In addition, LFC staff makes two conclusions that are highly misleading about this successful program that are not based in fact:

Transcription

1 Behavioral Health Services Division (BHSD) of the Human Services Department (HSD) Response to the Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, 2014 BHSD appreciates the Legislative Finance Committee s attempt to spotlight New Mexico s serious problems with substance abuse and mental health issues. In the recent Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, it briefly highlighted New Mexico s behavioral health (BH) needs and the many successful programs that are aiding in the promotion and sustainability of recovery for individuals with serious mental illness and chronic substance abuse. In line with this approach, the report takes the additional step of providing legislators with assessments of the Return-on-Investment (ROI) for many critical community BH services. The report promotes resource allocation, and reallocation, to prioritize spending on services with a high return and target efforts to high-risk, high-need areas of the state. Unfortunately, BHSD did not have an opportunity to respond to the report, and as a result, it is lacking important perspectives and provides an incomplete picture of the State s problems related to: unmet needs for services, workforce issues, unique cultural challenges, critical impact of prevention efforts and environmental forces. For example: o The report cites state and county BH related prevalence and other data but only reports on state spending and services for BH. However, there is no acknowledgment of the role of Medicare, VA, TriCare, and commercial insurance in addressing NM s behavioral health needs; o There is no reference to the role of the social determinants of health in NM which are some of the worst in the nation and therefore drive high incidences of BHrelated conditions; o There is no framing of BH within a public health model which requires effective and comprehensive environmental and agent specific strategies, not simply intervening in the lives of those who suffer from BH conditions; o The report misses the fact that there are significant gaps in the continuum of BH care in most communities that include the lack of mobile crisis, crisis stabilization units, intensive-community-based services, transitional service options (supportive housing, supportive education and employment, group homes, respite, and therapeutic foster care) for those to be diverted or discharged from jails, prisons, hospitals, and residential settings. EBP implementation cannot be expected to make up for these significant service gaps;

2 o There is no reference to the ongoing needs of those with co-occurring (mental health and substance use conditions and/or developmental disabilities), and of those who represent the cultural diversity of NM but who have unique cultural needs (Spanish-speaking, Native Americans, and hearing-impaired) which EBPs often do not address; o Behavioral health workforce challenges are dismissed in the report on the basis of national comparisons, but fails to examine how many practitioners are no longer practicing, are employed outside of the publicly funded BH system, or which of them carry an independent license to practice, and what the distribution of practitioners are to meet the needs in rural and frontier communities; and o The report, in limiting its focus to EBPs has missed the broader context within which EBP adoption must occur to be successful: an adequate and qualified BH workforce, a streamlined BH regulatory environment, broad-based early and routine screening to identify those requiring intervention, implementation of primary prevention EBP strategies, and the provision of enhanced systems of care, instead of program specific strategies. The report s assessment of the ROI for individual evidence-based programs also lacks broad stakeholder input. In setting a monetary value on critical services, the report describes the method to calculate the return as: incorporating NM statistics for cost, consequences, diagnosis rates and treatment rates. This analysis does not consider the value to the individual of recovery from mental illness or addiction, the value of sobriety for a single mother, or the value of preventing a teen suicide. In addition, the report admits it has not yet monetized the benefits of reduced homelessness which means the ROI likely understates the benefits (Page 8). Publishing such assessments of ROI for critical public BH services without comprehensive methods, developed in consultation with a broad array of stakeholders, could mislead NM Legislators in budget decisions and hence impede the State s effort to provide an effective array of both effective prevention and treatment services. HSD considers Centennial Care to be a major strategy to addressing New Mexico s tremendous behavioral health needs -- and early reporting suggests it is working. Medicaid expansion and the integration of behavioral health services, with physical health and long-term care services, provides a potentially seamless system for 170,000 more Medicaid members. A uniform process of care coordination helps members with significant BH needs identify their needs and arrange for treatment. Behavioral health services are expanding to include more Opioid Treatment providers and Substance Abuse Intensive Outpatient (IOP) Treatment sites throughout the state, three new recovery services and a new focus on the need for trauma-informed care for children and youth. In the first six months, over 30% more Medicaid members are receiving needed BH services under the Centennial Care integrated model than received such care under the previous model.

