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NASMHPD Meet-Me Call WebinarDecember 21, 2017
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Moving Upstream in a Coordinated Care Organization:
Incorporating ACEs
Maggie Bennington-Davis, MD MMMHealth Share of Oregon
www.healthshareoregon.org
Healthy, productive
adult
Pregnancy
3 yo
Birth
5 yo
6-12 yo
12-21 yo
21 yo +
Wanted Pregnancy
Healthy Mom / Child
Strong Attachments
Ready for kindergarten
Academic Success
Positive Relationships
Healthy Lifestyle
Our Goal: A healthy, productive next generation of Oregonians
Pregnancy
3 yo
Birth
5 yo
6-12 yo
12-21 yo
21 yo +
Chronic illness, Substance use, Mental illness,
Criminality, Isolation,Disability
Parents not able / ready to “parent”
Poor Attachment
KindergartenSchool Failure
Risk Behaviors
Adult violence,
SUD
From Story to Strategy• If early life adversity can lead to the worse
adult health outcomes…• What can health care do?• Where do we start?
Behavioral Problems
Skill Deficits
Social Deprivation
Substance Use Unhealthy
Relationships
Housing Insecurity
Job Insecurity
Unintended pregnancy
Abuse Neglect
Beyond ACEs: Chain Reactions of Adversity
Age 476 children age 15-32No GED/diploma, no employmentIn recovery from severe substance useChronic pain, cancer, multiple surgeries, no teeth or denturesMultiple psychiatric medications
Suicide attempt
Miranda
What we learned from the life stories…
Beyond ACEs: Chain Reactions of Adversity
birth 15 yo 18 yo 21 yo 27 yo
Age 476 children age 15-32No GED/diploma, no employmentIn recovery from severe substance useChronic pain, cancer, multiple surgeries, no teeth or denturesMultiple psychiatric medications
5 yo 11 yo 47 yo
Tumultuous, violent
relationship between parents, unstable housing
Parents split, dad got “left behind”
Lived with multiple
caretakers in various locations
Moves back in with mom, daily sexual abuse from stepfather
First pregnancy/birth,
stepbrother is father
3 children, still living in
abusive household
Begins heavy drug use and selling
Goes to prison on drug charges
Suicide attempt Heavy alcohol
use, drug relapses, cancer, car accidents
Goes to prison on drug charges
3 more children born
Miranda
Drops out of school
What we learned from the life stories…
What We Found: Hard Lives• Overall Health Share Members
– 43% had 4+ Adverse Childhood Experiences (National Average: 14%)• Highest (40+%): Physical abuse / neglect, household substance abuse,
parental divorce• Only 20% reported NO ACEs; national average = 41%
– Over half reported they struggled with school; 27% did not graduate High School or get a GED
– 33% ran away from home– 39% reported substance abuse; 28% in childhood– 41% were homeless at sometime; 22% homeless in childhood– 40% struggled to find work– 56% reported verbal abuse by a loved one; 26%, physically abused– 36% had been in jail
7
Pregnancy
3 yo
Birth
5 yo
6-12 yo
12-21 yo
21 yo +
Chronic illness, Substance use, Mental illness,
Criminality, Isolation,Disability
Parents not able / ready to “parent”
Poor Attachment
KindergartenSchool Failure
Risk Behaviors
Adult violence,
SUD
From Story to Strategy• If early life adversity can lead to the worse
adult health outcomes…• What can health care do?• Where do we start?
Behavioral Problems
Skill Deficits
Social Deprivation
Substance Use Unhealthy
Relationships
Housing Insecurity
Job Insecurity
Unintended pregnancy
Abuse Neglect
Healthy, productive
adult
Pregnancy
3 yo
Birth
5 yo
6-12 yo
12-21 yo
21 yo +
Wanted Pregnancy
Healthy Mom / Child
Strong Attachments
Ready for kindergarten
Academic Success
Positive Relationships
Healthy Lifestyle
Our Goal: A healthy, productive next generation of Oregonians
“Ready and Resilient”• How do we better address behavioral health needs?
