interact with other drugs, is often misused or abused or when your plan thinks a different or less expensive drug might work as well or better.

QUANTITY LIMITS: A limit on the amount of a medication your plan will cover over a period of time.

STEP THERAPY: A requirement to try one or more drugs first—sometimes for specific lengths of time—before your plan will cover a certain medication.

TIER: A level of coverage on your health plan’s formulary. Medications on lower tiers have lower cost sharing, while medications on higher tiers have higher costs and may have more restrictions.

UTILIZATION MANAGEMENT (UM): Techniques, such as preferred drug lists, prior authorization, quantity limits, tier levels or step therapy, that may be used to improve safety and/or quality, ensure appropriate use or to control costs.

KEY HEALTH PLAN DECISION‐MAKERSHEALTH PLAN MEDICAL AND PHARMACY DIRECTOR: Executives who oversee medical services and medications for a health plan and who make decisions about coverage and exceptions.

STATE INSURANCE COMMISSIONER: State official responsible for regulating insurance offered in his/her state, including commercial health insurance plans.

STATE MEDICAID DIRECTOR: State official responsible for the entire Medicaid program in his/her state.

MEDICAID MEDICAL AND PHARMACY DIRECTOR: State officials who oversee medical services and medications for the state Medicaid program and who make decisions about coverage or exceptions.

PHARMACY & THERAPEUTICS COMMITTEE (P&T COMMITTEE): A committee of experts that weighs effectiveness, safety, side effects, costs and other factors in making decisions about medications for a health plan or pharmacy benefit manager.

3803 N. Fairfax Drive, Suite 100 ▪ Arlington, VA ▪ 22203 ▪ 703.524.7600 June 2015

Access to Mental Health Medications

Why NAMI Cares The right medication is a key to recovery for many children and adults with mental health conditions. Yet, in a 2015 study of private health plans, NAMI found that coverage of antipsychotic and antidepressant medications was inadequate.1

People need choices because individuals react differently to different medications and because the effects of not getting the right mental health medication can be costly and dangerous.

Mental health medications are unique. While mental health medications work in similar ways, individual

responses vary greatly.1

− About a third of those with depression improve after treatment with an SSRI antidepressant.Others get better with different or added medication.2 Lack of treatment success with one SSRI does not predict the same effect with another.3

− Effectiveness of medications for ADHD varies markedly between patients depending on such factors as symptoms, presence of other conditions and family situation.4

− An antipsychotic medication that works well for one person with schizophrenia will not necessarily work for another.5

Psychiatric medications differ, even within the same class, with varyingside effects, drug interactions and effectiveness.− Some mental health medications have side effects that may pose serious health risks in

persons with common chronic disorders such as heart disease or obesity.

− Some children may only be able to tolerate a long‐acting or liquid form of ADHD medication.

− An antipsychotic that is sedating may help an agitated or sleepless person, but not someone who is withdrawn and lacks energy.

− Some antipsychotics have significantly shorter half‐lives (a few hours), which means symptoms may return quickly with a skipped dose.

People with mental health conditions are at high risk. More than one out of every 13 emergency department visits involves a

mental illness.6

Mood disorders are the top reason adults 18‐64 years old are admitted to ahospital after an emergency department visit and psychotic disorders are thefourth most common reason.7

Two out of three Medicaid beneficiaries with disabilities who have commonchronic conditions also have a mental illness. The hospital admission rates forthose with mental illness are 46% to 70% higher than for those without.8

3803 N. Fairfax Drive, Suite 100 ▪ Arlington, VA ▪ 22203 ▪ 703.524.7600 June 2015

Restricting medications shifts costs to the wrong places. Preferred drug lists, prior authorization and other restrictions pose substantial risks for people with serious mental health conditions. Medication failures can lead to emergency department visits, hospitalization, school failure, job loss‐‐even incarceration or suicide.

In a 2009 ten‐state study of Medicaid prescription drug policies, priorauthorization requirements were associated with people being 2.1 timesmore likely to be reported homeless and 3.1 times more likely to behospitalized.9

Preferred drug lists were associated with 1.8 times higher rates of emergencydepartment visits and 2.3 times higher rates of hospitalization.10

People who stopped taking medications because of access problems weremore than twice as likely to end up in jail.11

Preserving choice can achieve better outcomes and cost savings. Preserving choice in medications can achieve better health outcomes through more effective care and cost savings by reducing unavoidable emergency department visits and hospital stays.

Five percent of Medicaid beneficiaries with disabilities account for more than50 percent of overall Medicaid costs. In this highest‐cost group, mental illnessis in three of the top five most prevalent pairs of diseases.12

According to a 2015 research study, better adherence to antipsychotics alonecould yield an annual net savings of $3.2 billion to states, an average of $1,580per enrollee per year.13

1 Honberg, R; Diehl, S; Douglas, D (2015) A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care. National Alliance on Mental Illness (NAMI), Arlington, VA. 2 Ibid. 3 Ibid. 4 Arnold EL; Hodgkins P; Caci, H; et al; (2015) Effect of Treatment Modality on Long‐Term Outcomes in Attention‐Deficit/Hyperactivity Disorder: A Systematic Review. PLOSone. Accessed 6/24/15. http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0116407&representation=PDF 5 National Institute of Mental Health, Science Update, Ethnicity Predicts How Gene Variations Affect Response to Schizophrenia Medications, January 02, 2008. 6 Statistical Brief #92, Mental Health and Substance Abuse‐Related Emergency Department Visits among Adults, 2007. Healthcare Cost and Utilization Project (HCUP). June 2014. Agency for Healthcare Research and Quality, Rockville, MD. 7 Statistical Brief #174, Overview of Emergency Department Visits in the United States, 2011. Healthcare Cost and Utilization Project (HCUP). June 2014. Agency for Healthcare Research and Quality, Rockville, MD. 8 Boyd C; Leff B; Weiss C; et al. (Dec. 2010). Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations. Center for Health Care Strategies, Inc. 9 West, Joyce C., et al. (May 2009). Medication Prescription Drug Policies and Medication Access and Continuity: Findings From Ten States. Psychiatric Services; Vol. 60, No. 5. 10 Ibid. 11 Ibid. 12 Kronick, Rick, PhD, Bella, Melanie & Gilmer, Todd P., PhD. (October 2009). The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions. Center for Health Care Strategies, Inc. 13 Predmore ZS; Mattke S; Horvitz‐Lennon M (2015) Improving antipsychotic adherence among patients with schizophrenia: Savings for states. Psychiatric Services; 66(4):343‐345.

Insert Tab: Module 5 Script

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e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

3

30 s

ec

Bec

ause

of t

his

hist

ory

of in

equa

lity,

thre

e fe

dera

l law

s w

ere

pass

ed re

quiri

ng

mos

t hea

lth p

lans

to m

ust c

over

men

tal h

ealth

con

ditio

ns a

nd a

ddic

tion

the

sam

e w

ay th

ey c

over

oth

er m

edic

al c

ondi

tions

.

The

info

rmat

ion

I’m

ta

lkin

g a

bo

ut

is in

clud

ed o

n th

e Pa

rity

Ove

rvie

w

hand

out o

n pa

ge 1

.

We

will

als

o de

fine

som

e in

sura

nce

term

s du

ring

this

wor

ksho

p. T

hey

are

incl

uded

for l

ater

refe

renc

e in

a g

loss

ary

at th

e en

d of

you

r han

dout

s.

N

ext s

lide

Parit

y O

verv

iew

G

loss

ary

30 s

ec

Now

, bac

k to

par

ity la

ws:

Th

e Pa

ul W

ells

tone

and

Pet

e D

omen

ici M

enta

l Hea

lth P

arity

and

Add

ictio

n E

quity

Act

, or M

HP

AEA

[meh

-PEE

-ah]

, pas

sed

in 2

008.

Th

e Pa

tient

Pro

tect

ion

and

Affo

rdab

le C

are

Act o

f 201

0, o

r the

AC

A. T

his

is a

he

alth

insu

ranc

e re

form

law

that

als

o st

reng

then

s th

e pa

rity

requ

irem

ents

of

MH

PA

EA

. Th

e 21

st C

entu

ry C

ures

Act

of 2

016,

whi

ch is

a b

road

hea

lth s

ervi

ce a

nd

rese

arch

law

that

has

som

e pa

rity

prov

isio

ns.

Le

t’s ta

ke

a c

lose

r lo

ok a

t th

ese

law

s.

N

ext s

lide

Parit

y O

verv

iew

30 s

ec

The

Paul

Wel

lsto

ne a

nd P

ete

Dom

enic

i Men

tal H

ealth

Par

ity a

nd A

ddic

tion

Equ

ity A

ct o

f 200

8, o

r MH

PA

EA

, app

lies

to h

ealth

pla

ns fr

om la

rge

empl

oyer

s an

d M

edic

aid

man

aged

car

e pl

ans

(whi

ch is

mos

t Med

icai

d pl

ans)

.

MH

PA

EA

doe

s no

t requ

ire

hea

lth p

lans

to p

rovi

de m

enta

l hea

lth o

r add

ictio

n be

nefit

s, b

ut if

they

do,

trea

tmen

t lim

its a

nd o

ut o

f poc

ket c

osts

mus

t be

at th

e sa

me

leve

l as

othe

r typ

es o

f med

ical

car

e.

N

ext s

lide

Parit

y O

verv

iew

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

4

3 m

in

The

Patie

nt P

rote

ctio

n an

d Af

ford

able

Car

e Ac

t of 2

010,

or A

CA

is d

esig

ned

to

refo

rm h

ealth

insu

ranc

e. T

his

law

hel

ps p

eopl

e w

ho n

eed

men

tal h

ealth

or

subs

tanc

e ab

use

care

in s

ever

al w

ays.

It

sets

con

sum

er p

rote

ctio

n st

anda

rds.

For

exa

mpl

e, u

nder

this

law

hea

lth p

lans

ca

n no

long

er tu

rn p

eopl

e do

wn

or c

harg

e m

ore

for h

avin

g a

long

term

con

ditio

n su

ch a

s m

enta

l illn

ess.

The

law

als

o ba

rs h

ealth

pla

ns fr

om h

avin

g lif

etim

e or

an

nual

lim

its fo

r add

ictio

n tre

atm

ent o

r men

tal h

ealth

car

e.

The

AC

A a

llow

s st

ates

to e

nrol

l any

one

in M

edic

aid

who

se in

com

e is

at o

r bel

ow

138%

of t

he fe

dera

l pov

erty

leve

l - a

bout

$16

,400

per

yea

r for

one

per

son.

Ove

r ha

lf of

the

stat

es h

ave

expa

nded

Med

icai

d.

This

law

ext

ends

par

ity re

quire

men

ts to

all

indi

vidu

al a

nd s

mal

l gro

up h

ealth

pl

ans

whe

ther

they

are

sol

d in

the

heal

th in

sura

nce

exch

ange

or n

ot. I

t als

o re

quire

s pa

rity

in p

rivat

e he

alth

pla

ns u

sed

in M

edic

aid

expa

nsio

n an

d C

hild

ren

’s

Hea

lth In

sura

nce

Pla

ns, o

r CH

IP.

The

AC

A s

ets

up h

ealth

insu

ranc

e ex

chan

ges

in e

very

sta

te to

offe

r hea

lth p

lans

th

at m

eet q

ualit

y st

anda

rds.

The

law

pro

vide

s fo

r up-

front

tax

cred

its to

mak

e th

e pl

ans

affo

rdab

le.

Th

e A

CA

als

o re

quire

s al

l ind

ivid

ual a

nd s

mal

l gro

up p

lans

to c

over

10

esse

ntia

l he

alth

ben

efits

, or E

HB

. ‘B

eh

avio

ral h

ea

lth

’ is

one

of th

e E

HB

cat

egor

ies.

It

incl

udes

men

tal h

ealth

and

sub

stan

ce u

se c

are.

E

HB

s m

ust m

ee

t M

HP

AE

A s

tan

da

rds, n

ot o

nly

with

in t

he

‘b

eh

avio

ral h

ea

lth

’ ca

tego

ry, b

ut a

lso

in o

ther

cat

egor

ies

such

as

emer

genc

y ca

re.

S

o, th

e A

CA

requ

ire

s in

sure

rs to

cov

er m

enta

l hea

lth a

nd s

ubst

ance

use

car

e fo

r in

divi

dual

and

sm

all g

roup

pla

ns. T

his

is s

trong

er th

an th

e if/th

en s

tand

ard

of

MH

PA

EA

whi

ch a

pplie

s to

larg

e em

ploy

er-s

pons

ored

pla

ns.

Fina

lly, t

he A

CA

mak

es c

are

mor

e af

ford

able

by

setti

ng li

mits

on

how

muc

h co

nsum

ers

pay

out-o

f-poc

ket (

OO

P) p

er y

ear.

Nex

t slid

e

Parit

y O

verv

iew

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

5

1 m

in

If th

ese

law

s ha

ve b

een

on th

e bo

oks

for y

ears

, why

do

we

still

have

so

man

y pr

oble

ms

with

par

ity?

P

art o

f the

pro

blem

is th

at it

took

ye

ars

to p

rodu

ce th

e ru

les

that

spe

ll ou

t wha

t in

su

rers

mu

st

do

to

com

ply

with

th

e la

w.

The

fin

al ru

les w

ere

n’t issue

d fo

r p

riva

te

insu

rers

unt

il 20

13 a

nd fo

r Med

icai

d an

d C

HIP

unt

il 20

16.

Ano

ther

pro

blem

is th

at th

e di

ffere

nt ty

pes

of h

ealth

pla

ns a

re o

vers

een

by

diffe

rent

sta

te a

nd f

ed

era

l a

ge

ncie

s,

so

it

wa

sn

’t c

lea

r w

hic

h a

ge

ncie

s w

ere

ch

arge

d w

ith e

nfor

cing

the

law

. In

su

rers

ha

ve

n’t h

ad

ince

ntive

to

co

mp

ly w

ith

tho

se la

ws

beca

use

it is

not

bei

ng

mon

itore

d an

d en

forc

ed, s

o un

less

told

oth

erw

ise

they

cut

cos

ts to

turn

a p

rofit

fo

r the

ir sh

areh

olde

rs.

N

ext s

lide

Parit

y O

verv

iew

30 s

ec

The

21st C

entu

ry C

ures

Act

trie

s to

cle

ar u

p w

hat i

s re

quire

d of

hea

lth in

sure

rs

and

sort

out h

ow fe

dera

l and

sta

te g

over

nmen

t age

ncie

s m

ust e

nfor

ce p

arity

. P

arity

is o

nly

a sm

all s

ectio

n of

this

bro

ad la

w b

ut it

stre

ngth

ens

men

tal h

ealth

an

d ad

dict

ion

parit

y in

gen

eral

. 21st

Cen

tury

Cur

es a

lso

has

a se

ctio

n on

eat

ing

diso

rder

s, w

hich

are

ofte

n tre

ated

une

qual

ly.

