PCPA Outpatient Summit

Joan Erney, J.D.Office of Mental Health & Substance Abuse Services

December 2, 2009

Environmental Scan National

Beginning of new administration Rescinding of Proposed MA changes Increased attention to F&A Unclear CMS/SAMSHA Direction

HealthCare Reform Expanded population to serve Medical Home, PH/BH co-ordination MH/D&A Parity IT capability

Economic Realities Attention to Evidence Based Practices Support High Outcome, Low Cost Practices

State End of current administration Economic Challenges Transformational Agenda Unified Systems

Outpatient Clinic Services

Outpatient Clinic Services MA State Plan: Clinic Option Chapter 5200 Regulations; 1981

Modifications to Outpatient Co-occurring Option to support MH/SA Mobile Mental Health Treatment

(Rehab)

Outpatient Clinic Services

Outpatient Clinic Services (current) Psychiatric Supervision Medication Management Master’s level Therapists Individual and Group Therapy Physical Evaluation, Treatment Planning Linkages with mental health service

system

Outpatient Services Office of Mental Health & Substance Abuse Services

Environmental changes/impact on outpatient clinic services- just to name a few…

Inability to attract, adequately pay and retain psychiatrists, master’s level clinicians

Clinic limitations, site based Current regulatory limitations, staffing ratios as example Community Mental Health Centers role in delivery system,

consumer choice, elimination of catchment areas BHRS; behavioral interventions not attached to clinical home Team delivered, alternative treatment options “Medical Model” presumed at clinics Personal consumer preference, peer delivered preference Managed Care ( Commercial ) Medicare BH HealthChoices

Outpatient Services and yet… Office of Mental Health & Substance Abuse Services

Priority remains for persons with Serious Mental Illness and children with serious emotional disturbances; however….

Expanded demand; birth to death Prevention/mental health supports Maternal depression and early childhood needs Expanded children’s need; children who have experienced

trauma, or involvement with children and youth or juvenile justice system

Young adult, aging out or transition age youth Individuals with co-occurring drug and alcohol problems Expanded role to support Veterans Adults, Older Adults involved in the Criminal Justice System Physical Health; depression associated with heart disease,

chronic illnesses Older Adults, persons with serious mental illness, newly

diagnosed persons experiencing psychiatric symptoms, organic brain diseases

Outpatient : Changing the paradigm

Recovery and Resiliency Orientation Targeted specialties, by age, condition Individuals practitioners acting within

scope of practice Anticipate consumer choice of location,

clinician or support person, service option Provide Flexible business hours Provide consultative support; lead clinical

home

Outpatient : Changing the paradigm for persons with serious mental illness

Instead of treating as “chronic care” treat as long term investment to support an individual’s recovery

Instead of “case management”, consider partnership with individual or family to stay connected to treatment and personal supports; (navigator, case manager, peer)

Clinical Home instead of MH treatment clinic; partner is available and connected when and where needed

Outpatient: What are the possibilities

Reconsidering outpatient and ambulatory options for individuals Rehab option vs. Clinic Option Individual choice of clinic, clinician service

options Recovery Orientation, inclusive of peers in

service delivery Licensed practitioners acting within Scope

of Practice Team Delivered Services Strong Clinical Accountability Restructure Financial model

Where do we go from here Prioritize for New Administration Pilot outpatient models in

HealthChoices, build evidence base; Propose financial models; think

sustainability Check in and consult with

individuals and families using your services early and often!