– Early identification of families / children at risk• Access to and education about contraception• Screening and referrals for social determinants of health• Developmental Screening and Kindergarten Readiness with Early
Learning Hubs, using community health workers and family peers• Special focus on those at highest risk: children in foster care; children
born to substance users– Creating a recovery oriented system of care for substance use
disorders• System redesign balanced toward culturally specific peer services• Peer “in reach” to mental health, jails, primary care, needle exchange• Expansion of Medication Assisted Treatment in primary care,
maternity care, and mental health
– Address equity and disparities through culturally specific efforts and tactics
Health Share Strategic Planning …
Maggie Bennington-Davis, MDChief Medical Officer
Health Share of [email protected]
http://www.healthshareoregon.org/
Wraparound with Intensive Services (WISe)
Consistent screening and assessment, and comprehensive behavioral health services and supports to Medicaid-eligible individuals, up to 21 years of age, who have complex behavioral needs—youth and their families are served.
Required Elements of WISe:
– Intensive Care Coordination
– Intensive Services provided in Home and Community Settings
– Mobile Crisis Intervention and Stabilization Services
More about WISeWISe offers a higher level of care than traditional mental health services through these core components:
• The time and location of services: WISe is not office-based. Services are provided in locations and at times that work best for the youth and family, such as in the family home and on evenings and weekends.
• Team-based approach: Using a Wraparound model, WISe relies on an entire team to meet the youth and family’s needs. Intensive care coordination between all partners and team members is essential in achieving positive outcomes.
• Help during a crisis: Youth and families have access to crisis services any time of the day, 365 days a year. Youth receive services from an individual who is familiar with the family and their individualized crisis plan.
WISe Works!We use data from the Child, Adolescent Needs and Strengths tool (CANS) over time to show how we are doing.
Data source: Behavioral Health Assessment System (BHAS). WISe quarterly report available at https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Mental%20Health/CANSQMPReport.html
Carla Reyes, Assistant Secretary Washington State Behavioral Health Administration [email protected](360) 725-2260
For more information on WISe:
Tina Burrell, Child Youth and Family Behavioral Health Administrator Division of Behavioral Health and [email protected](360) 725-3796
National Association of Mental Health Program Directors
Royce BowlinBehavioral Health Director
December 21, 2017
Moving UpstreamExamples of Oregon’s Work
What is Parent Child InteractionTherapy?• Children 2-7 years old
• Significant social-emotional & behavioral problems
• Moment-by-moment coaching of parent
• Objective mastery criteria for treatment completion
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PCIT Program Development
• Two or more QMHP certified or actively receiving on-going training & consultation in PCIT.
• Administrative support for high fidelity PCIT implementation .
• On-going PCIT consultation & training.
• Data collection & out come tracking.
• Clients 2-7 years & their families in need of PCIT services.
• Therapy room which has been modified to support fidelity PCIT.
• Coaching & recording equipment.
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Children served in PCIT July 1st through December 31st, 2017
• 1,617* children served in PCIT • Data includes:
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PCIT Status Percent
Left PCIT < 4 sessions/<30 days 16.5%
Received PCIT- now closed 60.6%
Still receiving PCIT 22.9%
*(data which was entered incorrectly by provider was not included in analysis)
Outcomes ( 4 or more sessions/ 30+ days)
• 85% percent of Caregiver-Child Pairs demonstrate improvement in one or more of these areas:– Caregiver-Child Relationship– Positive Communication Skills– Child Behavioral scores on the Eyberg Child Behavior Inventory (ECBI)
• 26% meet research criteria for treatment completion 12- 20 sessions typical length of treatment
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Received PCIT 30 or more Days or 4 or more sessionsPre & Post Treatment Average Eyberg Child Behavioral
Intensity Scores
Left Treatment Before Meeting Completion Criteria Treatment Completed
22
Goal
PCIT Works Quickly!• Client is a 6 year old Mexican-American boy. Pre-treatment
Behavior Intensity score was 10 points above the age-typical range• Post Treatment Behavior Intensity score was well within the age
typical range. This was a 17 point drop in the intensity of problem behaviors within 7 sessions, plus some consultation to the school by therapist.