N

ext s

lide

Parit

y O

verv

iew

1 m

in

So

me

typ

es o

f p

lan

s d

on

’t ha

ve to

follo

w fe

dera

l par

ity la

w. T

ake

a lo

ok a

t you

r ha

ndou

t on

page

2.

Med

icar

e, th

e fe

dera

l hea

lth p

rogr

am fo

r sen

iors

and

peo

ple

with

dis

abilit

ies,

is

not u

nder

par

ity la

w. S

tate

Med

icai

d fe

e-fo

r-serv

ice

pro

gra

ms a

lso d

on

’t h

ave

to

co

mpl

y.

Sm

all s

tate

and

loca

l gov

ernm

ent p

lans

with

50

or

few

er

em

plo

ye

es d

on

’t h

ave

to

follo

w p

arity

, alth

ough

man

y ha

ve c

hose

n to

opt

in.

And

hea

lth p

lans

for

empl

oyee

s of

faith

org

aniz

atio

ns s

uch

as c

hurc

hes,

syn

agog

ues

or m

osqu

es,

can

opt o

ut o

f par

ity.

Fina

lly, s

mal

l gro

up a

nd in

divi

dual

pla

ns p

urch

ased

bef

ore

2010

do

not h

ave

to

com

ply

with

pa

rity

IF

th

e p

lan

ha

sn

’t c

ha

nge

d s

ince

the

AC

A w

as p

asse

d. T

hese

ar

e kn

own

as g

rand

fath

ered

pla

ns a

nd th

ere

are

very

few

left.

Hea

lth P

lans

an

d Fe

dera

l Pa

rity

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

6

The

fact

is th

at m

ost A

mer

ican

s ar

e co

vere

d by

hea

lth p

lans

that

are

und

er o

ne

or m

ore

fede

ral p

arity

law

s.

N

ext s

lide

3 m

in

Fede

ral l

aw p

rote

cts

parit

y in

sev

eral

type

s of

car

e.

Turn

to y

our P

arity

Pro

tect

ions

han

dout

on

page

3.

•

Inpa

tient

or h

ospi

tal c

are

mus

t be

cove

red

equa

lly in

or o

utsi

de th

e he

alth

pl

an n

etw

ork,

•

Out

patie

nt c

are

in a

nd o

ut o

f net

wor

k,

•

Res

iden

tial t

reat

men

t, •

Em

erge

ncy

care

, and

•

Pre

scrip

tion

drug

s.

Par

ity a

lso

appl

ies

to c

ost s

harin

g su

ch a

s co

-pay

s, c

o-in

sura

nce,

ded

uctib

les

and

out-o

f-poc

ket c

ost l

imits

. The

goa

l is

that

con

sum

ers

shou

ld n

ot h

ave

to p

ay

mor

e fo

r men

tal h

ealth

or s

ubst

ance

abu

se c

are

than

for g

ener

al m

edic

al c

are.

H

ealth

pla

ns a

re re

quire

d to

hav

e en

ough

men

tal h

ealth

and

sub

stan

ce u

se

outp

atie

nt p

rovi

ders

and

men

tal h

ealth

hos

pita

ls to

ser

ve m

embe

rs c

lose

to

hom

e. A

nd, p

rovi

der p

aym

ent r

ates

for m

enta

l hea

lth m

ust b

e on

the

sam

e le

vel

as o

ther

type

s of

car

e.

Fina

lly, s

tand

ards

use

d to

app

rove

or d

eny

treat

men

t req

uest

s m

ust b

e no

st

ricte

r for

men

tal h

ealth

and

add

ictio

n th

an fo

r med

ical

or s

urgi

cal c

are.

W

e’v

e ju

st

go

ne

thro

ugh

quite

a b

it of

info

rmat

ion.

Wha

t hav

e yo

u le

arne

d ab

out f

eder

al p

arity

law

that

sta

nds

out f

or y

ou?

[T

ake

a co

uple

of q

uick

resp

onse

s.]

Nex

t slid

e

Parit

y Pr

otec

tions

30 s

ec

You

may

be

won

derin

g ho

w to

tell

whe

ther

a h

ealth

pla

n is

follo

win

g pa

rity

law

. L

et’s g

o th

rou

gh

som

e c

om

mon

wa

rnin

g s

ign

s.

‘

Look

at t

he p

arity

vio

latio

n w

arni

ng s

igns

han

dout

on

page

4.

Nex

t slid

e

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

7

30 s

ec

Und

er p

arity

law

, hea

lth p

lans

ca

n’t c

over

few

er v

isits

for m

enta

l hea

lth o

r ad

dict

ion

treat

men

t tha

n fo

r oth

er ty

pes

of c

are.

So,

if th

ere

is n

o lim

it on

the

num

ber o

f vis

its to

an

endo

crin

olog

ist f

or d

iabe

tes,

ther

e sh

ould

be

no li

mits

on

visi

ts to

a p

sych

iatri

st, t

hera

pist

or a

ddic

tion

coun

selo

r.

And

, the

num

ber o

f cov

ered

day

s in

psy

chia

tric

hosp

ital m

ust b

e eq

ual t

o da

ys

for o

ther

kin

ds o

f inp

atie

nt tr

eatm

ent.

T

he

se

are

ca

lled

‘qu

antita

tive

tre

atm

en

t lim

its’ o

r QTL

. H

ealth

pla

ns u

sual

ly

com

ply

with

QTL

s be

caus

e th

ey a

re w

ritte

n in

to th

e he

alth

pla

n pr

opos

als

revi

ewed

by

the

gove

rnm

ent.

N

ext s

lide

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

30 s

ec

Bac

k to

sig

ns o

f par

ity is

sues

, a h

ealth

pla

n m

ay b

e vi

olat

ing

parit

y la

w if

it

do

esn

’t c

ove

r re

sid

entia

l tre

atm

ent o

r par

tial h

ospi

taliz

atio

n fo

r men

tal h

ealth

or

addi

ctio

n, b

ut d

oes

cove

r ste

p do

wn

care

in a

ski

lled

nurs

ing

faci

lity

afte

r a

stro

ke o

r hea

rt at

tack

. S

ome

heal

th p

lans

will

not p

ay fo

r men

tal h

ealth

or a

ddic

tion

care

if th

e m

embe

r qu

its b

efor

e th

e tre

atm

ent i

s co

mpl

ete.

Thi

s m

ay b

e a

parit

y vi

olat

ion

if th

e pl

an

do

esn

’t p

lace

the

sam

e r

equ

ire

men

t o

n o

the

r ty

pe

s o

f ca

re.

N

ext s

lide

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

2 m

in

Hea

lth p

lans

can

not c

harg

e m

ore

to th

eir m

embe

rs fo

r men

tal h

ealth

or a

ddic

tion

treat

men

t tha

n fo

r med

ical

or s

urgi

cal c

are.

Out

of p

ocke

t cos

ts in

clud

e co

paym

ents

, co-

insu

ranc

e an

d de

duct

ible

s.

A d

educ

tible

is h

ow m

uch

you

have

to p

ay in

med

ical

bills

bef

ore

the

heal

th p

lan

begi

ns to

pay

. Add

ed d

educ

tible

s fo

r men

tal h

ealth

and

add

ictio

n ca

re a

re n

ot

allo

wed

und

er p

arity

law

. A

cop

aym

ent,

or c

opay

, is

a se

t fee

that

hea

lth p

lan

mem

bers

mus

t pay

for e

ach

visi

t. P

arity

law

requ

ires

copa

ys fo

r men

tal h

ealth

or a

ddic

tion

treat

men

t to

be th

e sa

me

as fo

r sim

ilar t

ypes

of c

are

for o

ther

con

ditio

ns.

Be

awar

e th

at c

o-in

sura

nce

and

copa

ymen

ts a

re n

ot th

e sa

me.

Cop

aym

ents

are

a

set f

ee p

er v

isit,

whi

le c

o-in

sura

nce

is a

per

cent

age

of th

e to

tal c

ost o

f the

tre

atm

ent.

Fo

r exa

mpl

e, a

pla

n m

ay h

ave

a $2

0 co

-pa

y f

or

do

cto

r’s a

ppo

intm

ents

, b

ut t

he

phar

mac

y be

nefit

may

requ

ire a

20%

co-

insu

ranc

e. If

the

tota

l cos

t of m

edic

atio

n

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

8

is $

1,00

0 pe

r mon

th, t

he m

embe

r wou

ld o

we

$200

eve

ry m

on

th. T

ha

t’s b

ig

diffe

ren

ce

fro

m $

20 p

er

vis

it,

so

it

pa

ys t

o lo

ok a

t th

e f

ine

prin

t w

he

n y

ou

’re

bu

ying

hea

lth in

sura

nce.

C

o-in

su

ran

ce

usua

lly in

vo

lve

s le

ve

ls o

r ‘tie

rs’ of

ou

t of

po

cke

t co

sts

. F

or a

ge

neric

med

icat

ion

on ti

er 1

, the

hea

lth p

lan

wou

ld p

ay th

e fu

ll co

st a

nd th

e m

embe

r wo

uld

n’t o

we

an

yth

ing.

Fo

r med

icat

ions

on

tiers

2 –

4 m

embe

rs w

ould

ow

e an

incr

easi

ng p

erce

ntag

e of

the

cost

with

eac

h hi

gher

tier

. P

arity

law

s re

quire

hea

lth p

lans

to c

harg

e no

mor

e in

out

of p

ocke

t for

psy

chia

tric

med

icat

ions

than

for c

ompa

rabl

e m

edic

atio

ns to

trea

t oth

er c

ondi

tions

. Tha

t m

eans

that

a g

ener

ic a

ntid

epre

ssan

t or a

ntip

sych

otic

med

icat

ion

shou

ld b

e on

tie

r 1 o

r 2 w

ith li

ttle

or n

o co

pay.

The

sel

ectio

n of

bra

nd n

ame

med

icat

ion

on

each

tier

sho

uld

be s

imila

r acr

oss

the

vario

us m

edic

al c

ondi

tions

. N

ext s

lide

2 m

in

Ano

ther

type

of t

reat

men

t lim

it in

volv

es h

ow h

ealth

pla

ns re

view

requ

ests

for

men

tal h

ealth

or a

ddic

tion

treat

men

t com

pare

d to

oth

er ty

pes

of c

are.

Tre

atm

ent

revi

ews

are

done

for t

hree

mai

n re

ason

s:

1.

To m

ake

sure

the

best

type

of c

are

is b

eing

pro

vide

d,

2.

To p

reve

nt th

e w

rong

type

of c

are

from

bei

ng p

rovi

ded

and

3.

To r

ed

uce

th

e h

ea

lth

pla

n’s

cos

ts.

Hea

lth p

lans

dec

ide

whe

ther

car

e is

‘med

ica

lly n

eces

sary

,’ w

hen

deci

ding

w

heth

er to

app

rove

or d

eny

care

. Th

ey m

ay d

eny

care

bec

ause

it:

•

Is n

ot a

ppro

ved

for c

erta

in h

ealth

con

ditio

ns;

•

May

onl

y w

ork

unde

r cer

tain

con

ditio

ns;

•

Effe

ctiv

enes

s or

saf

ety

may

be

in q

uest

ion;

•

Or,

the

treat

men

t cos

ts m

ore

than

trea

tmen

ts fo

r the

sam

e co

nditi

on.

Thes

e ty

pes

of li

mita

tions

are

cal

led

Non

-Qua

ntita

tive

Trea

tmen

t Lim

its o

r NQ

TL,

and

this

is w

here

par

ity p

robl

ems

usua

lly a

ppea

r. Th

e w

ay in

sure

rs d

o th

is fo

r be

havi

oral

hea

lth c

are

is o

ften

mor

e st

rict t

han

for o

ther

type

s of

car

e. U

nder

pa

rity

law

hea

lth p

lans

mus

t sha

re th

e st

anda

rds

used

to a

ppro

ve o

r den

y ca

re if

th

e m

embe

r ask

s fo

r the

info

rmat

ion.

The

pla

n m

ust a

lso

shar

e w

ith a

pro

vide

r ac

ting

on b

ehal

f of a

mem

ber.

Nex

t slid

e

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

9

1 m

in

Prio

r aut

horiz

atio

n an

d st

ep th

erap

y ar

e ot

her e

xam

ples

of n

on-q

uant

itativ

e tre

atm

ent l

imita

tions

(NQ

LT).

P

rior a

utho

rizat

ion

or p

rior a

ppro

val (

PA

) mea

ns th

at th

e m

embe

r or p

rovi

der

mus

t con

tact

the

heal

th p

lan

to re

ques

t cov

erag

e of

trea

tmen

t. If

PA

is g

rant

ed,

the

plan

will

cove

r the

trea

tmen

t, al

thou

gh th

e m

embe

r may

stil

l hav

e an

out

-of-

pock

et c

ost.

Som

e pl

ans

requ

ire a

new

prio

r aut

horiz

atio

n ev

ery

year

or e

very

tim

e a

mem

ber r

each

es a

cer

tain

num

ber o

f vis

its.

If pr

ior a

utho

rizat

ion

is n

ot g

rant

ed, t

he p

lan

wo

n’t p

ay fo

r the

trea

tmen

t.

Ste

p th

erap

y, o

r fai

l firs

t, is

a ty

pe o

f prio

r aut

horiz

atio

n. W

ith s

tep

ther

apy,

the

mem

ber m

ust f

irst t

ry a

mor

e co

mm

on, l

ess

expe

nsiv

e tre

atm

ent o

r med

icat

ion

that

has

bee

n pr

oven

effe

ctiv

e fo

r mos

t peo

ple

with

a g

iven

con

ditio

n be

fore

they

ca

n “

ste

p”

to th

e r

ecom

me

nd

ed

trea

tmen

t.

Nex

t slid

e

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

4 m

in

Pro

vide

r cre

dent

ialin

g is

ano

ther

NQ

TL in

whi

ch h

ealth

pla

ns c

ontra

ct w

ith a

lim

ite

d n

um

be

r of

pro

vid

ers

wh

o m

ee

t th

e p

lan

’s q

ua

lity s

tan

da

rds. P

rovi

ders

m

ust g

o th

roug

h a

revi

ew p

roce

ss a

nd m

ay o

r may

not

be

acce

pted

into

a g

iven

he

alth

pla

n ne

twor

k. In

retu

rn fo

r clie

nt re

ferra

ls, t

hese

pro

vide

rs a

gree

to w

ork

for a

redu

ced

rate

and

follo

w p

lan

proc

edur

es. I

f the

insu

rer d

oes

this

diff

eren

tly

for m

enta

l hea

lth th

an o

ther

type

s of

pro

vide

rs, t

hat m

ay b

e a

parit

y vi

olat

ion.

