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New Mexico Behavioral Health

Collabora ve Mee ng

Human Services Department

37 Plaza la Prensa

Santa Fe, NM

Tuesday, January 14, 2020

Our Collaborative. Our Success!

New Mexico Behavioral Health Collaborative

____________________ ________________________________________________

January 14, 2020

37 Plaza La Prensa Santa Fe, New Mexico 1:00 p.m. – 5:00 p.m.

AGENDA 1. 1:00 – 1:15 p.m.

Call to Order Introduction of Collaborative Members/Recognize Remote Sites Introduction audience Review/Approval of Minutes from July 11, 2019

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3. 4. 5. 6.

1:15 – 2:00 p.m.

2 2:00—2:45 p.m.

2:45 – 3:00 p.m. 3:00 – 3:45 p.m. 3:45 – 4:30 p.m. 4:30—5:00 p.m.

BHSD Director & CEO of the Collaborative Updates Neal Bowen, Director, Bryce Pittenger, CEO Presentation on two BHSD budget asks – Neal Settlement of BH Lawsuits LFC budget presentation BH Liaison group Update on Research Development pipeline CYFD Medicaid metrics- alignment of MAD and BHSD efforts (DSIPT & PM) BH Week during legislature and BH collaborative participation CARA Dr. Andy Hsi, Cynthia Chavers, Falling Colors (Goal 2&3) Break FY21 Budget Update All Goals

SUD GAPS Analysis Michael Landen, DOH Public Comment Adjourn

Brian Blalock Children, Youth & Families Department

Secretary – Collaborative Co-Chair

David Scrase, MD NM Human Services Department Secretary – Collaborative Chair

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Approved Meeting Minutes New Mexico Behavioral Health Collaborative October 10, 2019 · 1:00–5:00 p.m. · 37 Plaza La Prensa, Santa Fe, New Mexico Handouts: Copies of the NM Behavioral Health Purchasing Collaborative Meeting public hand-outs may be obtained from the website www.newmexico.networkofcare.org/mh

Topic Discussion

Video Conferencing Sites Voting Members Present:

1. Call to Order Review/Approval of Agenda

Las Cruces CSED, Roswell CSED, and Clovis CSED Kathy Kunkel/DOH, David Scrase/HSD, Brian Blalock/CYFD, Bryce Pittenger, BHC CEO, Alisha Tafoya-Lucero/NMCD, Michael Regensberg/DFA, Jane Wisher/GHPC, Alice Liu McCoy/DDPC, Katrina Hotrum-Lopez/ALTSD, Lynn Trujillo/IAD, Gina Bell/MFA, Diane Mourning Brown/DVR, Ryan Stewart/PED, Robert Mitchell/AOC, Kate O’Neill/NMHED, Mariana Padilla/Children’s Cabinet Brian Blalock, Co-Chair, called the meeting to order at 1:00 p.m. with a quorum present.

▪ Introduction of Behavioral Health Collaborative Members. ▪ Introduction of participants. ▪ No participants in the video sites.

➢ Review/Approval of Agenda and Minutes A quorum was present-Handout-DRAFT Meeting Minutes, New Mexico Behavioral Health Collaborative July 11, 2019 Meeting and the July 11, 2019 agenda. A MOTION was made by Brian Blalock/CYFD, and seconded by Kathy Kunkel/DOH, to approve the October 10, 2019 agenda and the July 11, 2019 Behavioral Health Collaborative minutes. A correction on the April 11, 2019 minutes on the voting members listed Ashley Tafoya, changed to Alisha Tafoya. The MOTION was PASSED unanimously.

2. Update on Search of BHSD Director and Announcement of CEO for the BH Collaborative

Dr. David Scrase, HSD Cabinet Secretary ➢ Angela Medrano-Update: As you all heard and read in the news release, Bryce Pittenger is the new CEO for the

Behavioral Health Collaborative. HSD took a step back as we were conducting our search for a Director for the Behavioral Health Services Division (BHSD) and the CEO, it is a pretty complex set of shoes to fill. We made the decision to separate the two positions so Bryce is the interim CEO, and I am so pleased to announce that we have selected a Director for the Division. We took our time in our search and took into account the experience, and the complexity of building the network in New Mexico. I am so pleased to announce that our new leader comes to us with many years of leadership experience, the ability to reunite the provider community with our department, and it is Dr. Neal Bowen. Neal sends his regrets, he really wanted to be here today but he had other commitments as Chief Mental Health Officer at Hildago. He is very excited and thrilled to be coming to work with HSD/BHSD and will be here the 2nd week of November.