• Unable to participate in school due to Anxiety.• Through PCIT, the client’s anxiety decreased & his self-esteem &
confidence increased. His mother reported that the client is now able to go through the school day.
• The funding for this program has allowed for a clinician to be trained & provide the intervention in Spanish to this family.
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For more information about PCIT please contact:
Laurie Theodorou, LCSWEarly Childhood Mental Health Policy
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Other Upstream Interventions
The Good Behavior Game is a BP intervention in elementary schools that has been proven to reduce downstream physical & BH concerns, including suicides. • Teachers use pro-social classroom management techniques that reduce teacher stress &
increase the time spent actually teaching.• Teaches students how to work toward valued goals, & teaches them how to cooperate with
each other to reach those goals. • Students learn how to self-regulate during both learning & fun. • Students learn how to delay gratification for a bigger goal. And, the Game protects students
against lifetime mental, emotional, behavioral, & related physical illnesses for their futures.
25
Other Upstream InterventionsSources of Strength is a best practice youth-led resiliency program for middle school & high schools. • Youth school projects include positive social relationships with peers,
families & other adults. • Increasing access to medical care also is a focus. • The program uses positive peer social networks to avert unhealthy
norms & culture, & to reduce suicides by increasing help-seeking behaviors.
• This upstream model strengthens multiple sources of support (protective factors) around young individuals so that when times get hard they have strengths to rely on.
• This upstream model strengthens multiple sources of support (protective factors) around young individuals so that when times get hard they have strengths to rely on.
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For more information about these programs contact:
Ann D. Kirkwood, MASuicide Intervention Coordinator
27
Thank You!
28
Washington UpdateDecember 21, 2017
Stuart Yael Gordon, J.D., Director of Policy & Communications Christy Malik, M.S.W., Senior Policy Associate
Aaron J. Walker, M.P.A., Senior Policy Associate
NASMHPD Meet Me Call
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
FY 2018 Funding and Continued Funding for CHIP
Current FY 2018 Continuing Resolution (C.R.) funding Federal government was to expire December 8 under Public Law 115–56.
House (235-193), Senate (81-14) on December 7 passed Public Law 115-90, a short-term extension of previous C.R., that expires December 22. Extension continues funding at FY 2017 levels until final bill can be worked out.
• With Congress mired in tax reform, an additional C.R. is likely to be enacted which would take funding to January 19. C.R. also prioritizes states with emergency shortfalls for any money still remaining in CHIP after funding authorization
expired September 30. On November 3, H.R. 3922, re-authorizing CHIP funding for five years, passed the House, 242-174, with only 15
Democrats voting in favor.• Democrats’ opposition to House bill pay-fors (eliminating Medicare subsidies for enrollees earning more than
$500,000 annually, extending hospital Disproportionate Share (DSH) reductions for two more years, and shortening the 90-day grace period for non-payment of individual health insurance premiums to 30 days) could lead to extension for only two years, rather than the five years previously approved in Senate Finance and the House.
Both Republican and Democratic staffers from Senate Finance (Stuart Portman and Anne Dwyer) and House Ways and Means (Josh Trent and Rachel Pryor) committees told attendees at the National Association of Medicaid Directors conference in November that they believed funding would be approved by year’s end.
12/20/2017 30
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
CHIP Funding Still Awaits Enactment as States Prepare to Shut Down Programs
Minnesota was the first state to run out of CHIP funds, but tapped $35 million of its own money to keep going for several weeks. The New Hampshire legislature voted to fund CHIP and Medicaid expansion at a 50/50 matching rate in anticipation that Congress would
not renew CHIP and was likely to cut Medicaid. The State Board that runs the West Virginia CHIP program announced November 9 that the program will shut down February 28 without a
Federal extension. Virginia sent notices to enrollees December 12. Colorado, Connecticut, and Utah had already posted website notices their programs would
end. Alabama announced December 18 it will freeze enrollment on January 1, moving enrollees to Medicaid or private insurance. MACPAC Projected Exhaustion of Federal CHIP Funds in FY 2018.