N

arro

w n

etw

orks

allo

w h

ealth

pla

ns to

pay

the

prov

ider

less

per

vis

it be

caus

e th

ey c

an g

uara

ntee

a h

ighe

r num

ber o

f ref

erra

ls to

eac

h pr

ovid

er in

the

netw

ork.

Th

is s

trate

gy a

lso

mak

es it

eas

ier f

or h

ealth

pla

ns to

mon

itor t

he q

ualit

y of

car

e gi

ven

by th

eir p

rovi

ders

.

The

prob

lem

is th

at m

embe

rs o

ften

have

a re

ally

har

d tim

e fin

ding

an

in-n

etw

ork

men

tal h

ealth

or a

ddic

tion

treat

men

t pro

vide

r. H

ealth

pla

n pr

ovid

er d

irect

orie

s m

ay b

e ou

t of d

ate;

eve

n th

ose

that

are

on

line.

The

dire

ctor

y m

ay li

st p

rovi

ders

w

ho

are

no

lo

nge

r p

racticin

g o

r w

ho

are

n’t t

akin

g n

ew

pa

tie

nts

.

And

, it m

ay lo

ok li

ke th

e pl

an h

as a

pro

vide

r in

the

area

, whe

n in

real

ity, t

he

prov

ider

pra

ctic

es a

t a n

umbe

r of c

linic

s an

d on

ly ta

kes

a fe

w h

ealth

pla

n pa

tient

s fro

m a

giv

en to

wn.

War

ning

Sig

ns:

Parit

y Vi

olat

ion?

G

loss

ary

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

10

It is t

rue t

hat

it’s

ha

rd fo

r h

ea

lth

pla

ns to

kee

p di

rect

orie

s up

to d

ate

whe

n pr

ovid

ers

com

e an

d go

qui

ckly

. Th

e he

alth

insu

ranc

e in

dust

ry is

wor

king

on

a te

chni

cal s

olut

ion,

but

it m

ay b

e aw

hile

bef

ore

this

pro

blem

is s

olve

d.

In a

ny c

ase,

nar

row

net

wor

ks m

ean

that

con

sum

ers

pay

high

er o

ut o

f poc

ket

cost

s fo

r out

of n

etw

ork

prov

ider

s. T

his

extra

fina

ncia

l bur

den

may

be

a pa

rity

viol

atio

n. B

ecau

se o

f thi

s, if

no

in-n

etw

ork

prov

ider

s ar

e av

aila

ble

in a

loca

l are

a,

parit

y la

w re

quire

s he

alth

pla

ns to

pay

the

full

cost

for a

n ou

t-of-n

etw

ork

prov

ider

.

Le

t’s

sto

p h

ere

fo

r a

brie

f dis

cuss

ion.

Hav

e yo

u or

som

eone

you

car

e ab

out

expe

rienc

ed a

ny o

f the

se s

ituat

ions

? If

so,

wha

t hap

pene

d?

[Tak

e a

coup

le o

f qui

ck re

spon

ses.

]

Nex

t slid

e

2 m

in

Now

, w

e’d

lik

e t

o t

alk

ab

ou

t w

ha

t to

do

wh

en

yo

u b

elie

ve

a h

ea

lth p

lan

ma

y b

e

out o

f com

plia

nce

with

par

ity la

w.

Look

at y

our h

ando

ut o

n C

ompl

aint

s an

d A

ppea

ls o

n pa

ges

5 an

d 6.

Th

e m

embe

r - o

r the

pro

vide

r on

beha

lf of

the

mem

ber -

has

the

right

com

plai

n a

bou

t a h

ea

lth

pla

n d

ecis

ion

or

to ‘a

pp

ea

l’ a d

en

ial of

ca

re. A

n a

pp

ea

l is

a fo

rma

l w

ritte

n re

ques

t for

a d

iffer

ent d

ecis

ion.

M

embe

rs a

nd p

rovi

ders

hes

itate

to fi

le a

com

plai

nt fo

r fea

r tha

t the

hea

lth p

lan

may

dro

p th

em o

r get

eve

n in

som

e ot

her w

ay. R

est a

ssur

ed th

at is

stri

ctly

ag

ains

t the

law

to re

talia

te, a

nd h

ealth

pla

ns k

now

it. A

lso,

sta

te in

sura

nce

depa

rtmen

ts –

who

rece

ive

mos

t of t

he c

alls

– s

ay th

at c

ompl

aint

s an

d ap

peal

s ar

e fil

ed a

ll th

e tim

e as

a s

tand

ard

part

of th

e in

sura

nce

busi

ness

. C

ompl

aint

s an

d ap

peal

s to

sta

te a

nd fe

dera

l age

ncie

s ar

e im

porta

nt, b

ecau

se

the

gove

rnm

ent b

ases

enf

orce

men

t of p

arity

law

on

the

num

ber a

nd ty

pe o

f co

mpl

aint

s an

d ap

peal

s re

ceiv

ed. S

o, b

y fil

ing

a co

mpl

aint

or a

ppea

l with

the

gove

rnm

ent,

the

mem

ber i

s he

lpin

g t

hem

se

lve

s a

nd

eve

ryo

ne

els

e w

ho

isn

’t

getti

ng th

e ca

re th

ey a

re e

ntitl

ed to

und

er p

arity

law

.

N

ext s

lide

Com

plai

nts

and

Appe

als

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

11

2 m

in

It is

a g

ood

idea

to c

onta

ct th

e st

ate

heal

th in

sura

nce

depa

rtmen

t eve

n if

the

com

plai

nt o

r app

eal n

eeds

to g

o to

a fe

dera

l age

ncy

beca

use

stat

es a

re

resp

onsi

ble

to m

onito

r and

enf

orce

par

ity la

ws.

Thi

s he

lps

them

trac

k th

e nu

mbe

r of

com

plai

nts

and

appe

als

filed

from

peo

ple

in th

e st

ate.

A

nd, s

tate

insu

ranc

e de

partm

ents

hav

e co

nsum

er a

ssis

tanc

e st

aff w

ho w

ork

with

m

embe

rs to

mak

e su

re th

e pa

perw

ork

is c

ompl

eted

and

file

d co

rrect

ly. T

hey

can

also

con

tact

the

heal

th p

lans

on

your

beh

alf t

o re

ques

t a c

hang

e in

the

deci

sion

. L

et’s g

o th

rou

gh

th

e C

om

pla

ints

an

d A

pp

ea

ls h

and

out

to s

ee h

ow

the

pro

ce

ss

wor

ks.

[R

ea

d th

rou

gh

‘H

ow

to

pre

pa

re a

com

pla

int’ a

nd

‘W

ha

t h

ap

pen

s w

hen

a

co

mp

lain

t is

file

d?

’]

W

hat q

uest

ions

do

you

have

abo

ut th

is p

roce

ss?

[T

ake

a co

uple

of q

uick

resp

onse

s.]

N

ext s

lide

Com

plai

nts

and

Appe

als

3 m

in

Bef

ore

filin

g a

com

plai

nt o

r app

eal,

the

mem

ber a

nd th

e pr

ovid

er s

houl

d di

scus

s th

e re

com

men

ded

treat

men

t and

how

the

deni

al o

f car

e af

fect

s th

e m

embe

r. B

e sp

ecifi

c ab

out t

reat

men

t goa

ls. I

f the

hea

lth p

lan

has

prop

osed

an

alte

rnat

ive,

di

scus

s ho

w it

falls

sho

rt an

d w

hy th

e or

igin

al p

resc

ribed

trea

tmen

t is

still

pr

efer

red.

T

he

ne

xt

ste

p is to

com

pla

in t

o th

e h

ea

lth

pla

n’s

con

sum

er

se

rvic

e d

epa

rtm

en

t.

Ofte

n, th

e he

alth

pla

n w

ill c

hang

e th

e de

cisi

on if

the

reas

ons

for t

he c

hang

e ar

e ex

plai

ned

in d

etai

l.

If cu

stom

er s

ervi

ce re

pres

enta

tives

stil

l den

y th

e tre

atm

ent r

eque

st, t

he p

rovi

der

or m

embe

r can

com

plet

e an

d su

bmit

a w

ritte

n ap

peal

form

to th

e in

sura

nce

plan

, u

su

ally

by f

ax o

r em

ail.

Alth

ou

gh

mo

st p

eop

le d

on

’t b

oth

er

to f

ile a

n a

pp

ea

l, it

is

wel

l wor

th th

e tim

e an

d ef

fort

beca

use

heal

th p

lans

usu

ally

dec

ide

appe

als

in

favo

r of t

he m

embe

r.

If t

he

he

alth p

lan d

en

ies t

he

app

ea

l, t

hat’s n

ot th

e e

nd

of

the

sto

ry.

Th

e m

em

be

r or

pro

vide

r can

stil

l app

eal t

o th

e st

ate

insu

ranc

e de

partm

ent a

nd/o

r the

fede

ral

agen

cy in

cha

rge

of th

e pa

rticu

lar t

ype

of p

lan.

Com

plai

nts

and

Appe

als

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

12

Pag

e 6

of th

e C

ompl

aint

s an

d A

ppea

ls h

ando

ut h

as a

cha

rt sh

owin

g w

hich

go

vern

men

t age

ncie

s ha

ndle

app

eals

for d

iffer

ent t

ypes

of h

ealth

pla

ns.

•

The

U.S

. Dep

artm

ent o

f Lab

or is

resp

onsi

ble

for s

elf-i

nsur

ed h

ealth

pla

ns

spon

sore

d by

em

ploy

ers

with

50

or m

ore

wor

kers

. Tha

t mea

ns th

e em

ploy

er c

over

s its

ow

n he

alth

ben

efits

. •

The

stat

e he

alth

insu

ranc

e de

partm

ent h

andl

es c

ompl

aint

s an

d ap

peal

s ab

out p

lans

pur

chas

ed b

y in

divi

dual

s or

sm

all g

roup

s un

der 5

0 pe

ople

, w

heth

er th

e pl

an w

as s

old

insi

de o

r out

side

a s

tate

hea

lth in

sura

nce

exch

ange

or t

he fe

dera

l hea

lth in

sura

nce

mar

ketp

lace

. •

Hea

lth in

sura

nce

exch

ange

pla

ns a

re a

lso

the

resp

onsi

bilit

y of

the

fede

ral

Cen

ters

for M

edic

are

and

Med

icai

d Se

rvic

es, o

r CM

S.

•

App

eals

abo

ut M

edic

aid

man

aged

car

e pl

ans

shou

ld b

e fil

ed w

ith th

e st

ate

Med

icai

d pr

ogra

m a

nd C

MS

.

N

ext s

lide

1 m

in

If yo

u fe

el o

verw

helm

ed b

y ho

w c

ompl

icat

ed th

is is

, you

are

not

alo

ne.

In re

spon

se to

requ

ests

from

peo

ple

acro

ss th

e co

untry

, the

U.S

. Dep

artm

ent o

f H

ealth

and

Hum

an s

ervi

ces

set u

p a

web

-bas

ed c

lear

ingh

ouse

for p

arity

in

form

atio

n an

d co

mpl

aint

s. B

y ch

ecki

ng a

cou

ple

of b

oxes

and

ans

wer

ing

a fe

w

ques

tions

, the

web

site

link

s yo

u to

the

corre

ct g

over

nmen

tal a

genc

y re

spon

sibl

e fo

r the

com

plai

nt o

r app

eal.

H

ave

you

trie

d to

file

a p

arity

com

plai

nt o

r an

appe

al fo

r you

rsel

f or

som

eone

you

car

e ab

out?

How

did

it g

o?

[Tak

e a

coup

le o

f qui

ck re

spon

ses.

]

N

ext s

lide

Com

plai

nts

and

Appe

als

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

13

5 m

in

Now

le

t’s lo

ok a

t th

ree

brie

f sto

rie

s th

at

illustr

ate

ho

w c

om

mo

n p

arity

vio

latio

ns

look

from

the

mem

ber v

iew

poin

t.

In y

our h

ando

uts,

look

at S

ampl

e S

tory

1 o

n pa

ge 7

. [C

o-te

ache

r] w

ill re

ad a

sa

mpl

e st

ory,

then

we

’ll d

iscuss it a

s a

grou

p.

[Tea

cher

s, c

ircul

ate

and

help

par

ticip

ants

find

the

right

pag

es]

Are

you

read

y? G

reat

! [C

o-te

ache

r] pl

ease

read

the

first

sam

ple

stor

y.

[Co-

teac

her r

eads

sam

ple

stor

y.]

Doe

s th

is s

tory

hav

e pa

rity

issu

es?

If so

, wha

t are

they

? [T

ake

a co

uple

of

resp

onse

s. If

not

men

tione

d, g

o th

roug

h th

e fo

llow

ing

poin

ts.]

Ans

wer

s:

•

Ther

e m

ay b

e a

parit

y pr

oble

m w

ith to

prio

r aut

horiz

atio

n be

caus

e m

edic

al

care

is tr

eate

d di

ffere

ntly

. •

Med

ical

nec

essi

ty m

ay o

r may

not

be

a pr

oble

m. W

e ne

ed m

ore

info

rmat

ion

abou

t med

ical

nec

essi

ty c

riter

ia fo

r oth

er c

ondi

tions

. W

hat i

s th

e fir

st s

tep

she

shou

ld ta

ke?

[Wai

t for

a re

spon

se.]

Ans

wer

: Afte

r tal

king

with

her

pro

vide

r, sh

e sh

ould

con

tact

her

hea

lth p

lan.

W

hat g

over

nmen

t age

ncy

shou

ld s

he c

onta

ct?

[Wai

t for

a re

spon

se.]

A

nsw

er: S

he s

houl

d co

ntac

t the

sta

te d

epar

tmen

t of i

nsur

ance

bec

ause

this

is a

sm

all e

mpl

oyer

hea

lth p

lan.

N

ext s

lide

Wor

kshe

et:

Sam

ple

Stor

y 1

Not

e: If

you

are

te

achi

ng p

eopl

e w

ho a

re m

ostly

in

tere

sted

in

addi

ctio

n pa

rity,

su

bstit

ute

the

sam

ple

addi

ctio

n st

orie

s fo

r st

orie

s on

e an

d tw

o.

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

14

5 m

in

Tha

nks e

ve

ryo

ne

. L

et’s g

o o

n to

th

e s

eco

nd

sto

ry.

[Co-

teac

her n

ame]

ple

ase

read

sam

ple

men

tal h

ealth

sto

ry n

umbe

r 2.

[Co-

teac

her r

eads

sam

ple

stor

y.]

Doe

s th

is s

tory

hav

e pa

rity

issu

es?