3 In addition, LFC staff makes two conclusions that are highly misleading about this successful program that are not based in fact: o Report: the state does not have a comprehensive grasp on how it spends the estimated $209 million on adult behavioral health services, whether it is funding effective services, whether services are located in high need areas or whether services are producing expected results. This report estimates the state only spends 11 percent of its limited BH funding on proven and effective programs for adults. (Page1). Contrary to the report, HSD has a detailed grasp on how it spends all of its BH dollars. For both Medicaid and non-medicaid the state receives reports compiled by the five MCOs that address the quality and quantity of care. An extensive system of reports, on service utilization, access, financial and clinical practices, are gathered at regular intervals and reviewed by Medicaid staff to monitor the development of the system. Medicaid and non-medicaid pays for encounters not programs. Many of the services LFC claims are not proven effective, actually wrap-around evidence-based programs, and include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), among many others. Because the claims payment system does not accommodate a unique billing code modifier for every EBP provided, does not mean that 81% of BH services are sub-standard. It simply means that we our systems are unable to capture all of the EBP delivery that occurs. o Report says: The transformation to Centennial Care brings the behavioral health system nearly full circle for the approach to paying for services used before (Page 5) This conclusion disregards the benefits of integrated care to the Medicaid member and the benefit to providers of assistance with care coordination. Medicaid now provides comprehensive medical, behavioral health and long-term care services to an increasing percentage of the population instead of the previous patchwork of separate payers and funding streams. Unlike 2000, in 2014, over 170,000 previous uninsured New Mexicans received comprehensive Medicaid coverage in 2014, instead of having to patch together a variety of state and federal grant funded programs. The Medicaid benefit package is enriched with more comprehensive services which address the Essential Health Benefits included in the ACA. New services include preventive care, dental services for adults, habilitative services and expanded substance abuse and BH recovery services. Behavioral health services must now be covered at parity with physical health.

4 New Mexico s new Centennial Care 1115 Medicaid waiver provides for the true integration of medical, behavioral health and Long-term Care Services at all levels: financing, administration, reporting, and service provision. Members with both Medicaid and Medicare have access to integrated services and care coordination to negotiate the two systems. Unlike 2000, in 2014, four MCOs develop and manage a unified and integrated Medicaid program instead of the previous system of multiple MCOs administering multiple separate waiver programs. Multiple protections have been included in the design of Centennial Care to ensure that the service and funding levels for behavioral health and long-term care services are not reduced due to the integration of services, due to lessons learned from For the first time in state history, Medicaid s Centennial provides a uniform Health Risk Assessment (HRA) by which every Medicaid member is contacted by their MCO to identify the member s health, behavioral health, long-term care and social support needs. At no point in the past, has this attempt at universal screening for the needs of the Whole Person been implemented. Unlike 2000, in 2014, the HRA for each member is used to identify members with significant needs and assign them to a standard process of intensive care coordination. For those members who do not report significant health needs, the Health Risk Assessment is repeated annually and the care coordination system at each MCO monitors the member s utilization to identify any increased needs. Each Centennial Care member, with significant BH needs, is being assigned to an individual Care Coordinator to visit the member in their home and perform an inperson comprehensive needs assessment and develop a service plan. Care coordination works with each member to coordinate all medical, BH and LTC services, as well as, dental and ancillary services like Durable Medical Equipment, Pharmacy and Transportation. They coordinate the member s appointments with providers and facilitate communications between providers during transitions of care. Depending on the member s level of need, the Care Coordinator will contract the member quarterly or monthly by phone and visit the member to update the comprehensive needs assessment semi-annually or quarterly or at any time the member s needs change. Unlike 2000, in 2014 numerous structures are now in place to set policies to coordinate behavioral health services. Two state-level statutory committees provide for on-going assessment of the state s needs and oversight of the system. The NM BH Purchasing Collaborative meets quarterly to coordinate the BH services each agency manages. The Collaborative issues a Consolidated Behavioral Health Services Budget annually to the Legislature to provide a state-wide picture of the behavioral health services. The Behavioral Health Planning Council is a federally required, Governor appointed council of representatives of consumers, families, and providers. State law charges the council with advising the Governor and state in identifying needs and planning services. Since 2001, the Council s statutory