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➢ David Scrase-we were looking for a leader from the provider community, Neal’s experience is in the rural community is a big bonus because that is an area of greatest need. Part of the thinking of separating the two positions, we have a very big strategic plan and it’s not fair to expect someone to run the Behavioral Health Services Division and be responsible for the implementation of the Behavioral Health Collaborative strategic plan. Bryce has graciously stepped up and helping out. We are working on a plan to have a full-time person in that CEO role. We have immediate support from the Governor’s office to create and fund that new role. Having two outstanding leaders is going to make a big difference, it will be a leverage point in accomplishing the 4 goals of the collaborative.

Jane Wishner-the Governor has instructed all of us to be working across departments, so having the two is consistent with her vision. All reports will be posted on the NM Network of Care Website.

3. Behavioral Health Collaborative Goals Update

David Scrase, M.D., HSD We are doing a deep dive into Goal #1, which is my goal “Expanding the Network”. I show this slide all the time, the four-secretary’s working very closely together. We are trying to make major changes how we are structured, how our processes work, and how we share data. The Governor has her eye on the ball and is making sure we are doing everything we can ensuring New Mexican’s get services. ➢ Expansion of the BH Provider Network-David Scrase, M.D., HSD Cabinet Secretary

▪ The Us Office of Inspector General Report on Behavioral Healthcare Access in New Mexico (September 2019). A reminder of why this is so important. This slide shows the number of New Mexicans served as of June 2019. The data from Falling Colors is not included, I would like to get it so we can have the whole number of how many people in New Mexico are being served. We serve over half of our population.

▪ MASLOW’s Hierarchy of provider reimbursement ▪ Value Based Purchasing (VBP)-there are steps we have to do before we start talking about VBP ▪ Quality Metrics-Need quality providers ▪ Adequate Network-need a quality Metrix

▪ OIG report on behavioral health access for Medicaid enrollees in New Mexico-there isn’t any major surprise in this report, but there is interesting statics in the end. New Mexico has 2,665 licensed behavioral health providers that serve nearly 670,000 Medicaid managed care enrollees. Of the 2665, there are 328 Independently licensed prescribing BH providers, only 202 Psychiatrists. 1872 Independently non-prescribing BH providers and 465 Non-independently licensed BH health providers.

▪ Only 30% of NM behavioral health providers serve Medicaid managed care enrollees-Shortages of behavioral health providers are a problem that affects behavioral healthcare for all populations, not just for its managed care enrollees. A study of the New Mexico healthcare workforce found that 9,528 behavioral health providers had active licenses in the State.

▪ More than half of New Mexico’s counties have fewer than 2 licensed providers per 1,000 enrollees; these counties are rural or frontier. Los Alamos is the only county that had greater than 7 providers. It is then broken down by Urban, Rural and Frontier. You see Urban areas like Las Cruces, Santa Fe, Farmington, ect. you have a greater number of providers. Then you look at Rural and Frontier areas, we need to look directly at these and rebuild that effort.

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▪ 62% of NM behavioral health providers work in Behavioral Health Organizations (BHO’s). These organizations say it is hard to find and retain staff. Of these BHO’s, one in three did not have a prescriber on staff, two in three BHO’s did not have a provider specializing in substance use disorders on staff. Most of the BHOs in need of additional staff are located in rural and frontier areas and are having staffing challenges affect enrollees with all types of diagnoses.

▪ 43% of BHO’s report that enrollees have difficulty accessing the full range of BH services at the frequency they need. Most BHOs (29 of 53) report that they do not have urgent appointments available within 24 hours or routine appointments available within 14 days with providers in their BHO for Medicaid managed care enrollees. BH Services includes a variety of services that generally fall into four categories. Recover and support services, non-intensive outpatient, intensive outpatient, and inpatient/residential services.

• 81% said they had difficulty arranging Recovery and support services, 79% with Intensive outpatient services, and 74% said they had difficulty arranging inpatient and residential services.