If so

, wha

t are

they

? [T

ake

a co

uple

of

resp

onse

s. If

not

men

tione

d, g

o th

roug

h th

e fo

llow

ing

poin

ts.]

Ans

wer

s:

•

It m

akes

a d

iffer

ence

whe

ther

the

med

icat

ions

for d

iabe

tes

and

men

tal

heal

th a

re g

ener

ic o

r bra

nd n

ame.

If b

oth

are

bran

d na

me,

ther

e m

ay b

e a

parit

y vi

olat

ion.

If th

e di

abet

es d

rug

is g

ener

ic a

nd th

e m

enta

l hea

lth d

rug

is b

rand

nam

e, th

ere

may

not

be

a pa

rity

issu

e be

caus

e he

alth

pla

ns h

ave

the

optio

n to

pla

ce m

ore

expe

nsiv

e dr

ugs

on h

ighe

r tie

rs.

•

The

step

ther

apy

requ

irem

ent m

ay v

iola

te p

arity

if it

onl

y ap

plie

s to

his

ps

ychi

atric

med

icat

ions

. •

Reg

ardl

ess,

he

wou

ld h

ave

stan

ding

to a

ppea

l the

ste

p th

erap

y re

quire

men

t sin

ce h

e ha

s al

read

y go

ne th

roug

h st

ep th

erap

y tw

ice.

W

hat i

s th

e fir

st s

tep

he s

houl

d ta

ke?

[Wai

t for

a re

spon

se.]

Ans

wer

: Afte

r tal

king

with

his

pro

vide

r, he

or h

is p

rovi

der s

houl

d co

ntac

t his

he

alth

pla

n.

Wha

t gov

ernm

ent a

genc

y, o

r age

ncie

s, s

houl

d he

con

tact

? [W

ait f

or a

re

spon

se.]

A

nsw

er: H

e sh

ould

con

tact

the

stat

e de

partm

ent o

f ins

uran

ce a

nd C

MS

bec

ause

th

is is

an

indi

vidu

al h

ealth

pla

n pu

rcha

sed

on th

e st

ate

exch

ange

.

Nex

t slid

e

Wor

kshe

et:

Sam

ple

Stor

y 2

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

15

5 m

in

Tha

nks e

ve

ryo

ne

. L

et’s g

o o

n to

th

e th

ird

sto

ry.

[Co-

teac

her n

ame]

ple

ase

read

sam

ple

men

tal h

ealth

sto

ry n

umbe

r 3.

[Co-

teac

her r

eads

sam

ple

stor

y.]

Doe

s th

is s

tory

hav

e pa

rity

issu

es?

If so

, wha

t are

they

? [T

ake

a co

uple

of

resp

onse

s. If

not

men

tione

d, g

o th

roug

h th

e fo

llow

ing

poin

ts.]

Ans

wer

:

•

This

app

ears

to b

e a

parit

y is

sue

beca

use

the

psyc

hiat

ric re

side

ntia

l tre

atm

ent w

as re

view

ed m

ore

ofte

n th

an th

e re

hab

faci

lity

for h

er in

jury

. W

hat i

s th

e fir

st s

tep

she

shou

ld ta

ke?

[Wai

t for

a re

spon

se.]

Ans

wer

s:

•

Afte

r tal

king

with

the

prov

ider

, her

dau

ghte

r or t

he p

rovi

der s

houl

d co

ntac

t th

e m

anag

ed c

are

plan

. •

If sh

e ha

s a

med

ical

pow

er o

f atto

rney

or o

ther

lega

l sta

ndin

g to

act

on

beha

lf of

her

dau

ghte

r, sh

e ca

n co

ntac

t the

man

aged

car

e pl

an d

irect

ly.

Wha

t gov

ernm

ent a

genc

y, o

r age

ncie

s, s

houl

d sh

e co

ntac

t? [

Wai

t for

a

resp

onse

.]

Ans

wer

: She

sho

uld

cont

act t

he s

tate

Med

icai

d pr

ogra

m a

nd C

MS

. N

ext s

lide

Wor

kshe

et:

Sam

ple

Stor

y 3

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

16

16 m

in

Now

it’s y

ou

r tu

rn t

o p

ractice

fili

ng a

n ap

peal

. Ple

ase

pair

up w

ith a

noth

er

pers

on. O

ne o

f you

will

pla

y th

e he

alth

pla

n m

embe

r and

the

othe

r will

pla

y th

e m

enta

l hea

lth c

are

prov

ider

.

• H

ere

’s t

he s

ituat

ion:

You

r req

uest

for i

ndiv

idua

l the

rapy

for p

osttr

aum

atic

st

ress

dis

orde

r, or

PTS

D, h

as b

een

deni

ed. T

he h

ealth

pla

n re

quire

s gr

oup

ther

apy

first

, but

the

mem

ber i

s ne

rvou

s ar

ound

stra

nger

s.

• Y

ou

’ll h

ave

15

min

ute

s t

o c

ompl

ete

the

Sam

ple

Stat

e H

ealth

Insu

ranc

e C

ompl

aint

For

m o

n pa

ge 1

0 an

d 11

. When

it’s y

our t

urn

to fi

ll ou

t the

fo

rm, w

rite

your

nam

e an

d co

ntac

t inf

orm

atio

n. P

rete

nd y

ou

’re

the

pe

rson

w

ith P

TSD

.

• W

e w

ill ci

rcul

ate

arou

nd th

e ro

om to

ans

wer

any

que

stio

ns y

ou m

ay h

ave.

• W

e’ll

le

t yo

u k

no

w w

he

n it’s n

ea

rly t

ime

to g

ive y

ou

a c

ha

nce

to w

rap

up.

[B

oth

teac

hers

circ

ulat

e ar

ound

the

room

. Whe

n on

ly 3

min

utes

rem

ain,

tell

pa

rtic

ipa

nts

it’s tim

e to

wra

p u

p.]

T

ha

nk y

ou

, e

ve

ryo

ne

. It’s

tim

e to

la

y y

ou

r p

encils

do

wn

.

N

ext s

lide.

Sam

ple

Con

sum

er

Com

plai

nt

Form

2 m

in

Ple

ase

give

you

rsel

ves

a pa

t on

the

back

for w

orki

ng th

roug

h th

is e

xerc

ise.

Le

t’s

talk

abo

ut th

e ex

perie

nce.

W

hat d

id y

ou le

arn

from

filli

ng o

ut th

is fo

rm?

W

hat w

as m

ost h

elpf

ul fo

r you

?

How

will

you

use

wha

t you

hav

e le

arne

d?

[Tak

e a

few

resp

onse

s to

eac

h qu

estio

n]

Nex

t slid

e

Parit

y: F

airn

ess

in H

ealth

Cov

erag

e N

AMI S

mar

ts fo

r Adv

ocac

y Ve

rsio

n

Rev

ised

Jun

e 20

17

Slid

e T

ime

Scrip

t H

ando

uts

17

30 s

ec

This

web

site

, ww

w.P

arity

Reg

istry

.org

, has

exc

elle

nt in

form

atio

n in

pla

in

lang

uage

to h

elp

you

lear

n m

ore

abou

t par

ity. S

pons

ored

by

the

Ken

nedy

For

um

and

the

Sca

tterg

ood

Foun

datio

n, P

arity

Trac

k is

col

lect

ing

stor

ies

of p

eopl

e w

ho

have

exp

erie

nced

par

ity v

iola

tions

to h

elp

fight

for s

trong

er e

nfor

cem

ent o

f sta

te

and

fede

ral p

arity

law

.

By

subm

ittin

g yo

ur s

tory

on

the

Par

ityTr

ack

web

site

in a

dditi

on to

filin

g w

ith th

e p

rop

er

age

ncy,

yo

u’ll

he

lp t

he

ove

rall

str

uggle

fo

r p

arity

. Y

ou

can

giv

e y

ou

r n

am

e

or

no

t, it’s u

p t

o y

ou

.

Nex

t slid

e

30 s

ec

If yo

u w

ould

like

mor

e in

form

atio

n or

ass

ista

nce,

this

slid

e an

d yo

ur h

ando

uts

incl

ude

som

e he

lpfu

l sta

te a

nd n

atio

nal r

esou

rces

.

Aga

in, w

e re

com

men

d go

ing

to y

our s

tate

dep

artm

ent o

f ins

uran

ce in

add

ition

to

the

othe

r thi

ngs

you

do.

That

will

mak

e su

re y

our p

arity

com

plai

nt is

regi

ster

ed

with

the

stat

e, w

hich

will

hel

p st

reng

then

the

parit

y la

w fo

r eve

ryon

e.

Nex

t slid

e

Res

ourc

es

1 m

in

Than

k yo

u al

l for

giv

ing

your

tim

e an

d en

ergy

to th

is w

orks

hop.

Ple

ase

appl

aud

your

selv

es fo

r eve

ryth

ing

you'

ve a

ccom

plis

hed

toda

y.

Ple

as

e r

em

em

be

r to

fill

ou

t y

ou

r p

ost-

train

ing

ev

alu

ati

on

an

d t

urn

it

in t

o

(na

me

lo

ca

tio

n o

r p

ers

on

).

Nex

t slid

e

Eval

uatio

n

30 s

ec

If yo

u w

ould

like

mor

e in

form

atio

n on

NA

MI S

ma

rts fo

r A

dvo

ca

cy, c

onta

ct y

our

loca

l or s

tate

NA

MI o

rgan

izat

ion.

http://www.parityregistry.org/

Insert Tab: Module 5 Worksheets

NAMI Smarts for AdvocacyParity: Fairness in Health Coverage

1 NAMI ● 3803 N. Fairfax Drive, Suite 100 ● Arlington, VA 22203 (703) 524-7600 ● www.nami.org ● www.facebook.com/NAMI

Overview What is parity? Parity means ‘at the same level’. Mental health and addiction treatment parity requires health insurance plans to cover mental health and substance abuse treatment at the same level as other types of medical care.

Why is parity important?Health insurance should help millions of Americans get the mental health or addiction treatment they need, yet too many health plan members face lower visit limits, higher out of pocket costs and stricter rules on how care is reviewed than for medical and surgical benefits.

Federal Parity Laws The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) MHPAEA applies to large group and self-insured health plans and Medicaid managed care plans. MHPAEA does not require health plans to provide mental health or addiction benefits, but if they do, treatment limits and out of pocket costs must be at the same level as medical and surgical care.

The Patient Protection and Affordable Care Act of 2010 (ACA)The ACA strengthens coverage for mental health and addiction through: Consumer protections: Health plans can’t turn people down or charge more for having major

illnesses such as mental health or substance use conditions. The law does not allow lifetime orannual treatment limits. Parents can include adult children on their health plan up to age 26.

Medicaid expansion: States have the choice to expand Medicaid eligibility to any householdwith an income at or below 138% of the federal poverty level ($16,400/year for one person).

Health insurance exchange: Every state must have a state or federally run health insuranceexchange with health plans that meet certain standards. Exchange plan premiums are partlycovered by up-front tax credits up to 400% of the federal poverty level ($97,200 for one person).

Parity in individual and small group plans: Requires all individual and small group healthplans to meet MHPAEA parity requirements whether or not they are sold through an exchange.Requires parity in private health plans that cover people in Medicaid expansion and Children’sHealth Insurance Plans (CHIP).

Essential Health Benefits: All individual and small group plans must cover 10 Essential HealthBenefits (EHB). Behavioral health is one EHB category. EHBs must meet parity standards, notonly within the ‘behavioral health’ category, but also in other categories such as emergency care.

The 21st Century Cures Act of 2016 The parity section of this law requires the U.S. Department of Health and Human Services to:

Issue new guidance on how to comply with federal parity laws Hold a public meeting on state and federal agencies coordination regarding parity Publish a report on federal parity investigations - issued each year for five years

The Government Accountability Office (a federal watchdog) will study enforcement offederal parity law.

New resources are required on eating disorder treatment parity. Health professionals willbe educated about eating disorders and effective treatment.



Health Plans and Federal Parity Not all types of health coverage must meet parity requirements, and conditions under which parity applies vary. The following chart shows the types of health plans that must comply with federal parity law and the conditions that apply.

Type of Plan Parity? Notes

Employer Sponsored

Large employer > 50 employees Yes

Not required to provide mental health or addiction benefits, but if they do, coverage must be on par with other medical benefits.

Small employer 2 to 50 employees Depends If created after 3/23/2010, must provide mental health

benefits. Required to follow federal parity law.

Federal Employee Health Benefits Plan (FEHBP) Yes Must provide mental health benefits; required to

follow federal parity law.1

Non-federal government No Some health plans for state or local government workers can opt out of federal parity law.

Faith-based organizations No Plans for employees of faith-based organizations can opt out of federal parity law.

Retiree only No Plans that only cover retirees can opt out of federal parity law.

Government Programs

Medicare No Federal health plan for people who are age 65 or older and people with disabilities. Federal parity law does not apply.

Children’s Health Insurance Program (CHIP) Yes

Government health plan for low to middle income children. Federal parity law applies.

Medicaid Depends

Government health plan for certain low-income children and adults.2 Federal parity law applies to Medicaid managed care plans, but not Medicaid Fee-for-Service (FFS) plans.

TRICARE No Federal health care program for uniformed military service members and their families

Individual Plans

Individual health plans (You buy for self or family) Depends

If created after 3/23/2010 or changed since, must provide mental health benefits; required to follow federal parity law.

1 U.S. Office of Personnel Management, FEHB Program Carrier Letter, No. 2008‐17 (November 10, 2008), https://www.opm.gov/healthcare‐insurance/healthcare/carriers/2008/2008‐17.pdf 2 Federal law restricts the use of Medicaid dollars for service to adults between the ages of 21 and 64 in certain types of free standing psychiatric hospitals and residential facilities. 42 U.S.C. 1369(d).



Parity Protections Federal parity law protects health plan members by requiring the same level of coverage for mental health and addiction treatment as for other types of medical and surgical care.

Types of care:

Hospital or residential treatment Outpatient visits Emergency or crisis care Prescription drugs Both in-network and out-of-network

Out-of-Pocket Costs: Costs for mental health or addiction treatment must not be greater than costs for most other medical care

Co-pays: Flat fee per visit or service Co-insurance: Percentage of total service cost Maximum out-of-pocket costs: What you pay before the plan pays 100% Deductibles: What you pay before the plan begins to pay Annual or lifetime dollar limits: The most a plan will pay in a year or lifetime

Treatment limits: The number of visits or days for mental health or addiction treatment must be no less than limits for most other medical care

Number of outpatient visits Number of days in hospital or residential care Limits on prescription medications Excluded types of treatment or situations

Other limits: Other types of limits must not be more restrictive for mental health or addiction treatment than for other types of medical care

Prescription drug costs or requirements Prior-approval requirements Clinical standards used to approve or deny care Availability of providers



Warning Signs: Parity Violation? Fewer visits or days for MH/SUD care

Warning sign: The health plan covers fewer office visits or inpatient days for mental health or addiction treatment than for other types of medical care.