See National Academy of State Health Policy Infographic for shutting down CHIP programs. 12/20/2017
31
Quarter of Fiscal Year Number of States StatesFirst quarter (October–December 2017) 4 Arizona, District of Columbia, Minnesota, and North Carolina
Second quarter (January–March 2018)
27 Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Massachusetts, Mississippi, Missouri, Montana, Nevada, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, and Washington
Third quarter (April–June 2018)
19 Alabama, Georgia, Illinois, Indiana, Iowa, Maine, Michigan, Maryland, Nebraska, New Hampshire, New Jersey, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, West Virginia, and Wisconsin
Fourth quarter (July–September 2018) 1 Wyoming
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
Tax Reform & the Individual Mandate
Full House of Representatives passed the Conference Committee version of the Tax Cut and Jobs Act, H.R. 1, on December 19, by a 227-203 vote, with only 12 Republicans joining the unanimous opposition by Democrats.
Early the next morning, the Senate passed the bill 51-48, after stripping out three provisions at the behest of the Senate Parliamentarian. The Senate change meant the bill had to return to the House for a second approval on December 20.
The Conference Committee version includes repeal of the individual mandate penalties included in the Senate version.
• Congressional Budget Office said November 8 that repealing the individual mandate as part of the tax legislation, allowing approximately 13 million healthier enrollees (including those in employer-sponsored health insurance plans) to drop coverage and weakening the risk pool, would raise premiums for those remaining 10 percent annually.
Senate version originally passed 51-49 with Senator Susan Collins’ (R-ME) support only when she was promised passage of the bipartisan Alexander-Murray legislation (24 co-sponsors), authorizing two years of Cost-Sharing Reduction payments (CSRs) terminated by President Trump on October 12 to insurers and passage of separate legislation sponsored by her and Senator Bill Nelson (D-FL) , S. 1835, creating a two-year $4.5 billion reinsurance fund for states to cover costs of high-cost enrollees. She also favors keeping the medical expense deduction eliminated in the House bill.
Senator Collins said December 7 that she would consider changing her vote on the final tax bill if the promises are not kept, but she eventually voted yes on the bill, as did Senators Bob Corker (R-TN) and Jeff Flake (R-AZ), who had initially expressed misgivings.
• Current plans are to add those provisions to the FY 2018 funding bill, but conservatives insist the language must include theHyde Amendment prohibition against the use of Federal funds for abortions.
12/20/2017 32
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
Tax Reform & the Individual Mandate (cont’d)
But there appears to be less support for Alexander-Murray among Democrats as elimination of CSRs has led to higher advance payment tax credit subsidies for individuals enrolled in more generous Gold plans.
Speaker Paul Ryan (R-WI) has said the House cannot support passage of authorization for CSRs, reinsurance funding, which he calls hand-outs to insurers.
Freedom Caucus Chair Mark Meadows (R-NC), previously opposed, said December 6 he’d support inclusion of Alexander-Murray in the FY 2018 spending bill to get Democrats on board on that bill.
Mental Health Liaison Group sent Senate, House letters opposing mandate repeal and the House repeal of the medical expense deduction.
• Conference Committee version does not repeal the medical expense reduction. Instead, it adopts the Senate language reducing the threshold for taking the deduction in 2018 only from 10 percent of adjusted gross income to 7.5 percent (the pre-ACA level) and retroactively for taxpayers 65 or older for tax years 2013 through 2016.
Will $10,000 limit on the Federal deduction for state and local property, income, and sales taxes lead to reduction of state revenues supporting mental health and substance use programs?