▪ OIG Key conclusions-we don’t have enough licensed behavioral health providers, BH providers are very unevenly distributed with rural and frontier counties having fewer providers and prescribers per Medicaid managed care patients.

▪ OIG Key recommendations-the Centers for Medicare & Medicaid Services (CMS) to come together and identify the issues of behavioral health services and develop strategies to ensure that Medicaid managed care patients have timely access to these services. New Mexico Human Services Department expand New Mexico’s behavioral health workforce, and improve access to services by reviewing it access to care standards and by increasing access to transportation, access to broadband, and the use of telehealth. Improve the effectiveness of services by increasing electronic health records, care coordination initiatives, to integrate behavioral and primary healthcare, open-access scheduling and the treat first clinical model. CMS and New Mexico HSD concurred with these recommendations. I feel hesitant by imposing additional requirements on behavioral health providers saying you can’t be a Medicaid provider unless you are implementing MMR. We want to expand people providing behavioral health services, making the network adequate. The challenges faced by New Mexico, are likely shared by other States and will require both State and national attention.

▪ Solutions-Albuquerque Journal said Governor should take the lead on Access to Health Care-Shortage on physicians in New Mexico. The Journal doesn’t do assignments to state government. The journal followed that five-segment story in February on the shortages of physicians in New Mexico. They interviewed the Governor and she talked about things we will be doing: Medicaid Rate increases, Increase recruiting efforts and funding, expand team and multidisciplinary approaches.

▪ Solutions: Medicaid behavioral health Provider Network Enhancement STRATEGIES Rebuild the BH provider network in New Mexico (HSD)

• Execute strategic BH provider rate increases and new payment methodologies

• Settling BH Lawsuits-we have settled 5 of the 10

• Expand primary care and psychiatry training slots in NM, Expand and invest in telehealth models (Project ECHO, UNM Access, other ACCESS programs), Loan forgiveness expansion, expand value based purchasing to improve outcomes

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• Provide help with service start-up, HSD/BHSD has to take the responsibility to go out and sit with people and walk them through the process.

• Create a Medicaid provider network analysis for the State of NM using existing DOH, UNM, and other data

• Identify and prioritize gaps in network, make selective and strategic investment to broaden access Behavioral Health, Primary Care, Rural healthcare (30% of Medicaid), Others as identified by network analysis.

• Convene a Provider Advisory Group to develop priorities and strategies for network expansion ▪ Solutions: CYFD behavioral health Provider Network Enhancement STRATEGIES Bryce Pittenger-We have identified a shortage in the workforce with providers and prescribers but also with paraprofessionals. The purpose is for state agencies to partner with state universities to be able to sustain evidence based promises and best practices throughout the changing and stakes of state government.

• CYFD BHS collaborates with New Mexico State University (NMSU) to lead and coordinate several of its behavioral health workforce efforts, to include:

• High-Fidelity Wraparound, Family Peer Support Services (FPSS)-joint MOU we have the the NM credentialing board and BHSD with Adult Peer support services, we are in the process of introducing Youth Peer Support Services (YPSS), Youth Support Services (YSS), Cultural and Linguistic Competency (CLC), Child and Adolescent Needs and Strengths (CANS) tool, Training/tools for staff working with survivors of child sex trafficking

▪ Solutions: CYFd behavioral health Provider Network Enhancement STRATEGIES ▪ Nurtured Heart Approach (NHA) as a strategy towards the development of a trauma-responsive system- Infuse the

workforce with basic trauma informed program that is not just for clinicians, it is for foster parents, shelter providers, RTC shelter providers and community providers and for advocates. We all want to be speaking the same language and we all understand the behaviors that interact with children are based out of pain and out of trauma. We want to be able to say these are the strategies that work and we want to tell you how to do it. I want to get to a point that we won’t do a contract unless you are sending folks through the Nurtured part

• Infant and Early Childhood Mental Health (IECMH) program oversees the infant and early childhood mental health services-we need to collectively as a group start to understand what is the whole dynamic

▪ Trainings provided or sponsored by CYFD BHS in SFY 2019-this is a list of some of the trainings we have sponsored to infuse the workforce throughout the state of New Mexico

➢ Solutions: Medicaid fee schedule Three Year Plan ▪ David Scrase-Fee Schedule that is Fair-we are not paying providers fairly. We want the schedule to be fair,

benchmarked to regional/national rates (e.g., RBRVS), adjustable based o cost of business and on state revenue, and aligned with Medicaid strategic plan.