MH/SUD residential or partial hospital care not covered

Warning sign: The health plan does not cover residential treatment or partial hospital care for mental health or addiction treatment, but similar care is covered for other medical conditions.

Higher out of pocket costs for mental health/addiction care Warning sign: The health plan charges more for mental health and addiction care:

Added deductible for mental health and substance abuse care Higher copay for services (set fee per visit or prescription) Higher co-insurance (percentage of total cost) Medication or treatment placed on a higher tier (percentage of total cost)

Care denied unequally: Not medically necessary

Warning sign: The health plan reviews requests for mental health or addiction treatment more often or in a stricter way than for other types of care.

Health plans approve or deny requests for care based on medical necessity. A treatment request may be denied because:

It is not approved for certain health conditions The treatment may only work under certain conditions Effectiveness or safety may be in question The cost is higher than other types of care for the same condition

Having to ask permission more for mental health or addiction care

Warning sign: The health plan requires prior approval more often for mental health and addiction treatment than other types of care.

With prior authorization or prior approval (PA) the member or provider must contact the health plan to ask permission before starting treatment. If PA is granted, the plan will pay.

Step therapy means the member must try a common, less expensive treatment or medication that is proven effective for a given condition before “stepping” to the prescribed treatment.

Can’t find in-network mental health or addiction providers 11111 Warning sign: It is hard to find local mental health or addiction treatment providers in the health plan network, but other types are available. Provider directory not up to date.

To keep premiums low, health plans contract with a limited number of providers who meet quality standards. In return for client referrals, providers go through a review process, agree to work for a reduced rate and follow plan procedures. This is called a provider network.



Complaints and Appeals When care is denied, a health plan member or provider has the right to complain (about the quality of care or coverage) or to ‘appeal’ (ask for a different decision). Complaints and appeals are a standard part of the insurance business. State and federal agencies need complaints and appeals because they are helpful in finding out where the problems are and making the parity law stick.

How to prepare a complaint: 1. Member and provider discuss the reason for the complaint or appeal. Write down the

details.

2. Member or provider contacts the health plan customer service office to ask for a different decision.

3. If not resolved, the member or provider files a written complaint with the health plan.

4. At the same time, the member or provider contacts the state health insurance department:

For information

For help filing a complaint with the health plan

To file a complaint with the correct government agency.

What happens when a complaint is filed?

1. Fill out a complaint form and attached documents, if any, that provide details.

2. Submit the completed complaint form and attachments by U.S. mail, fax or email.

3. When the state insurance agency receives the form, you will receive a written notice that your complaint has been received. A file number will be assigned which you should use any time you contact them about your complaint.

4. The state insurance agency will forward the complaint to the health insurance company or agent and request a response. The company or agent has a limited time to respond, usually 30 days.

5. When the state receives a response one of the following will happen:

a. If the complaint has been resolved, the file will be closed. You’ll get a letter.

b. If an insurance law has been violated, they will be asked to correct the problem.

c. If the company is not abiding by the policy, they will be asked to correct the problem.

d. If the insurer or agent has not responded to all questions or has not looked into the complaint in detail, they will be required to do so.

e. If no violation is found, you will get a letter explaining why the case is closed.

6. It takes about 45 days from the time a complaint is received to when the problem is solved. A complex complaint could take longer.



Complaints and Appeals, continued. This chart shows the government agencies responsible for different types of health plans. If you are not sure where to file a complaint or appeal, visit the HHS parity complaint website shown below. At the same time, contact your state insurance department.

Type of Health Plan Government Agency

Employer-based plans: Large group or self-insured

Department of Labor (DOL)

Individual health plan: Federal Marketplace or State Exchange

State Health Insurance Dept. Centers for Medicare & Medicaid Services (CMS)

Individual or small group Non-exchange plan

State Health Insurance Dept.

Medicaid Managed Care or Children’s Health Insurance Plan (CHIP)

State Medicaid Program CMS

Federal Employee Health Benefit plan (FEHB)

U.S. Office of Personnel Management

Not sure where to file?

Federal HHS parity complaint website www.hhs.gov/mental-health-and-addiction-insurance-help

Information Links:

o Federal agencies o State insurance departments



Sample Mental Health Story 1: Worksheet

A 38-year-old married woman covered by her husband’s small group employer-sponsored health plan:

Discussion questions:

Does this story have parity issues? If so, what are they? What is the first step she should take? What government agency or agencies should she contact? * TMS: Transcranial Magnetic Stimulation is used for treatment-resistant depression

“My health plan requires prior authorization for mental health, but not for medical care. The doctor prescribed TMS * for my depression, but my health plan denied the service as ‘not medically necessary’ despite the fact that I’ve tried everything.”




A 59-year-old man with an individual health plan purchased through the state health insurance exchange:


Does this story have parity issues? If so, what are they? What is the first step he should take? What government agency or agencies should he contact?

“My brand name diabetes medication is on tier 1 with no coinsurance, but my mental health medications are on tier 3 and I can’t afford $240.00 out of pocket every month.

I have to ‘step up’ by taking less expensive psych meds for 6 weeks. I only get the one I need if the other doesn’t work. I changed health plans twice before and had to ‘step up’ each time. Why can’t they look at my record and approve the right drug from the start?”




A 20-year-old single woman with Medicaid managed care. Her mother is speaking:


Does this story have parity issues? If so, what are they? What is the first step she should take? What government agency or agencies should she contact?

“Our Managed Care Organization (MCO) evaluated medical necessity for day hospital treatment almost on a daily basis. That made no sense because the decision to admit our daughter to this type of treatment was based on her receiving residential care for four weeks. Care was denied several times while she was there and it was a constant struggle to extend the stay.

I don’t understand why this is different than her stay in the rehab facility after she broke her leg.”



Sample Consumer Complaint Form National Association of Insurance Commissioners

Required fields are marked with an asterisk* Complainant’s information: * First name Middle *Last name

*Address

*City *State *ZIP

County Country International ZIP Email address: Please re-enter email address as verification:

*Phone number: Extension:

*Alternate phone number: Extension: How do you want to be contacted? Insured Information (if different than above)

* First name Middle *Last name Other parties involved in this problem:

* First name Middle *Last name

*Type of Insurance *Reason for Complaint check one or use ctrl key to make multiple selections Annuity Auto Commercial Dental Disability Group health Home Individual Life Long term care Medicare supplement Other Title Workers comp

Agent handling Cancellation Claim delay Claim denial Delays/no response Information requested Misrepresentation Nonrenewal Other Premium & rating Premium notice/billing Premium refund Unsatisfactory settlement offer

Other desc. Other desc.



*Details of complaint

*What do you consider to be a fair resolution?

Maximum fair resolution length: 4,000 characters. Characters left:

Note: After the final submission of this form, you will be provided an opportunity to attach supporting documents. Will you be mailing or attaching additional supporting information? To download form: https://sbs-tn.naic.org/Lion-Web/servlet/org.naic.sbs.ext.onlineComplaint.OnlineComplaintCtrl?spanishVersion=N



Resources

State: Dept. of Commerce & Insurance: State insurance agency staffed to answer insurance

questions and assist with complaints and/or appeals. Telephone: ________________ Email: ____________________ Download complaint form: ______________________________________________

Medicaid: • Customer service line: ___________________ • Complaints and Appeals: ________________

State Mental Health Authority: State agency responsible for mental health and addiction services.

Telephone: ________________ Information & Referral, M-F, 8:00am – 4:30pm • Crisis Line: _____________________

Federal: U.S. Department of Health and Human Services (HHS) Parity Portal. Website to file

parity complaints and appeals with the correct government agency. www.hhs.gov/mental-health-and-addiction-insurance-help

U.S. Department of Labor (DOL) • EBSA (Employee Benefits Security Administration): Federal agency responsible

for employer sponsored and large self-insured health plans. Phone: 866-444-3272 www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa

CMS (Centers for Medicare and Medicaid Services): Federal agency responsible for Medicare, Medicaid and health insurance exchange or federal Marketplace health plans. • Helpline: 877-267-2323 extension 61565 • [email protected]

SAMHSA (Substance Abuse and Mental Health Services Administration): Federal agency responsible for mental health and substance use services. • Helpline: 800-662-4357

Advocacy Organizations: Depression Bipolar Support Alliance (DBSA): Organization of individuals and families

affected by mood disorders. Provides help, support, and education. www.dbsalliance.org Mental Health America (MHA): Addresses the needs of people with mental illness and

promotes the mental health of all Americans. http://www.mentalhealthamerica.net National Alliance on Mental Illness (NAMI): Organization of individuals and families

affected by mental health conditions. Provides support, education, advocacy, awareness. Helpline: 1-800-950-6264, [email protected] Parity information: www.NAMI.org/parity

ParityTrack: Helps people with mental health and substance use disorders understand and exercise their rights under parity law. www.paritytrack.org



Glossary

Appeal: If a health plan will not pay a claim or drops a member from coverage, the member has the right to appeal for a different decision and have it reviewed by a third party. Insurers must explain why the claim has been denied or coverage has been dropped. Children’s Health Insurance Program (CHIP): CHIP provides health coverage for eligible children, through both Medicaid and separate CHIP programs. CHIP is funded with federal and state dollars and operated by states under federal rules.

Co-insurance: The health plan member shares the cost of a covered service. Coinsurance is a percent (for example, 20%) of the allowed cost of service. For example, if the allowed amount for an office visit is $100 and the member has met the deductible, the coinsurance payment of 20% would be $20. The health plan pays the remaining allowed amount.

Complaint: If a health plan member has reason to believe that the plan is not providing benefits as required in the health plan policy or the law, the member can file a complaint with the health plan or the state of federal government agency in charge the plan.

Consumer protections: Health care law offers rights and protections that make coverage more fair and easy to understand. Some protections may apply to plans in the Health Insurance Marketplace, other individual plans, job-based plans, and some apply to all health coverage. Copayment, copay: A fixed amount (Example: $20) the health plan member pays for a covered service, usually at the time of service. The amount can vary by the type of covered health care service.

Credentialing: The process deciding whether a professional will be included in a health plan network. The health plan usually reviews education, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence.

Deductible: How much the member owes for covered health care services before the health insurance begins to pay. The deductible does not apply to preventive services such as annual check-ups or mental health screening, meaning that the plan will pay even before the deductible has been met.

Essential Health Benefits (EHB): Under the Patient Protection and Affordable Care Act, all individual and small group health plans (except grandfathered plans) must cover 10 types of care: (1) outpatient services; (2) emergency services; (3) hospital care; (4) maternity and newborn care; (5) behavioral health services; (6) prescription drugs; (7) rehabilitation; (8) lab services; (9) preventive and wellness services; and (10) children’s services, including dental and vision. All EHB must comply with federal parity law.

Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a preferred drug list (PDL).

Grandfathered health plan: Health plans that existed on March 23, 2010, and haven’t cut benefits or increased member costs. Grandfathered do not have to offer parity or other protections required under the Affordable Care Act. Insurance companies must notify members who have grandfathered plans.

Individual health plan: Health coverage purchased by an individual for self or family either through a health insurance exchange, or directly from the health insurance company.

Medical necessity, medically necessary: Health care services or supplies needed to prevent, diagnose, or treat a condition, and that meet accepted standards of medicine

Narrow network: To lower costs, health plans contract with a limited number of service providers, hospitals, labs and pharmacies. The monthly premium may be lower, but members pay more if they use out-of-network care.



Glossary Out of pocket cost (OOP): The amount owed by a health plan member during a policy period before the health insurance plan begins to pay 100% of the allowed amount. This limit does not include the premium, balance-billed charges or costs for benefits not covered under the plan.

Parity (Mental Health and Addiction): Most health insurance plans are legally required to cover mental health and addiction treatment at the same level as other types of medical care.

Provider Network: Facilities, providers and suppliers contracted with a health plan to provide care to members. The health plan covers more of the cost of care for in-network providers. However, for a given type of care, if no in-network provider is available within a certain distance from the member’s home, the health plan is required to pay for an out of network provider.

Prior authorization, prior approval (PA): A decision by the health plan that a health care service, treatment plan or prescription drug is medically necessary. Sometimes called preauthorization, prior approval or precertification.

Medically necessary, medical necessity: Health care services or supplies needed to prevent, diagnose or treat an illness or condition and that meet accepted standards of medicine.

Non-quantitative treatment limits (NQTL): Standards used to review treatment requests for type and duration of care that do not involve numbers of visits or days. NQTLS include prior approval, step therapy and other techniques to decide whether a service is medically necessary. Under the ACA, an NQTL must not limit mental health or addiction treatment more than medical or surgical care.

Quantitative treatment limits (QTL): Standards that limit the type or duration of benefits that involve a number of visits, days or costs. Examples include the number of visits or inpatient days, copays, coinsurance or annual dollar limits. Under the Patient Protection and Affordable Care Act (ACA), QTL must be no more restrictive for mental health or substance use care than for medical surgical care.

Self-insured/self-funded health plan: A health plan in which the employer assumes the financial risk for providing health care benefits to its employees.

Small group health plan: Employer-sponsored health insurance offered by an employer with 2 to 50 employees.

Step therapy, fail first: A type of prior approval in which the member must try and fail to respond to certain treatments that are less expensive, but effective for most people with a given condition, before they can “step” to a different treatment. For example, the plan may require a generic drug, then a less expensive brand-name drug from its formulary, before covering a similar, more expensive brand-name prescription drug.

Substantially all: If a type of cost requirement or treatment limit applies to substantially all medical/surgical benefits in a class, then that requirement or limit may apply to mental health or substance use disorder benefits if it is on par with two-thirds or more of the medical/surgical benefits for the same class of treatment.

Tier: A level of health coverage for a given type of care. For example, health plan members would pay more out of pocket costs for a prescription drug on tier 3 than for a medication on tier 1.

Utilization management (UM): Array of procedures used by insurers to evaluate whether requested care is medically necessary, efficient and in line with accepted medical practice. Examples of utilization management practices include prior authorization and step therapy.



Evaluation Presenter Name: _________________________________________ Date: ____________

Location of Presentation (City & State): __________________________________________

Your Name (optional, but preferred): ____________________________________________

1. Overall, my knowledge and skill level about health insurance parity is...


1 2 3 4 5 6 7 8 9 10 None Some Good Excellent


2. Overall, my level of confidence about asserting parity rights is...





4. How do you plan to use what you have learned in this training? What will you do differently?

5. What comments, if any, do you have about this training?

6. We seek to support the entire community. To help us track how we are doing,please check all that apply. I am:

American Indian or Alaska Native Asian American Black or African American Hispanic or Latino Native Hawaiian, Pacific Islander White or Caucasian Multiracial Other: _____________________

Mental Health

Substance Use

Person with condition Family caregiver of adult Parent/guardian of child or youth Service provider Peer provider Advocate Military, veteran or mil/vet family Other

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ed m

enta

l illn

ess

can

get p

eopl

e in

to tr

oubl

e w

ith th

e la

w. O

ur ja

ils a

re fi

lled

with

peo

ple

who

wou

ld n

ot b

e th

ere

if th

ey

had

the

care

they

nee

d.