• A CBS News Poll released last week found that only 35 percent of respondents favor the plan, with 41 percent expecting their taxes to rise and more than 2/3 believing the plan will most benefit large corporations (76 percent) and wealthy Americans (69 percent).
12/20/2017 33
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
Additional Funding to Combat Opioid Crisis Appears Unlikely
Senate Appropriations held hearing December 5, on Addressing the Opioid Crisis in America: Prevention, Treatment and Recovery.
Witnesses: Former Congressman Patrick Kennedy (a member of the President’s Commission on Combatting Addiction and the Opioid Crisis), SAMHSA Assistant Secretary Elinor McCance-Katz, National Institutes of Health Director Francis Collins, and National Center For Injury Prevention And Control Director Debra Houry (HHS witnesses shared written testimony).
At the hearing Republican and Democratic Senators pushed for emergency funding to address the crisis, but the White House has yet to declare the national emergency promised by President Trump to commit additional money beyond the $1.1 billion authorized under 21st Century Cures.
• On both sides of the Capitol, Democrats have introduced bills to increase funding for the opioid epidemic by $45 billion over 10 years.
• President’s Opioid Commission offered 55 recommendations in its November 11 final report, but did not recommend new funding.
Patrick Kennedy testified in favor of $25 billion in additional funding for a comprehensive approach and action to enforce mental health parity, comparing that cost to the $36 billion allocated for disaster recovery in Florida, Texas, and California.
12/20/2017 34
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
Additional Funding to Combat Opioid Crisis Appears Unlikely (cont’d)
Senator Chris Murphy (D-CT) noted HHS has yet to issue—as required under Cures—insurer guidance on NQTLs or a report to Congress on parity violations, or to audit insurers with five or more reported violations.
• Dr. McCance-Katz noted that HHS has created a portal for consumers to report violations.
Dr. Collins said NIH would meet two days (last week) with 33 PhRMA companies to discuss development of non-addicting pain relievers and other approaches to treating pain (such as by blocking sodium pathways to receptors in the brain).
• Dr. Collins said NIH currently spends $116 million annually on opioid research.
In a separate December 13 Senate Health Education Labor and Pensions Committee hearing on the implementation of 21st
Century Cures, Dr. McCance-Katz defended the allocations states received of the initial $1.1 billion in Federal funding againstcomplaints by Senators Sheldon Whitehouse (D-RI) and HELP Chairman Lamar Alexander (R-TN), both from high-impact rural states, saying SAMHSA had followed the allocation language in Cures which required preference be given to “States with an incidence or prevalence of opioid use disorders that is substantially higher relative to other States.”
• Dr. McCance-Katz said a reallocation based on a per capita impact distribution would require states to reapply for the 2017 distribution, an approach SAMHSA declined to take based on the administrative impact that would have resulted. But she said technical assistance is also being provided to high-impact rural states and new moneys are being allocated based on rate of deaths and increase in deaths from year-to-year.
• Senator Alexander promised to amend the statutory allocation language.12/20/2017 35
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
CBO Scores the National Suicide Hotline Improvement Act
Last month, the National Suicide Hotline Improvement Act (S. 1015), sponsored by Sens. Hatch (R-UT) and Donnelly (D-IN), passed Senate with unanimous consent on November 8, 2017. A parallel bill (H.R. 2345), sponsored by Rep. Stuart (R-UT), was referred to the House Committee on Energy and Commerce Subcommittee on Communications and Technology (11/10/17) and to the Committee on Veterans’ Affairs Subcommittee on Health (11/08/17).
Under S. 1015, the VA and SAMHSA are required to develop a comprehensive study to include:• the analysis of the effectiveness of the current National Suicide Prevention Hotline (800-273-TALK) system and the
Veterans Crisis Line; • recommendations on how to improve the current National Suicide Prevention Lifeline and Veterans Crisis Line,
including replacing the current 800-273-TALK number with a N11 dialing code to be used when someone is in suicidal or mental health crisis; and
• the cost associated with developing a N11 dialing code, including logistics and incurred cost to providers, states, and local municipalities.