▪ Solutions-Provider Rate Increases PART 1A-on July 1, 2019 $60 M plan aimed at enhancing access to health care in New Mexico. $37.4 M: E&M codes-these are the codes that doctors charge for Office visits. Primary care providers in the state will see an increase from 70% to 90% of what Medicare pays for such services. Long Term Support Services providers-$11.9 M, $4.6 M for dental services, and $2.1 M for community-based pharmacies. We also provided $2.0 M for topical fluoride varnish. $800,000 to TCM and CCM. These codes are hard to understand. TCM is Transitional Care Management, Medicare already pays for this service. This service emphasizes on post-discharge, when people get out of the hospital. CCM is harder to do-they pay the provider and their clinical office staff. They are managing

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the care of a complicated patient. It is hard because of the documentation. Programs of All-Inclusive Care for the Elderly (PACE) $650,000-keeps elderly out of nursing homes, $320,000 to assisted living facilities, and $230,000 to supportive housing services (helping people get housing)

▪ Solutions-Provider Rate Increases Part 1B- on October 1, 2019 we rolled out 78.5 M in rate increases. Outpatient BH codes $58.6 M, again Primary care providers in the state will see an increase from 70% to 90% of what Medicare pays for such services, Not for Profit (NFP) Hospitals $15 M, Federally Qualified Health Centers (FQHCs) $4.4 M, and Project ECHO (Extension for Community Healthcare Outcomes) provider presentations $0.9 M.

▪ Other legislation that also helps providers-Hospitals resulted in $53 M NET payment increase, Nursing Homes will result in a $32 M NET payment increase

➢ Medicaid Fee Schedule Three Year Plan ▪ Next two years-Continue to focus on Behavioral Health, additional providers not addressed in year 1, move to single

multiple of Medicare Resource-based relative value scale (RBRVS) fee schedule, and how do we get money to actual providers vs. organization? We will be working with provider organizations on how do we get this dollars to providers.

▪ Behavioral Health Collaborative-Nine cabinet secretaries have come together and put together a large number of tasks. We have a menu of things that each agency for the behavioral health goals. The total is 35 m

• Behavioral Health Workforce Analysis will be done before the next fiscal year. We are working with Higher Ed. It is a very purposeful way pipeline here in New Mexico for training of behavioral health providers with free higher education. The is going to be a huge breakthrough. We are working with Kate on looking on our existing loan repayment plans for all of the providers and figuring out how we are going to expand this.

• Improve physician training & financial aid for non-physician providers- Correct barriers to training completion and implement all fed/state financial aid. Behavioral Health (BH) startup fund-will provide Loan program for BH startups.

• Behavioral Health Provider rate increases which we already mentioned, Bryce talked about the NMSU Innovation Center Support, the Nurtured Hearts program support, and Peer support and community health workers for elders/PWD.

• The Department of Health will be improving the Las Vegas Behavioral Health Institute. They will require the institute to increase number of behavioral and psychiatric long-term care patients as a percentage of the overall. The new Behavioral Health wing at Fort Bayard will have 15-bed psychiatric and behavioral health long-term care wing at Fort Bayard Medical Center (FBMC)

Q/A Did the report include IHS? (David) Native Americans are served by managed care. Native Americans are now at 44.5% managed care and 55.5% in Medicaid fee for service. This did not include Medicaid fee for service Most people in small frontier counties don’t go to a mental health facility, they go to their primary care and I feel we need to get to integrated care, our workforce out there, our undergraduates, the primary care are not required to attend certain training? (David) I just want to make sure that people that have questions have a chance to ask them. we are having this big discussion, we are dramatically changing incentives for our MCO’s. there is 60 M Dollars out there for Managed Care organizations. We pay them big chunks of money for certain performance. We have decided to make 50% of that money to go for performance incentives based on behavioral health. So, to do that we have to have measures, so how do you measure

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the number of behavioral health, everything a behavioral health provider does. We are working on how do we more accurately quantify what is a behavioral health service and how do they deliver. I did get some preliminary data, if you analyze what we have done since July 2019, we have over 20% increase in behavioral health visits ➢ Expansion of Community Based Mental Health Services for Children