5 responsibilities have been expanded to include substance abuse. HSD s Behavioral Health Services Division (BHSD) staff work closely with the Medicaid program to coordinate the management of the non-medicaid services funded through HSD. Unlike other LFC reports, HSD was not offered an opportunity to attach it s response to this Results First Report when it was published. Nor was HSD invited to testify when the report was presented to the LFC in public hearing. Providing our response would have assured that Legislators would have a more complete picture regarding the status of BH needs and services in NM.

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7 NM BH Strategic Plan Review Children s Array of Services Section Comments By: CHILDREN S SERVICES Actionable in 2011 No Progress Being Worked On By Completed Comments Solicit input from the BH Planning Council and its Subcommittees, consumers, family members, and providers, on criteria and strategies to expand and guide the sizing of the Children s Purchasing Plan the services needed to build out the array and the targets for shifting to more community-based care Work with the NM Health Care Reform Leadership Team and other groups addressing health care reform to ensure that children s behavioral health is part of their planning related to prevention, wellness, health disparities, consumer protection, education, outreach and communication, and overall payment and delivery system reform Continue to promote and deliver training in evidence based practices (e.g., train the Matrix Model and the American Society of Addiction Medicine (ASAM) placement criteria for implementation of Intensive Outpatient Services (IOP) for adolescents) Pilot an Intensive Outpatient Program for youth ages who are leaving the juvenile justice system which includes transitional living and independent skill development Schools examine and revise, as needed, comprehensive Safe School Plans and wellness policies that address substance abuse and violence prevention Promote the integration of special education and IEPs with behavioral health plans and services BHSD-HSD Strategic Plan Review December 8, Page 1

8 NM BH Strategic Plan Review Children s Array of Services Section Work with tribal communities to identify needs to build and balance service arrays including increasing prevention, wellness, and community supports Mid-Range Initiate shifts in the Children s Purchasing Plan as outlined below. These shifts will prioritize services that are outcome-driven, use evidence-informed practices, are culturally competent, and can be developed in tribal, rural, and frontier communities. Expand access to services across the array through the investment of Children Youth and Families Department (CYFD) funds (e.g., care coordination using a wraparound approach, respite services, infant mental health services, and transitional living services) Expand early detection and intervention services for youth experiencing their first episode of psychosis in order to decrease movement to more seriousness Based on the youth Intensive Outpatient Program pilot project, develop a comprehensive clinical model that utilizes a system of care philosophy; and, include an evaluation component to examine the model s effectiveness Youth with serious mental illnesses (SMI) will be transitioned from the youth system to the adult system in a seamless fashion. Incentives for the providers will be developed to better ensure participation Develop a road map for employment opportunities for transitioning youth; partner with public education, vocational rehabilitation, and workforce solutions agencies; educate youth, families & stakeholders in its use Increase screening and assessment in school based health centers BHSD-HSD Strategic Plan Review December 8, Page 2

9 NM BH Strategic Plan Review Children s Array of Services Section Create a model for prevention and early intervention systems within school based health centers Expand school-based early intervention strategies in school-community collaborations Develop a consistent risk and protection approach to a range of prevention issues, including substance use (e.g., underage and binge drinking), suicide, mental health, violence, teen pregnancy, school dropout and delinquency Expand community based prevention and wellness as resources become available Long Term (3 Years) Continue shifts in the Children s Purchasing Plan as outlined below. These shifts will prioritize services that are outcome-driven, use evidence-based practices, are culturally competent, and can be developed in tribal, rural, and frontier communities. Seek funding to expand the evaluated youth Intensive Outpatient Program (IOP) model for regional access Implement a standardized substance abuse assessment for youth Create full time capacity in school based health centers to provide mental health and substance abuse prevention, assessment, crisis intervention, and early intervention services Implement comprehensive school based plans that address prevention and wellness especially as related to substance abuse and violence BHSD-HSD Strategic Plan Review December 8, Page 3