The FCC will use the VA and SAMHSA studies to develop a comprehensive study and report for submission to Congress. The CBO estimates that the National Suicide Hotline Improvement Act (S. 1015) would cost less than $500,000 for the
VA and SAMHSA to complete the required feasibility analysis between 2018 and 2022.
12/21/17 36
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
HELP Hearing Hears from Dr. McCance-Katz on Cures Implementation
Dr. McCance-Katz said the SAMHSA Center for Behavioral Health Statistics and Quality (CBHSQ) would be developing a standardized evaluation for grant programs with specific questions related to each program to help SAMHSA determine whether programs are meeting stated goals. She:
• said she is not satisfied with SAMHSA’s current data collection efforts, and that data should show not only how many people have been treated using SAMHSA funds, but also what services have been received, what diagnoses were treated, and what outcomes were achieved;
• noted that a director has been appointed to run the National Mental Health and Substance Use Policy Laboratory created under Cures to identify and promote evidence-based practices and service delivery models;
• called the 10 percent Mental Health Block Grant set-aside for treatment of First Episode Psychosis codified under Cures “vitally important to ensuring that people with SMI receive appropriate treatment;” and
• acknowledged to Senator Al Franken (D-MN) that parity enforcement and the effectiveness of the parity HHS portal for filing complaints is a work in progress.
12/20/2017 37
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
HELP Hearing Hears from Dr. McCance-Katz on Cures Implementation (cont’d)
Dr. McCance-Katz said SAMHSA is working with the Department of Health and Human Services’ Office of Civil Rights (OCR) on guidance on 42 CFR Part 2, and noted the release by OCR of an October 27 guidance regarding the sharing of patient information during opioid overdose treatment. She said she expected another guidance will be released shortly on the applicability of both 42 CFR Part 2 and HIPAA in treatment of substance abuse disorders.
In answer to questions from Senator Chris Murphy (D-CT) regarding what actions SAMHSA is taking to integrate medical and behavioral health care, Dr. McCance-Katz said that SAMHSA is monitoring the success of the 8-state § 223 Certified Community Behavioral Health Clinic demonstration program and said she will personally advocate for extension and expansion of the demonstration nationally.
Dr. McCance-Katz promised Senator Bill Cassidy (R-LA) she would work with the Centers for Medicare and Medicaid Services to ensure CMS and SAMHSA are aligned and collaborating in the collection of program outcome measures.
12/20/2017 38
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released
SAMHSA released the first report to Congress of the Interagency Serious Mental Illness Coordinating Committee on December 14.
• The 24-member ISMICC (14 public members) was created under 21st Century Cures.
Report included 45 recommendations (many suggested by NASMHPD) in 5 focus areas:1. Strengthening Federal Coordination to Improve Care2. Access and Engagement: Making It Easier to Get Good Care3. Treatment and Recovery: Closing the Gap Between What Works and What is Offered 4. Increasing Opportunities for Diversion and Improve Care for People With SMI and SED Involved in the
Criminal and Juvenile Justice Systems5. Developing Finance Strategies to Increase Availability and Affordability of Care
Full-time staffer assigned to ISMICC, Public Health Service Captain and CMHS Project Officer David Morrissette, to ensure continued coordination with other Federal agencies
12/20/2017 39
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released (cont’d)
Strengthening Federal Coordination to Improve Care:• Improve ongoing interdepartmental coordination under the guidance of the Assistant
Secretary for Mental Health and Substance Use.• Develop and implement an interdepartmental strategic plan to improve the lives of
people with SMI and SED and their families.• Create a comprehensive inventory of federal activities that affect the provision of
services for people with SMI and SED.• Harmonize and improve policies to support federal coordination.• Evaluate the federal approach to serving people with SMI and SED.• Use data to improve quality of care and outcomes.• Ensure that quality measurement efforts include mental health.• Improve national linkage of data to improve services
12/20/2017 40
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released (cont’d)
Access and Engagement: Making It Easier to Get Good Care:• Define and implement a national standard for crisis care.• Develop a continuum of care that includes adequate psychiatric bed capacity and community-based
alternatives to hospitalization. • Educate providers, service agencies, people with SMI and SED and their families, and caregivers about
the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other privacy laws, including 42 CFR Part 2, in the context of psychiatric care.