Brian Blalock, CYFD Cabinet Secretary-I will be talking about three things, the R&D Projects, Assessment Tools, and how we are holding ourselves accountable that we are doing things in the right way. ▪ Research and Development (R&D) – all this means is that children not getting services now. We are working on

Structural changes with rate increases and ways we are paying services. Another part we are working on how do we grow services right now. How do we help kids right now? Part of the research and development methodology is to figure out what you need, start building it, launch it and track to make it successful. Everything we have been building, everything we have implemented has an evaluation piece in it. we tweak it, we grow it with federal funds using Medicaid etc. these are the four stages, we plan, launch, evaluate/iterate and expand with public funding.

• Infant Mental Health-we currently have sites in Dona Ana, Silver City, Luna, Santa Fe, and Albuquerque. Medicaid funded expansion includes 8 Northern Pueblos, San Felipe, three Albuquerque providers, Valencia County, Sandoval County, Hobbs, and Farmington. Numbers served: 200 children per year. we have doubled our children served per year.

• High Fidelity Wraparound State: Evaluate/Iterate- SAMHSA funded pilot providing intensive care coordination in

a strengths-based model focused on adult supports and behavioral health interventions. We have Five current sites: Clovis, Farmington, Hobbs, two Albuquerque providers. We are trying to grow programs all over the state. Numbers served-150 youth per year. This is not enough kids, but this is what we are doing right now.

• Behavior Management Services- we are rewriting what it looks like, and giving it an enhanced rate so we get to roll it out. This looks a lot like therapeutic behavioral services, it is a really short-term intensive service in order to reduce institutionalization. We are focusing on population, the first year is going to be 150 kids. Our focus is to take all those kids that are out of state from New Mexico at residential facilities and bring them back into the community and getting them back into New Mexico. We are looking at a plan launch of January 1st.

• Peer Case Management (TCM) Stage: Planning / Pre-Launch- Peer to Peer kids with lived experience. It helps our workforce because it gets these peers to working.

• EMT Corps State: Planning-this is in its planning stage. We have a planning grant and we are working with UNM to really focus on working those kids coming out of trouble from the juvenile justice system, giving a job as emergency medical technician. You are probably asking what does that have to do with behavioral health. Turns out you take their lived experience and give them a job to interactive with lots of trauma. This includes a therapeutic community based component to be sure they are able to process it and can work with it.

▪ What is the Child and Adolescent Needs and Strengths (CANS) Tool-The CANS Tool lets us see if our kids are getting better and if our interventions are working and our contracted parties are being successful making our children healthier. We built a module with the help of Falling Colors so we can start rolling it out for all the kids, 2500 in protective services, 1000 in county probation, 137 in juvenile justice system, and the others serving in our behavioral health care.

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• The CANS tool we are using is the Adverse Childhood Experiences (ACES) software. The purpose for using the ACES and the CANS is it drives us that services are delivered and it drives us to hold ourselves accountable weather or not our kids are getting better.

• Office Children’s Rights-internally with CYFD honestly kids fall through the cracks, we want to make sure that they get help as soon as possible. Director for Children’s rights makes sure that youth and special youth with special populations, special youth with disabilities, their voices are being heard of what we are doing, their voices being heard in our policy and when we don’t get them the right service that we are held accountable. Part of that office is the office of the Director of Child Advocacy to help us interact with school districts to make sure we get good IEP services and section 504 services for our kids and making sure that the behavioral health care is seamless between us, the school district and the community.