La

stly

, with

out m

enta

l hea

lth c

are,

we

sacr

ifice

our

futu

re to

sui

cide

. Eve

ry

thirt

een

min

utes

, we

lose

one

life

to s

uici

de.

slid

e 6

30 s

ec.

Tot

al: 4

min

So

, w

ha

t can

yo

u d

o to c

ha

nge

th

is s

itua

tio

n?

Ta

lk to

yo

ur

legis

lato

r!

Le

gis

lato

rs r

esp

on

d b

est

to p

eop

le th

ey k

no

w w

ho

liv

e in

th

eir d

istr

ict.

Hun

dre

ds o

f b

ills lan

d o

n th

eir d

esk e

ve

ry s

essio

n,

so a

pe

rsona

l sto

ry f

rom

a

co

nstitu

en

t in

cre

ase

s th

e c

ha

nce t

ha

t th

ey w

ill ta

ke

actio

n.

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 3

© 2

013

NAM

I, In

c.

sl

ide

7 30

sec

.

To

tal:

4.5

min

Bui

ldin

g go

od re

latio

nshi

ps w

ith y

our l

egis

lato

rs is

impo

rtant

bec

ause

they

m

ake

key

deci

sion

s ab

out l

aws

& b

udge

ts th

at c

ontro

l who

can

get

wha

t typ

e of

car

e, fo

r how

long

and

at w

hat c

ost.

sl

ide

8 30

sec

.

To

tal:

5 m

in

So

your

per

sona

l exp

erie

nce,

if b

rief,

focu

sed

and

wel

l tol

d, w

ill su

ppor

t our

le

gis

lative

“a

sk”

wh

ich w

ill s

ave

liv

es a

nd

sa

ve

ta

xp

aye

r d

olla

rs.

sl

ide

9 1

min

Tot

al: 6

min

Now

le

t’s lo

ok a

t th

e v

alua

ble

role

you

can

pla

y as

gra

ssro

ots

advo

cate

s.

One

reas

on p

eo

ple

don

’t c

onta

ct th

eir le

gis

lato

r is

that

the

y d

on

’t th

ink

they

kn

ow e

noug

h. B

ut a

ccor

ding

to re

sear

ch, s

torie

s th

at h

elp

the

liste

ner s

tand

in

you

r sho

es a

re fa

r mor

e po

wer

ful t

han

fact

s an

d fig

ures

.

Any

lobb

yist

will

tell

you

that

real

sto

ries,

if b

rief a

nd s

ince

re, a

re

advo

cacy

gol

d. T

hey

are

one

of th

e su

rest

way

s to

gai

n su

ppor

t for

men

tal

heal

th c

are

and

brea

k th

e st

igm

a of

men

tal h

ealth

con

ditio

ns.

K

eep

thes

e th

ough

ts in

min

d:

1.

Your

sto

ry is

alw

ays

right

2.

Yo

ur li

ved

expe

rienc

e ha

s va

lue

and

mea

ning

3.

You

don

't ha

ve to

hav

e al

l the

ans

wer

s--ju

st a

cle

ar "

ask"

[Pau

se s

light

ly a

fter e

ach

of th

ese

stat

emen

ts to

let p

eopl

e pr

oces

s.]

If yo

u th

ink

abou

t it,

this

is v

ery

empo

wer

ing.

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 4

© 2

013

NAM

I, In

c.

slid

e 10

30

sec

To

tal:

6.5

min

Her

e ar

e fo

ur ti

ps fo

r tel

ling

a st

ory

that

will

mov

e yo

ur le

gisl

ator

...

The

first

tip

is to

kee

p yo

ur s

tory

brie

f. W

e liv

e in

a w

orld

of s

ound

bite

s an

d te

xt m

essa

ges,

and

legi

slat

ors

are

very

bus

y, s

o ai

m fo

r a m

inut

e or

two.

W

e al

l cou

ld te

ll vo

lum

es a

bout

wha

t has

hap

pene

d to

us,

but

, you

will

lose

yo

ur li

sten

ers

if yo

u gi

ve to

o m

uch

deta

il.

Thin

k ab

out a

mov

ie tr

aile

r—in

30

seco

nds

you

get t

he h

ighl

ight

s an

d w

ant t

o se

e m

ore.

Tha

t is

the

effe

ct y

ou w

ant t

o ac

hiev

e.

slid

e 11

30

sec

Tota

l: 7

min

We

men

tione

d th

at s

torie

s th

at e

voke

em

otio

n ar

e po

wer

ful.

Use

viv

id

lang

uage

to p

lace

the

liste

ner i

n yo

ur s

hoes

. Pai

nt a

pic

ture

of w

hat y

ou w

ent

thro

ugh,

wha

t hel

ped

and

wha

t life

is li

ke n

ow.

How

ever

, if y

our s

tory

cau

ses

you

to c

ry, i

t will

ove

rwhe

lm o

ther

s an

d th

ey

will

shu

t dow

n. B

ut if

you

r sto

ry b

rings

out

em

otio

n—w

ithou

t cau

sing

you

to

tear

up—

you

will

mov

e ot

hers

. If

yo

u f

ind y

ou

r sto

ry h

ittin

g t

oo

clo

se

to

ho

me, fo

cu

s o

n t

he

pa

rts that

don

’t

brin

g up

as

muc

h pa

in o

r use

lang

uage

that

allo

ws

you

to m

aint

ain

com

posu

re. T

he m

ore

you

prac

tice,

the

easi

er it

will

get

.

slid

e 12

30

sec

To

tal:

7.5

min

Ano

ther

tip

is to

use

pos

itive

con

cept

s lik

e ho

pe a

nd re

cove

ry, i

f pos

sibl

e.

If yo

ur s

tory

doe

sn't

have

a h

opef

ul a

spec

t--so

meo

ne o

r som

ethi

ng th

at

help

ed--t

hen

desc

ribe

wha

t wou

ld h

ave

help

ed o

r wha

t cou

ld h

elp

othe

rs.

Hop

e is

a p

ower

ful m

otiv

ator

for p

olic

y m

aker

s. B

ecau

se th

ey w

ant t

o in

vest

ta

xpay

er d

olla

rs e

ffect

ivel

y, th

ey n

eed

to k

now

that

reco

very

is a

real

po

ssib

ility.

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 5

© 2

013

NAM

I, In

c.

slid

e 13

30

sec

To

tal:

8 m

in

Last

, but

not

leas

t: M

ak

e a

n “

ask

” o

f you

r lis

tene

r. Th

is is

a c

ritic

al s

tep

that

m

any

advo

cate

s le

ave

out.

Than

k yo

ur li

sten

er fo

r hea

ring

your

sto

ry. T

hen,

pu

t the

m o

n th

e ho

ok b

y as

king

if y

ou c

an c

ount

on

them

to s

uppo

rt yo

ur

issu

e.

If y

ou

r lis

ten

er

an

sw

ers

with

a c

lea

r “y

es”,

th

an

k th

em

fo

r th

eir s

up

po

rt.

If

yo

ur

liste

ne

r a

nsw

ers

with

a c

lea

r “n

o”

or

a v

agu

e r

esp

on

se,

tha

nk t

hem

fo

r ta

kin

g t

he t

ime

to m

ee

t w

ith

yo

u a

nd

le

t th

em

kn

ow

yo

u’d

lik

e t

o s

erv

e a

s a

re

sour

ce o

n m

enta

l hea

lth.

Reg

ardl

ess

of th

e re

spon

se, p

lan

on fo

llow

ing

up o

ften

and

to p

olite

ly b

uild

a

rela

tions

hip.

Thi

s w

ill he

lp y

ou g

ently

shi

ft op

inio

ns o

r, in

the

case

of a

su

ppor

ter,

help

them

bec

ome

a le

gisl

ativ

e ch

ampi

on.

slid

e 14

3

min

T

otal

: 11

min

Now

we

’ll s

ho

w y

ou

ho

w t

he

se

tip

s c

an

be

use

d to

te

ll a

po

we

rfu

l sto

ry –

with

an

adv

ocac

y as

k - 2

min

utes

or l

ess.

[Nam

e] w

ill te

ll [h

is/h

er] s

tory

and

I w

ill tra

ck th

e tim

e ju

st to

pro

ve th

at it

can

be

done

. Th

e st

ory

is to

ld a

s if

[he/

she]

wer

e gi

ving

test

imon

y at

a le

gisl

ativ

e he

arin

g.

But

, thi

s ba

sic

form

at c

an b

e ea

sily

ada

pted

to fi

t oth

er s

ituat

ions

. A

s yo

u lis

ten,

kee

p an

ope

n m

ind.

Not

ice

your

reac

tions

, wha

t mov

es y

ou.

[C

o-te

ache

r] te

lls s

tory

with

the

men

tal h

ealth

bud

get a

sk.

[Tea

cher

kee

ps ti

me.

Tha

nks

spea

ker a

nd c

alls

for a

ppla

use.

] W

ha

t la

ng

uag

e m

oved

yo

u?

Wh

at

rea

lly

ca

ug

ht

yo

ur

att

en

tio

n?

[T

ake

one

resp

onse

.]

Han

dout

: Sa

mpl

e St

ory

slid

e 15

4

min

T

otal

: 15

min

Now

that

you

've

liste

ned

to th

e sa

mpl

e st

ory

and

notic

ed it

s im

pact

, loo

k at

th

e Se

ven

Step

s C

heck

list o

n pa

ge 2

, whi

ch s

how

the

parts

of a

brie

f, ef

fect

ive

stor

y. W

e're

goi

ng to

revi

ew th

ese

seve

n st

eps

now

. The

n, y

ou'll

use

them

to d

raft

your

ow

n st

ory.

[T

each

er re

view

s ch

eckl

ist,

refe

rring

to s

ampl

e st

ory.

]

Han

dout

: Se

ven

Step

s C

heck

list

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 6

© 2

013

NAM

I, In

c.

slid

e 16

17

min

T

otal

: 32

min

Now

you

're re

ady

to u

se y

our S

tory

Pra

ctic

e Sh

eet o

n pa

ges

3 an

d 4

to

star

t writ

ing

your

ow

n st

ory.

Fo

r hel

p, u

se y

our S

even

Ste

ps C

heck

list a

nd th

e sa

mpl

e st

ory.

Rem

embe

r, th

e be

st p

repa

ratio

n fo

r tel

ling

an e

ffect

ive

stor

y is

to k

no

w y

ou

r “a

sk

.”

Here

’s th

e s

ce

na

rio

: Y

ou

’re te

lling

you

r sto

ry to

urg

e yo

ur le

gisl

ator

to s

uppo

rt H

B 3

9 th

e m

enta

l hea

lth b

udge

t.

Yo

ur

“ask”

ca

n b

e t

he

sa

me a

s th

e s

am

ple

sto

ry o

r you

can

put

it in

you

r ow

n w

ords

. Yo

u'll

have

15

min

utes

to fi

ll ou

t you

r sto

ry p

ract

ice

shee

t. I’

ll le

t yo

u

know

whe

n yo

u ha

ve a

few

min

. lef

t to

finis

h up

. If

yo

u d

on

’t f

inis

h,

do

n’t w

orr

y;

this

is just

a p

ractice

and

yo

u c

an

fine

tune

it in

yo

ur o

wn

time.

Als

o,

if it’s e

asie

r, w

rite

in “

bu

llet

po

ints

” in

ste

ad o

f fu

ll se

nten

ces.

If

you

finis

h ea

rly, p

ract

ice

read

ing

your

sto

ry s

ilent

ly.

[C

ircul

ate

whi

le p

artic

ipan

ts a

re w

ritin

g. F

or th

ose

who

fini

sh e

arly

, ask

if

they

wou

ld le

t you

read

thei

r sto

ry. P

rais

e th

em fo

r the

stro

ng p

hras

es.]

W

arn

part

icip

ants

2 m

inut

e be

fore

tim

e is

up.

St

op p

artic

ipan

ts a

t 15

min

. If

you

didn

't fin

ish

your

sto

ry, f

eel f

ree

to fi

nish

in y

our o

wn

time.

W

ha

t d

id y

ou

le

arn

ab

ou

t w

riti

ng

yo

ur

sto

ry?

[Ta

ke o

ne re

spon

se.]

Han

dout

: St

ory

Prac

tice

Shee

t

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 7

© 2

013

NAM

I, In

c.

slid

e 17

10

min

T

otal

: 42

min

Yo

u h

ave

all

finis

he

d o

r h

ave

a g

oo

d s

tart

on

yo

ur

sto

ry.

No

w,

we

’ll p

ractice

shar

ing

them

and

giv

ing

cons

truct

ive

feed

back

. To

get

read

y, p

leas

e ha

ve y

our S

tory

Pra

ctic

e Sh

eet,

a no

te p

ad a

nd a

pe

ncil.

E

ach

of y

ou w

ill ha

ve a

cha

nce

to s

hare

you

r sto

ry w

ith a

par

tner

. You

will

try

to te

ll yo

ur s

tory

in tw

o m

inut

es o

r les

s.

The

othe

r per

son

will

keep

tim

e an

d st

op th

e st

oryt

elle

r at t

wo

min

utes

. W

hile

you

tim

e, a

lso

liste

n to

the

stor

y.

Not

ice

your

reac

tion

to th

e flo

w, w

ords

or p

hras

es th

at m

ove

you

and

area

s th

at c

ould

be

stre

ngth

ened

. If

you

like,

on

the

note

pad

jot d

own

wha

t cam

e ac

ross

as

stro

ng o

r sug

gest

ions

to m

ake

the

stor

y ev

en s

trong

er.

Afte

r the

sto

ryte

ller’s t

wo

min

ute

s a

re u

p, th

e lis

tene

r sho

uld

prov

ide

brie

f co

nstr

uctive fe

edba

ck. S

ay w

hat w

orke

d in

the

stor

y, a

nd h

ow it

cou

ld b

e im

prov

ed.

Rem

embe

r tha

t con

stru

ctiv

e fe

edba

ck s

houl

d he

lp y

ou s

ee w

hat i

s po

wer

ful

abou

t you

r sto

ry a

nd h

ow y

ou c

ould

mak

e it

even

bet

ter.

Ple

ase

turn

to y

our n

eigh

bor a

nd

le

t m

e k

no

w w

he

n y

ou

’re

re

ady

by

look

ing

at m

e.