• Reassess civil commitment standards and processes. • Establish standardized assessments for level of care and monitoring of consumer progress. • Prioritize early identification and intervention for children, youth, and young adults.• Use telehealth and other technologies to increase access to care. • Maximize the capacity of the behavioral health workforce.• Support family members and caregivers.• Expect SMI and SED screening to occur in all primary care settings
12/20/2017 41
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released (cont’d)
Treatment and Recovery: Closing the Gap Between What Works and What is Offered:• Provide a comprehensive continuum of care for people with SMI and SED.• Make screening and early intervention among children, youth, transition-age youth, and young adults a
national expectation.• Make coordinated specialty care for first-episode psychosis available nationwide.• Make trauma-informed, whole-person health care the expectation in all our systems of care for people
with SMI and SED.• Implement effective systems of care for children, youth, and transition-aged youth throughout the nation.• Make housing more readily available for people with SMI and SED.• Advance the national adoption of effective suicide prevention strategies.• Develop a priority research agenda for SED/SMI prevention, diagnosis, treatment, and recovery services.• Make integrated services readily available to people with co-occurring mental illnesses and substance use
disorders, including medication-assisted treatment (MAT) for opioid use disorders.• Develop national and state capacity to disseminate and support implementation of the national standards
for a comprehensive continuum of effective care for people with SMI and SED.12/20/2017 42
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released (cont’d)
Increasing Opportunities for Diversion and Improve Care for People With SMI and SED Involved in the Criminal and Juvenile Justice Systems:
• Support interventions at all stages of justice involvement. Consider all points included in the sequential intercept model.• Develop an integrated crisis response system to divert people with SMI and SED from the justice system.• Prepare and train all first responders on how to work with people with SMI and SED.• Establish and incentivize best practices for competency restoration that use community-based evaluation and services.• Develop and sustain therapeutic justice dockets in federal, state, and local courts for any person with SMI or SED who
becomes involved in the justice system.• Require universal screening for mental illnesses, substance use disorders, and other behavioral health needs in jails.• Strictly limit or eliminate the use of solitary confinement, seclusion, restraint, or other forms of restrictive housing for
people with SMI and SED.• Reduce barriers that impede immediate access to treatment and recovery services on release from correctional facilities.• Build on efforts under the Mentally Ill Offender Treatment and Crime Reduction Act, 21st Century Cures, and other
federal programs to reduce incarceration of people with mental illness and co-occurring substance use disorders.
12/20/2017 43
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
First ISMICC Report to Congress Released (cont’d)
Developing Finance Strategies to Increase Availability and Affordability of Care:• Implement population health payment models in federal health benefit programs.• Adequately fund the full range of services needed by people with SMI and SED.• Fully enforce parity to ensure that people with SMI and SED receive the mental health and substance
abuse services they are entitled to, and that benefits are offered on terms comparable to those for physical illnesses.
• Eliminate financing practices and policies that discriminate against behavioral health care.• Pay for psychiatric and other behavioral health services at rates equivalent to other health care
services.• Provide reimbursement for outreach and engagement services related to mental health care.• Fund adequate home- and community-based services for children/youth with SED and adults with SMI.• Expand the Certified Community Behavioral Health Clinic (CCBHC) program nationwide.
12/20/2017 44
©National Association of State Mental Health Program Directors, Inc. All rights reserved.
Thank you!!
Scheduled Meet-Me Call Webinar Dates
January 18, 2018February 15, 2018March 15, 2018
Please mark your calendar for the third Thursday of each month at 12 Noon Eastern Time