Q/A-I am curious what’s the plan? What about the current pressure to send kids out of state, I know we want to bring them back, what is happing right now with the kids needing services and there is nothing available in state? Brian – we don’t have enough services, we have some services so as we get them up and running our high at-risk kids that are on their way out of state to get services. I didn’t mention some of the facility beds that aren’t strictly behavioral health but we do have for example, Child Sex Trafficking is an issue in New Mexico as well as all over the country, we are just started running numbers and problems. We just rolled out risk assessment for child sex trafficking survivors with CSE-IT tool. The creation of CSEC Director to create policies for working with survivors of child sex trafficking including statewide deployment of CSE-IT tool. We have zero beds in New Mexico hat are set aside for child sex trafficking survivors. The horrible thing about that is this is one of that this is one of the populations that are getting in residential time shows to be a good thing. A lot of the other times, if you can keep from getting residential time, you can keep kids here and get wrap services, you get better outcomes with Wrap instead of institutions. We just received 1 million dollars from Bernalillo County (Bryce) up to a million, Secretary Hotrum-Lopez helped us in her prior position with the proposal, it is a fabulous illustration of how state and county and city collaborate. (Brian) so up to 1 million dollars to get CSE beds for Bernalillo County, and then we also have a facility to do the same thing. The next 24 months we go from zero to 30 beds for that population. Q/A: I especially appreciate the attention to human trafficking you’ve done since we have so many that are overlooked for services, are you able to give us briefly a set timeline for the developing the office of children’s rights and are you anticipating on meeting any community coalitions support to develop such an office or any part of your strategic plan? (Brian)- I will take all the community support and input as well, most of our strategic plan was developed traveling around state most of April thru June in my car. I think particularly for that office, as far as support goes, it is Governor priority for us to get that office on tract, the timeline is really a question of making sure we are not taking from St. Peter to pay St. Paul (laughing), Carole is doing big chunks of this now and now it is a question of backfilling that role. If you know of talented lawyers who want to work with the state send them to me because the timeline is just as soon as we backfill what we are looking for. Are there any programs for kids outdoors, the friends of the Santa Fe National Forest have 5 working groups with trails? It gets the kids outside, gets them involved? (Brian) we do have some cool things, Bryce-there is Americorp, there are some programs in Taos clearing trails. They get paid for it and get the behavioral health support. There is Santa Fe Mountain Center, we have some contracts with them to provide experience, outdoor therapy, adventure type experience to provoke some of the emotional and social experience

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➢ Substance Use Disorder Kathy Kunkel, DOH Cabinet Secretary-overall, we have three main strategies. Mike and I have organized these slides on goal three. Currently we are looking at our two facilities, New Mexico Rehab Center in Roswell and Turquoise Lodge. Our goal is to reduce substance use disorder across the state and we are going to initiate that in our institutions is just beginning and then the Public Health Division is hiring physicians so we can continue that treatment at the facilities. This is our current goal as you see in the budget, this is a big step just for the Department of Health, being able to initiate that in our facilities. The public health department is very committed to continuing that in a way we have not done in the past. We have submitted in the budget that we want to start an incubator program. I just got Secretary Hotrum to join me, we are working with the county, the city, and the state legislators to initiate RTC, the continuum of care and the ongoing treatment. Dr. Michael Landen- ▪ Substance Use Priority Goal-DOH brings to the table a population health view on this realm. The disease of despair,

deaths of despair, New Mexico is number 2 after West Virginia in drug overdose deaths and suicide. These are very big health status indicators for all this work we are talking about. The services are key but ultimately why are we doing this service? What is the purpose of this services? It is to improve people’s health. The health of New Mexicans in this area is not good. We have to look at this broadly and make sure that all our measure line up and point toward reducing the overdose deaths rates. the state is already well focused on reducing drug overdose deaths. We have done a lot of very good work, that indicator is established.

▪ Alcohol related deaths and substance use disorder have gone up in 2018. We need to do something about that. why did drug overdose go up? it went up because of methamphetamine overdose deaths. We have worked very well medicated assisted treatments, we are showing progress. We are having a positive impact with the prescription drug overdose. Methamphetamine is a huge problem and how are we doing with dealing with methamphetamine disorder in the state? we have a lot of work to do

▪ We have a strategic plan around behavioral health and then we have an overarching behavioral health improvement.

▪ 3 Major Health Issues

• Improves access to Primary Care, Obesity and Diabetes, and Substance Use and Mental Health-we have four priority areas. For Substance use and Mental Health, we have four priority areas: Alcohol, Drug overdose, Suicide, and Tobacco. We are going to focus here on the first three. We are in the process of rolling out the State Improvement Plan and assuring it connects with the work of the collaborative and other key partnerships in the state. ex: drug overdose death, we had an overdose prevention and pain management advisory council, we also have a drug overdose prevention state agency workgroup that coordinates particularly the alcohol related efforts in our alcohol related mortality prevention efforts at the state level. We are heading up a similar workgroup with alcohol use disorder.