[Wai

t unt

il ev

eryo

ne is

in a

pai

r.]

Yo

u’ll

ha

ve

ju

st

4 m

inute

s fo

r eac

h ro

und

for s

tory

tellin

g a

nd

feed

back

, so

use

your

tim

e w

isel

y. If

you

fini

sh e

arly

, tel

l you

r sto

ry a

gain

. St

op ro

und

1 af

ter 4

min

. It

’s tim

e t

o t

rade

ro

les a

nd

be

gin

with

an

oth

er

sto

ryte

ller

an

d fe

ed

back.

Stop

roun

d 2

afte

r 4 m

in.

Ho

w d

id t

ha

t g

o f

or

ev

ery

on

e?

W

ha

t d

id y

ou

le

arn

ab

ou

t te

llin

g y

ou

r s

tory

?

[Tak

e a

resp

onse

or t

wo]

Han

dout

: St

ory

Prac

tice

Shee

t Su

pplie

s:

Not

epad

s Pe

ncils

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 8

© 2

013

NAM

I, In

c.

sl

ide

18

30 s

ec.

Tota

l: 42

.5 m

in

Now

th

at

yo

u’v

e d

rafte

d yo

ur s

tory

, you

can

pol

ish

it up

and

use

it a

s a

foun

datio

n fo

r adv

ocac

y. A

nd, w

ith ju

st a

few

cha

nges

, you

can

targ

et y

our

stor

y to

diff

eren

t aud

ienc

es a

nd a

rang

e of

issu

es.

Your

sto

ry d

rives

the

poin

t hom

e by

hel

ping

the

legi

slat

or u

nder

stan

d w

hat i

t is

like

to li

ve w

ith a

men

tal h

ealth

con

ditio

n. M

ost i

mpo

rtant

, by

help

ing

an

elec

ted

offic

ial s

ee th

roug

h yo

ur e

yes,

you

r sto

ry b

uild

s a

rela

tions

hip.

A

nd

bu

ildin

g a

co

nne

ction

is f

ar

mo

re im

po

rtan

t th

an

po

we

rin

g t

hro

ugh

a

nu

mb

er

of

pe

op

le o

r po

ints

, b

ecau

se

a g

oo

d r

ela

tio

nsh

ip in

cre

ase

s th

e o

dd

s

tha

t th

e le

gis

lato

r w

ill a

ct

on

yo

ur

requ

ests

in

th

e fu

ture

.

sl

ide

19

1 m

in

To

tal:

43.5

min

How

eve

r, w

e w

ou

ld lik

e o

ur

mee

tin

gs t

o m

ake

as s

tron

g a

n im

pre

ssio

n a

s

po

ssib

le. T

hin

k a

bo

ut a

n e

ffe

ctive

me

etin

g y

ou

’ve

be

en

pa

rt o

f, e

spe

cia

lly

with

a le

gis

lato

r.

In o

ne

wo

rd, w

ho

ca

n d

es

cri

be

wh

at

he

lps

a m

ee

tin

g w

ork

?

Wh

at

ca

n lea

d t

o a

dis

ap

po

inti

ng

me

eti

ng

?

[Ta

ke

on

e r

esp

on

se

to

ea

ch

qu

estio

n. P

ara

phra

se

wh

at

yo

u h

ea

rd.]

G

rea

t re

sp

on

se

! T

ha

nk y

ou

. K

eep

th

ese t

ho

ugh

ts in m

ind

as w

e g

o t

hro

ugh

a

fe

w t

ips a

nd

to

ols

to

str

en

gth

en y

ou

r m

ee

tings.

sl

ide

20

30 s

ec

T

otal

: 44

min

Take

a lo

ok a

t you

r han

dout

, Mak

ing

Your

Cas

e. I

’ll g

o o

ve

r 4

tip

s n

ow

an

d

you

can

revi

ew th

e re

st in

you

r ow

n tim

e.

The

first

tip

is to

kno

w y

our i

ssue

. You

r pol

icym

aker

will

exp

ect y

ou to

be

mee

ting

with

him

or h

er a

bout

an

issu

e—no

t jus

t to

chat

. H

avin

g cl

arity

abo

ut y

our i

ssue

and

wha

t pos

ition

or a

ctio

n yo

u w

ant y

our

legi

slat

or to

take

is v

ital t

o an

effe

ctiv

e m

eetin

g.

Han

dout

: M

akin

g Yo

ur C

ase

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 9

© 2

013

NAM

I, In

c.

sl

ide

21

1 m

in

T

otal

: 45

min

A b

riefin

g sh

eet h

elp

you

orga

nize

the

basi

c in

form

atio

n on

pag

e [p

age]

.

Wha

t do

you

notic

e ab

out t

he s

ampl

e br

iefin

g sh

eet i

n yo

ur p

acke

t?

[Ta

ke

a c

ou

ple

of

respo

nse

s. P

ara

ph

rase

, th

en

wa

lk th

rou

gh

th

e b

riefing

sh

ee

t.]

We’v

e p

rovid

ed

a b

lank

form

for y

ou to

use

in fu

ture

mee

tings

with

legi

slat

ors

or p

olic

ymak

ers.

Han

dout

: B

riefin

g Sh

eet

sl

ide

22

30 s

ec

Tot

al:4

5.5

min

The

seco

nd ti

p is

to k

now

you

r pol

icym

aker

. Yo

u c

an b

uild

a s

tron

ge

r co

nne

ctio

n (

an

d a

mo

re t

arg

ete

d m

essa

ge

) by k

no

win

g a

nd

un

de

rsta

nd

ing

yo

ur

ele

cte

d o

ffic

ial.

K

no

win

g y

ou

r p

olic

ym

ake

r ca

n h

elp

yo

u c

hoo

se

wh

at

yo

u s

ay a

nd

ho

w y

ou

sa

y it—

an

d m

ay h

elp

yo

u c

ho

ose w

ho

to

bring t

o a

le

gis

lative

vis

it.

Han

dout

M

akin

g Yo

ur C

ase

sl

ide

23

1 m

in

T

otal

: 46

min

We’v

e p

rovid

ed

an

oth

er

too

l, c

alle

d a

Back

gro

un

de

r to

he

lp y

ou

re

se

arc

h

yo

ur

legis

lato

r. A

sim

ple

we

b-s

ea

rch o

n t

he

legis

lato

r’s n

am

e w

ill b

rin

g u

p th

e

info

rma

tio

n y

ou

nee

d. T

he

n y

ou

ca

n ju

st

copy a

nd

pa

ste

into

th

e s

he

et

like

w

e h

ave

do

ne

in

th

is s

am

ple

.

What do

yo

u n

otice

abo

ut

the

ba

ckgro

und

er

tha

t w

ou

ld h

elp

yo

u d

uring t

he

m

eetin

g?

[T

ake

on

e r

esp

on

se

. P

ara

ph

rase

, th

en w

alk

th

rou

gh

the

ba

ckgro

und

er.]

A

nd

aga

in,

the

re is a

te

mp

late

fo

r yo

u t

o u

se.

Han

dout

: B

ackg

roun

der

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

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crip

t Pa

ge 1

0

© 2

013

NAM

I, In

c.

slid

e 24

30

sec

To

tal:

46.5

min

The

th

ird t

ip is to

pla

n y

ou

r vis

it.

Mee

ting

with

you

r pol

icym

aker

can

be

intim

idat

ing.

Pla

nnin

g w

ill h

elp

you

feel

mor

e co

nfid

ent.

Ther

e is

ano

ther

reas

on to

pla

n. Y

ou m

ay fi

nd y

ours

elf i

n a

grou

p m

eetin

g w

ith a

pol

icym

aker

. The

mor

e pe

ople

in a

gro

up, t

he m

ore

com

plic

ated

the

“flo

w”

an

d th

e g

rea

ter

the

cha

nce o

f p

eo

ple

go

ing “

off

me

ssa

ge

.”

Fortu

nate

ly, t

he s

olut

ion

is s

impl

e. P

repa

re.

Han

dout

: M

akin

g Yo

ur C

ase

sl

ide

25

1 m

in

Tot

al: 4

7.5

min

Take

a lo

ok a

t the

Mee

ting

Rol

es h

ando

ut in

you

r pac

ket.

Ther

e ar

e th

ree

basi

c ro

les

to k

eep

in m

ind.

1.

The

lead

sta

rts th

e co

nver

satio

n, m

akes

the

ask

and

clos

es th

e m

eetin

g on

a p

ositi

ve n

ote.

2.

The

mes

seng

er la

ys o

ut fa

cts

and

talk

ing

poin

ts to

sup

port

the

ask.

3.

The

sto

ryte

ller b

rings

the

issu

e ‘o

ff th

e pa

ge’ b

y re

latin

g pe

rson

al

expe

rienc

e to

the

issu

e.

If yo

u ar

e v

isitin

g a

le

gis

lato

r b

y y

ou

rself, yo

u’ll

ta

ke

all

thre

e r

ole

s.

Goi

ng to

a

mee

ting

as a

pai

r is

effe

ctiv

e be

caus

e th

e le

gisl

ator

form

s th

e th

ird le

g of

a

“tr

ian

gle

” w

hic

h e

ncou

rage

s pr

oduc

tive

dial

ogue

. In

that

cas

e, o

ne p

erso

n m

ay ta

ke th

e le

ad a

nd th

e m

esse

nger

role

whi

le th

e ot

her i

s th

e st

oryt

elle

r.

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rger

gro

up c

an m

ake

a st

rong

imp

ressio

n,

bu

t it’s

im

po

rtan

t to

hav

e on

e le

ad, t

o id

en

tify

oth

er

role

s in a

dva

nce

an

d t

o r

em

em

be

r th

at

it isn

’t

nece

ssar

y fo

r eve

ryon

e to

spe

ak.

Han

dout

: M

eetin

g R

oles

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 1

1

© 2

013

NAM

I, In

c.

slid

e 26

30

sec

T

otal

: 48

min

Her

e's

our l

ast t

ip:

Mak

e a

n “

ask

” o

f you

r lis

tene

r. If

you

are

talk

ing

to a

le

gisl

ator

, let

them

kno

w w

hat w

ould

hel

p ot

hers

(suc

h as

the

Cen

ters

for

Exc

elle

nce)

and

then

, ask

them

if y

ou c

an c

ount

on

thei

r sup

port.

Th

is p

uts

them

on

the

hook

by

aski

ng th

em fo

r a c

omm

itmen

t. Th

is w

ill te

ll yo

u a

lot.

If th

ey c

omm

it, y

ou h

ave

a su

ppor

ter.

If th

ey s

ay n

o or

they

are

no

ncom

mitt

al, y

ou k

now

whe

re th

ey s

tand

and

that

you

nee

d to

follo

w u

p an

d nu

rture

the

rela

tions

hip

to b

uild

sup

port.

D

on

’t t

ake

a n

ega

tive

or

no

ncom

mitta

l re

sp

onse

per

sona

lly. Y

our l

egis

lato

r m

ay b

e un

der p

ress

ure

to ta

ke a

par

ticul

ar p

ositi

on o

n yo

ur is

sue

or m

ay b

e be

ing

caut

ious

. Tak

e it

in s

tride

and

wor

k to

bui

ld a

pos

itive

rela

tions

hip.

Han

dout

: M

akin

g Yo

ur C

ase

slid

e 27

6

min

T

otal

: 54

min

To h

elp

you

see

how

thes

e tip

s an

d to

ols

wor

k,

we

’re

go

ing t

o d

em

on

str

ate

a

mee

ting

with

a p

olic

ymak

er a

nd tw

o co

nstit

uent

s. I

’ll p

lay th

e S

enat

or

whi

le [N

ame]

and

[Nam

e] w

ill b

e co

nstit

uent

s.

Whi

le y

ou li

sten

, not

ice

the

role

s th

e tw

o co

nstit

uent

s pl

ay a

nd w

here

you

he

ar o

ur ti

ps in

act

ion.

Als

o lis

ten

for f

acts

and

a s

tory

hig

hlig

ht.

D

emon

stra

te a

mee

ting

usin

g M

eetin

g yo

ur L

egis

lato

r dem

o sc

ript.

[Pre

p: a

rran

ge 2

hel

pers

. Ask

them

to re

ad th

roug

h th

e sc

ript a

head

of

time]

D

id y

ou

no

tic

e h

ow

mu

ch

wa

s c

on

ve

ye

d in

ju

st

a f

ew

sh

ort

min

ute

s?

W

ha

t d

id y

ou

no

tic

e a

bo

ut

the r

ole

s p

eo

ple

pla

ye

d a

nd

th

e f

low

?

[Tak

e a

resp

onse

] D

id y

ou

no

tic

e t

he

po

lic

ym

ak

er

sp

inn

ing

th

e c

on

vers

ati

on

in

a d

iffe

ren

t d

ire

cti

on

? W

ha

t d

id y

ou

no

te a

bo

ut

the r

esp

on

se

?

[Tak

e a

resp

onse

]

Fact

she

et in

brig

ht

gree

n fo

lder

3

copi

es o

f Dem

o:

Mee

ting

Your

Po

licym

aker

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

e Sc

ript

Prep

/han

dout

s R

ev. M

ar. 2

017

NA

MI S

mar

ts fo

r Adv

ocac

y: T

each

er S

crip

t Pa

ge 1

2

© 2

013

NAM

I, In

c.

sl

ide

28

7 m

in

Tota

l: 61

min

Turn

to th

e M

eetin

g Yo

ur L

egis

lato

r Che

cklis

t on

page

13.

This

han

dout

br

eaks

dow

n th

e st

eps

of m

eetin

g a

polic

ymak

er.

Not

ice

that

the

chec

klis

t has

thre

e pa

rts:

Sta

ge 1

: Mak

e a

Con

nect

ion,

S

tage

2: D

eliv

er y

our M

essa

ge,

Sta

ge 3

: Clo

se o

n a

Posi

tive

Not

e [W

alk

thro

ugh

the

poin

ts in

eac

h se

ctio

n]

Alw

ays

rem

embe

r to

se

nd

a th

an

k y

ou

no

te o

r e

ma

il aft

er

yo

ur

me

etin

g.

It’s

no

t onl

y po

lite,

but

it w

ill le

ave

a po

sitiv

e im

pres

sion

and

giv

e yo

u an

othe

r ch

ance

to m

ake

your

ask

. Th

ere

is a

sim

ple

than

k-yo

u w

orks

heet

in y

our

hand

outs

.

Han

dout

: M

eetin

g Yo

ur

Legi

slat

or C

heck

list

slid

e 29

1.

5 m

in

Tot

al: 6

2.5

min

Wh

at

did

yo

u t

ak

e a

wa

y f

rom

th

is e

xp

eri

en

ce

to

day

?

Wh

at

do

es

th

is c

ha

ng

e f

or

yo

u?