• Improvement plan-we are going to engage coalitions and partners to take on parts of the plan and hopefully all this activity will line up so we can impact these key health status impact behaviors. The next key strategy is the substance use disorder treatment data analysis. What we are going to do by the calendar year, we are going to look at state level and county data. The state number, type and location of treatment implications, number of

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people receiving treatment, number of people with substance use disorder, and the gap analysis-which is the difference between treatment need and current treatment and plan on maintaining that. we don’t have a systematic view, we have pieces but we must put that together collectively. We hope to have an approach to this. This will help a lot of the efforts like Open Beds and other efforts to ensure we are connecting people that need treatment. We will then track to show that the gap is narrowing. We fill this will help with respect to our overall health status indicators, alcohol related deaths and drug overdose deaths.

Q/A: you touched a little on tobacco, does anyone in the state had these discussions? (Michael) there have been many discussions on how to build the state infrastructure when dealing with all types of tobacco issues and we will see what moves forward. We all have a regulatory structure on tobacco oversight in New Mexico. Q/A: Do you have a theory as why those overdose deaths are going up? as a state we are not focused adequately. Can you explain that? (Michael) New Mexico has gone from number 1 to number 17 in overdose deaths. We have focused as a state on multiple levels in reducing that specific indicator. We are not focused as a state on that specific indicator on alcohol. We reviewed as the best state as the best in drug overdose prevention initiatives. We would not be viewed the same for alcohol. We have not adequately mobilized ourselves to deal with that. I think the collaborative, though its focus on building up the primary care system, building our behavioral health, addressing substance use disorder, and focusing on the health state improvement, and really focus on alcohol related deaths, all these agencies here have a role in addressing our alcohol related deaths. If we can come together better, we are proposing to do specifically on alcohol through this cross-agency workgroup problems, develop an agenda over time and mobilize our work on that, I believe we can do it. the rate of alcohol related deaths is substantially higher than drug overdose deaths. We have more federal funds coming in with drug overdose deaths than we do with alcohol. (David) it is overwhelming how much funding there is with opioids right now and nothing with alcohol. The other thing about is it takes along time to die with alcohol unless you are in an automobile accident, it can take 20-30 years to develop cirrhosis-liver failure. I can see where rates would continue to drift up overtime, I could understand if we have an aggressive program to prevent alcohol deaths, I can see how we will not see the change in death rates for 10-20 years. (Kathy) Dr. Landen has asked to start alcohol evaluating the effect of our treatment program ➢ Behavioral Health for the Criminal Justice Population

Katrina Hotrum-Lopez, ALTSD Cabinet Secretary- I have experience with dealing with the criminal justice and people with behavioral health issues. ▪ Goals and Focuses:

• How do we get counties engaged in these discussions? Seeing what we can stream line, see what we can learn about different populations and then having outcome measures.

• The prison population is very different from the jail population, so sort of separating them out but finding the common areas that are very important. The Human Services Department has done a lot of work already in terms of individuals put on the justice involved. We have done a lot of work the sequential intercept mapping not only in Albuquerque but in Bernalillo County. We take some of those things that we have learned and start implementing some common things across the state.

• If we can take what we have learned and start implementing the common thing across the state. We have additional focuses when we talk about the budget that we want to look at, that we can start measuring that

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would help the story for the state and the county on terms of what the behavioral health needs are, ex: cooccurring disorder, substance use disorder that is happing in our criminally justice populations.

• Intercept Zero and One-we want to focus on intercept zero, where we are really using these diversions to have people access the help that they need, when they need it, and we will be focusing on those areas. Right now, we are taking a rough inventory of what we have, of what we can link to and when you begin with the criminal justice system and what happens to you when you get out and how do we stabilize you.

Jane Wishner- I see Anita Morales is here and Mika Tari, I don’t know if you want an update on the 2.5 m that has been provided to BHSD that is going out to counties. Anita-this past legislative session, they awarded 2.5 million dollars which we dispersed among five (5) counties with the effort in developing the intervention demonstration project (IDP). Four (4) of these five counties within a detention center, to develop and implement a jail based behavioral health service program which will work with individuals incarcerated form the point of incarceration and through transition and re-entry and back into the community. Each of the five counties have developed a program specific to the needs of the community and has grown very organically. I think we are going to see a very different pulse and get a very different flavor of how that will support the state as a whole. We are hoping that out of this project we will be able to develop a universal model or framework that can be rolled out to the various counties and give them a leg up on behavioral health in their county. It works on the sequential intercept model, the funding in this particular case was specific to incarceration and Is concentrated on the 4 and 5 of that model. Grant County is implementing a Forensic Assertive Community Treatment (FACT) Team. This approach will work to address all stages of the continuum of care for those incarcerated. Services will include initial crisis response to crisis stabilization to providing more effective community based services. In this instance, The FACT Team will provide wraparound services with people with severe mental health issues from jail and into the community services to detainees prior to their release, at the time of release and for an extended period of time after release. San Juan County is developing a re-integration process with an intensive case management and a housing component that will help work with transitional housing for those who have been identified as homeless or without permanent housing. San Miguel County has already instituted a Medicated Assisted Treatment (MAT) program in their jail. This project will help them to further support that program. Right now, they work with detainees with dual diagnoses there are 6 participants in the “In-custody” program and 16 in the “After-release” program. The MAT program provides Cognitive Behavioral Therapy to the detainees to assist with recovery and restoration. Sierra County is a small, rural county with a population of 11,282, and take the challenge that they do not house their detainees within their own county. Instead, they use the Luna County Detention Center and transport detainees regularly to that facility. They are using total wraparound services. Sierra County will use IDP funding to create a process whereby their detainees will receive jail-based treatment services following any screenings that happen at the time of booking into the Luna County Jail. Valencia County is operating a 24/7 behavioral health center in their jail. It is very exciting, the key implementation partner left and now they are learning how to regroup. The immediate challenge we are facing is this is a one-time funding. Valencia County has taken on the challenge to work together to redesign their program. they plan to use the IDP funding to expand its Behavioral Health Assessment, Evaluation, and Diagnostic services within the jail, and create a targeted re-entry program. David – we are putting money in the budget to make this reoccurring. And second Mika, Angela, Bryce, and I spent the whole day as a road trip in Sierra County and Truth or Consequences in the LHHS Behavioral Health Subcommittee on

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Tuesday and there is a tremendous amount of talk about the program that is rolling out in Sierra County and how this was saving them from their biggest problem they have, basically just having their justice system being their behavioral health treatment centers. It was very very positive community response from the work you are doing. Comment: A couple of days I went to a strategic planning for the Early Childhood for community members. I would highly recommend if you are going to be doing something for these initiatives, that was a really good way. The room was packed, it was full of professionals, community members are really affected in early childhood that have a lot of experience in trying to help children. One of the things that was a reoccurring thing over and over was that people were essentially saying they wanted to see a system of care. They wanted to see our state agencies work together collaboratively. There were less gaps and that we continue this strategic process, that we continue to listen to our workers that have their foot on the ground. David-thank you for your comment, that is a good summary, I know this is why we are all here today. Marianna Padilla is here with us today, she has been coordinating the efforts with us to get the Early Childhood Education and Care Department off the ground. Marianna Padilla – We received a Federal Grant, three of our agencies that applied for that funding together, Department of Health, PED, and CYFD. We are in the middle of our year-long planning process, our needs assessment. I was at that meeting as well, the outcome was fantastic, it was really well attended. All our meetings around the state have been equally as well attended so I appreciate that comment. We also have a workforce and a family service survey that have gone out. The end of this month we are really diving into the strategic plan component of this grant. We are also in the process of writing our second phase application which will help us with implementation. Jane Wisher-on New Mexico First, many of you may be familiar with is planning a town hall meeting on health care New Mexico on April 8 and 9th, they have already determined that behavioral health is a big issue, I encourage you and as we get more information we will let information out on the website and maybe at the next collaborative meeting. I encourage you all to participate

4. Public Comment Public Comments: Open to the audience None

5. Break Out Groups ➢ SOR/STR/OD2A Grants-FHB Conference Room ➢ PAX-Collaborative Conference Room 2019 Exec. Summary Report for Consumer Satisfaction Project-BH Conference Room

6. Adjourn Motion to Adjourn: Kathy Kunkel/DOH 2nd Katrina Hotrum-Lopez, ALTSD ➢ The MOTION was PASSED unanimously.

7.