W

he

re d

o y

ou

pla

n t

o u

se

yo

ur

sto

ry?

[T

ake

a co

uple

of q

uick

resp

onse

s]

Than

k yo

u al

l for

taki

ng th

e tim

e to

bui

ld y

our a

dvoc

acy

skills

. Giv

e yo

urse

lves

a ro

und

of a

ppla

use.

slid

e 30

30

sec

To

tal:

63 m

in

Th

is w

ork

sho

p is p

art

of

NA

MI

Sm

art

s fo

r A

dvo

ca

cy,

NA

MI’s g

rassro

ots

skill

b

uild

ing p

rogra

m. If

you

’d lik

e to

kn

ow

mo

re a

bo

ut th

e p

rogra

m, see

me

aft

er

the

wor

ksho

p.

Adv

ocac

y D

ay: C

hang

ing

Hea

rts

& M

inds

Slid

e/tim

eSc

ript

Prep

/han

dout

s

Rev

. Mar

. 201

7N

AM

I Sm

arts

for A

dvoc

acy:

Tea

cher

Scr

ipt

Page

13

© 2

013

NAM

I, In

c.

slid

e 31

2 m

inTo

tal:

65 m

in

Bef

ore

you

go, p

leas

e ta

ke a

min

ute

to c

ompl

ete

your

eva

luat

ion.

We

look

at

thes

e cl

osel

y be

caus

e w

e al

way

s se

ek to

impr

ove

the

prog

ram

.

And

no

w I

’ll tu

rn it

ove

r to

[mod

erat

or].

Han

dout

:Ev

alua

tion

form

Demo: Meeting Your Policymaker(Two Constituents)

Meeting Stage 1: Make a connection

Introductions

Senator Walker: “Good morning, everyone. Thank you for coming.”

John (Lead): (shakes hand) “Hello, Senator. I’m John Adams from Spring Valley. We’re members of NAMI Springville, part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.

We really appreciate your taking the time to meet with us—we know you’re very busy.”

Jenny (Storyteller): (shakes hand) "It's a pleasure to meet you, Senator. I'm Jenny Jonesfrom Springville."

Senator Walker: “It's a pleasure to have you here. I know NAMI; you’ve always done a great job bringing up mental health issues."

Show appreciation

John (Lead): "Senator Walker, before we talk about some important issues affecting yourconstituents who live with mental illness, we'd like you to know that we appreciate yourmany years of service in our legislature."

Senator Walker: “Thank you, I've spent twelve years in public office, now."

Jenny (Storyteller): "We also appreciate that, as a doctor, you value the health of yourconstituents and have provided important leadership on the Medicaid Health Plan andhealth care issues in our state."

Senator Walker: "Well, I’ve seen too many people in emergency rooms with issues thatcould have been prevented for pennies, including a lot of people who needed mentalhealth care.”

Issue and position

John (Lead): "I’m glad you mentioned that, Senator. We’re here because we want to urge you to support mental health services in HB 39, the mental health budget.”

Rev Dec 2016 NAMI Smarts for Advocacy: Meeting Your Policymaker Module 3 Page 2 © 2013 NAMI, Inc.

Meeting Stage 2: Deliver your message

The need or problem John (Lead): “More families than ever are seeking help from our mental health centers. But with budget cuts, people can’t get the mental health services they need.” Senator Walker: “I’ve always been a supporter of mental health; I was a co-sponsor on NAMI’s parity bill. But, it‘s going to be an extremely tight budget this year. There are serious revenue shortfalls and we’re still figuring out where we can find savings. We’ve got to get spending under control.” Talking points

John (Lead): “We understand, Senator. It’s going to be challenging, but the people of our state deserve the opportunity to be productive and healthy. To have that opportunity, they need access to mental health care. Also, if we don’t protect mental health services, it’s going to cost us more in other places. When our children can’t get help for mental health conditions, they fall behind in school and families struggle. When adults can’t get treatment, costs shift to jails, emergency rooms and hospitals.” Senator Walker: “Isn’t that the truth. Like that kid involved in that police shooting—they’re saying he has a mental illness. I can’t believe those parents of his didn’t do something before a tragedy happened.” Story

Jenny (Storyteller): “Yes, there’s a lot of speculation around that. I just wish the media would talk about stories of recovery, like mine, instead of focusing on sensational news. I’m here because my life is affected by mental illness. My son, Andy, lives with bipolar disorder and I can tell you that treatment can make the difference between despair and recovery. Today, Andy’s living on his own, working as an artist and making me proud. I never thought I'd see him experience this kind of recovery. But, it wasn’t always that way. Before he got the treatment he needs, I saw him in the back of police cars and held him in my arms after a suicide attempt. No child should have to go through this." Senator Walker: “I really appreciate your story, Jenny, and I’m so happy to hear your son is doing well. Is Andy showing his art anywhere?” Talking points

Jenny (Storyteller): “Yes, a gallery is representing him. But, what I’m worried about is that there are thousands of others in our state just like my son, except most don’t get the help they need.

Rev Dec 2016 NAMI Smarts for Advocacy: Meeting Your Policymaker Module 3 Page 3 © 2013 NAMI, Inc.

More than one in ten youth and about one in seventeen adults lives with a serious mental illness, so it’s more common than most people think. Many of our returning service men and women are experiencing mental illness, too.” What will help others

Jenny (Storyteller): “We need more mental health services, not fewer. It’s an investment in health and productivity. If people can get the right care at the right time, they can be successful, like my son." The “ask”

John (Lead): “The people of our state need your vote to protect mental health care. Can we count on your support of HB 39, Senator?” Senator Walker (standing): “You’ve both made some excellent points and I’ll keep them in mind. I know how important mental health services are and I’ll think about this as we’re working on the budget.”

Meeting Stage 3: Close on a positive note

Say thank you John (Lead): (shakes hand) “Thank you so much, Senator Walker. We appreciate you taking the time to hear about our issues.” Provide information

Jenny (Storyteller): "Thank you for meeting with us, Senator. We know your time is limited, so we'd like to leave you with this packet that contains a fact sheet and NAMI's other legislative priorities. We hope we can count on your support for them." Offer to be a resource

John (Lead): “Please know that we'd welcome the opportunity to be a resource to you in the future. We’d also like to follow up and see how you intend to vote on our issues.” Senator Walker: "Certainly. Please give my staff your contact information before you leave so they can get hold of you.” Make a request

Jenny (Storyteller): (shakes hand) "Thank you, Senator. If you have time, we would be honored if you would have your picture taken with us for our newsletter.” Senator Walker: "I think I can take a moment for a picture. And please tell Andy "hello" for me, will you?" Jenny (Storyteller): "Of course, Senator. Thank you. That will make his day."

Insert Tab: Advocacy Day Worksheets

NAMI Smarts for Advocacy Advocacy Day: Changing Hearts & Minds

Rev. March 2017 NAMI Smarts for Advocacy: Hearts & Minds Page 1© 2013 NAMI, Inc.

Sample Family Member Story1. My introduction

Hello, I’m Jenny Jones from Springville. I’m a member of NAMI Springville, part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.

I’m also the proud mother of a 23-year-old son who lives with bipolar disorder. I’d like toshare my story with you and ask for your support of mental health services.

2. What happenedWhen my son was still a toddler, I had a thought that no mother should have: I wondered ifmy beautiful boy would be in juvenile detention on his 16th birthday. He just did notrespond the way other children did to requests, to routines, to daily life and love.

As he grew, we never knew what would be broken, who might be hurt or when it wouldhappen.

3. What helpedIn fifth grade, my son's teacher said, "Jenny, honey, I've taught hundreds and hundreds ofkids. I know when a boy is misbehaving and I know when something is wrong. Andsomething is wrong. You just keep looking for help."

When Andy was finally diagnosed with bipolar disorder, our lives changed. With treatment,he started smiling, enjoying school and making friends.

4. How I'm different todayOn his sixteenth birthday, Andy wasn't in juvenile detention; he was creating art. Today,he’s enjoying life, working hard and making me proud.

5. What is the need orproblem

My son is proof that treatment works. But, not everyone gets the help they need.

6. What will help othersA strong mental health system will help children and adults get the right care at the righttime.

7. My "ask"Thank you for meeting with me and listening to my story. Can I count on you to protectmental health services—and give families the hope of recovery?

Rev. March 2017 NAMI Smarts for Advocacy: Hearts & Minds Page 2 © 2013 NAMI, Inc.

Seven Steps Telling Your Story Checklist The following seven steps will help you craft a brief and powerful story.

1. Introduce yourself

Give your name and city or town. Include your organization. Describe yourself as “a member of NAMI [State Org or NAMI Affiliate], part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.”

Share how you are affected by mental illness. Are you living with mental illness, a family member, a caregiver? This brings a "real face" to mental illness.

State your issue and position. Let your listener know what you want them to support or oppose (or do). This helps your listener focus.

2. What happened?

What happened before you received the help you needed? Keep this brief--think about the most important thing you’d like your listener to know.

3. What helped?

Describe what helped in your recovery (or would have helped). This adds a hopeful tone and helps show the value of services and supports.

4. How are you different today?

Share what is going right in your life or how you are experiencing recovery. This concludes your personal story on a positive note that inspires.

5. What is the need or problem?

Mention the problem or need you want addressed. Transition to the challenge(s) faced by people living with mental illness.

6. What will help others?

Talk about what will help. Let your listener know what will address the need or problem you described.

7. Make your "ask"

Ask your legislator if you can count on their support (or opposition). Include a bill number, if possible. Thank your legislator for his or her time.


Story Practice Sheet

1. Introduction

Include your name and city. Describe yourself as a member of NAMI [State or Affiliate], part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness. Add how you are affected by mental illness, your issue and position.

2. What happened Aim for 3-9 sentences. Briefly describe the most important and compelling thing(s) about your situation.

3. What helped

Aim for 1-5 sentences. Briefly describe what helped in your recovery (or what would have helped). Aim for a hopeful tone that helps show what is helpful.



Aim for 1-3 sentences. Share what is going right in your life or how you are experiencing recovery. This concludes your personal story on a positive note that inspires.

5. The need or problem

Aim for 1-2 sentences. Transition to the challenge(s) faced by people living with mental illness that you want addressed.

6. What will help others

Aim for 1-2 sentences. Talk about what will help. Let your legislator know what will address the need or problem you described.

7. My "ask"

Aim for 1-2 sentences. Thank your legislator for listening to you. Then, ask your legislator for a commitment. Be specific.


Making Your Case: Tips for Legislative Advocacy

Prep for success

✓ Know your issue. Identify your issue, describe the problem, talking points, your story, the solution and your “ask.” Use a briefing sheet to stay organized.

✓ Know your legislator. Research your legislators online. Read their bios. Find out what committees they are on, their interests and any action on your issues. Use a backgrounder to note important details.

✓ Plan your meeting. If meeting as part of a group, identify roles and coordinate what you will say. A group of two is often the most effective. Use the Meeting Roles worksheet as a guide.

✓ Dress respectfully. Business or business casual is best; no jeans, no revealing clothing. T-shirts are fine if part of an advocacy campaign.

✓ Be Prompt. Legislators are busy. Arrive a few minutes before the appointed time. Be prepared to wait. Committee hearings or meetings may run overtime.

During the meeting

✓ Speak respectfully. Address the legislator by their title and last name: Senator or Representative [last name]. Don’t argue. Respond politely, even to uninformed or stigmatizing comments.

✓ Be truthful. If you don’t know the answer to a question, say so. Offer to find the information, then contact your NAMI office if you need help.

✓ Manage spin. Don’t get caught up in side issues. Practice bringing the focus back to where it belongs—on people living with mental health conditions.

✓ Expect resistance. Practice positive responses to challenging comments and questions. Use facts to support your statements, if possible.

✓ Make an Ask. Ask your legislator whether you can count on their support (or opposition). Include a bill number, if possible.

Follow up

✓ Send a thank you note. A brief thank you note or email is not only polite, it will leave a positive impression and allows you to repeat your ask.

✓ Check back regarding position. Write, call or email a polite inquiry a week or two after your meeting.

✓ If needed: Follow through on a request. If the legislator asks for more information, follow up immediately. Ask NAMI for help if you need it.


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Rev March 2017 NAMI Smarts for Advocacy: Hearts & Minds Page 13© 2013 NAMI, Inc.

Meeting Your Legislator ChecklistStage 1: Make a connection

✓ Address your legislator by their elected title. Add their last name, if you like.

✓ Give your name and city or town.✓ Include your organization. We encourage you to describe yourself as “a

member of NAMI [State Org or Affiliate], part of America’s largest grassroots mental health organization, the National Alliance on Mental Illness.”

✓ Thank your legislator for his/her time. Mention something positive he or shehas done or touch on a shared interest or connection.

✓ Describe the issue. State the position or action you want your legislator to take.

Stage 2: Deliver your message

✓ State the problem or need you want addressed. Transition to thechallenge(s) faced by people living with mental health conditions.

✓ Add talking points. Talk briefly about the issue and/or why the bill is needed.

✓ Describe what will help others. Let your legislator know what will help addressthe need or problem you described.

✓ Ask your legislator for their support (or opposition). Be specific about theaction or position you want them to take. Include a bill number, if possible.

✓ Describe your next issue. Repeat the process.

Stage 3: Close on a positive note

✓ Thank your legislator. Let your legislator know you appreciate their time andattention.

✓ Optional: Provide written information. Leave a fact sheet, legislative packetor summary of your issue(s) or bill(s). Ask for support on your other issues, ifapplicable. Include information on your organization and its programs.

✓ Optional: Offer to help. Tell your legislator that you are willing to serve as aresource on mental health issues.

✓ Request a picture or extend an invitation. Ask your legislator to pose for agroup photo or ask him/her to visit a local program or event, like the NAMI Walk.


EvaluationNAMI Smarts: Changing Hearts & MindsPresenter Name: _________________________________________ Date: ____________

Location of Presentation (City & State): __________________________________________

Your Name (optional, but preferred): ____________________________________________

1. Overall, my knowledge and skill level about advocacy is...


1 2 3 4 5 6 7 8 9 10None Some Good Excellent


2. Overall, my level of confidence about advocacy is...





4. How do you plan to use what you have learned in this training? What will you do differently?

5. What comments, if any, do you have about this training?

6. We seek to support the entire community. To help us track how we are doing,please check all that apply. I am:

American Indian or Alaska Native Asian American Black or African American Hispanic or Latino Native Hawaiian, Pacific Islander White or Caucasian Multiracial Other: _____________________

Mental Health

Substance Use

Person with condition

Family caregiver of adult

Parent/guardian of child or youth

Service provider

Peer provider

Advocate

Military, veteran or mil/vet family

Other

nami smarts for...mi smarts for advocacy workshop, medication: protecting choice, part of nami’s...

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