10 NM BH Strategic Plan Review Children s Array of Services Section Expand the full service community school model statewide Develop strategies to support movement towards a full continuum of promotion and prevention services within communities for universal, selected, and indicated populations Develop a coordinated effort linking primary care and BH across communities, including tribal communities, to address prevention and wellness, including positive youth development strategies Incorporate expenditures in State facilities currently not under the auspices of the Children s Purchasing Plan. BHSD-HSD Strategic Plan Review December 8, Page 4

11 NM BH Strategic Plan Review Children s Array of Services Section New Priorities for Next Plan Children s Array of Services Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 5

12 NM BH Strategic Plan Review Adult s Array of Services Section Comments By: ADULT S SERVICES Actionable in 2011 No Progress Being Worked On BY Completed Comments Solicit input from the BH Planning Council and its Subcommittees, consumers, family members, and providers, on criteria and strategies to expand and guide the sizing of the Adult Purchasing Plan the services needed to build out the array and the targets for shifting to more community-based care Work with NM Health Care Reform Leadership Team and other groups addressing health care reform to ensure that adult behavioral health is part of their planning related to prevention, wellness, health disparities, consumer protection, education, outreach and communication, and overall payment and delivery system reform Map all prevention, early intervention, and treatment resources across the state Access to Recovery (ATR), Total Community Approach (TCA), Substance Abuse Prevention and Treatment (SAPT) and Community Mental Health Services (CMHS) Block Grant funds, compulsive gambling, medication assisted treatment, supportive housing programs and resources as well as other General Fund substance abuse expenditures Mid-Range Initiate shifts in the Adult Purchasing Plan as outlined below. These shifts will prioritize services that are outcomedriven, use evidence-based practices, are culturally competent, and can be developed in tribal, rural, and frontier communities. BHSD-HSD Strategic Plan Review December 8, Page 6

13 NM BH Strategic Plan Review Adult s Array of Services Section Increase supportive housing to decrease transitional living services Increase consumer-operated services and bolster improvement of psychosocial rehabilitation services Increase comprehensive community support services and focus on evidencedinformed outpatient therapies Fill gaps in the continuum of available services and ensure substance use residential services are used only when that level of care is appropriate Increasing the utilization of substance abuse Intensive Outpatient Programs (IOP) Develop a plan for more access to prevention, screening and early intervention, and strategies that promote wellness Create a comprehensive, evidence-informed strategy to prevent and reduce substance abuse, including binge and chronic drinking by adults, including adults over 65 Create an IOP model for mental health; develop a strategy for piloting this model Educate providers about appropriate services for elderly and persons with disabilities who also experience severe and complex behavioral problems and co-occurring acute medical issues Expand community based prevention and wellness as resources become available BHSD-HSD Strategic Plan Review December 8, Page 7

14 NM BH Strategic Plan Review Adult s Array of Services Section Long Term (3 Years) Continue shifts in the Adult Purchasing Plan as outlined below. These shifts will prioritize services that are outcomedriven, use evidence-based practices, are culturally competent, and can be developed in tribal, rural, and frontier communities. Invest Behavioral Health Services Division s (BHSD) non-medicaid funds in services that will fill gaps in the service array Implement broad, high risk drinking reduction strategies using cross agency coordination efforts to leverage greater impact Expand the capacity of community-based providers that serve people who are elderly and persons with physical disabilities with severe and complex behavioral problems and co-occurring acute medical issues Expand the capacity of facilities that serve people who are elderly and persons with physical disabilities with severe and complex behavioral problems and cooccurring acute medical issues Incorporate expenditures in State facilities currently not under the auspices for the Collaborative, into the Adult Purchasing Plan. BHSD-HSD Strategic Plan Review December 8, Page 8

15 NM BH Strategic Plan Review Adult s Array of Services Section New Priorities for Next Plan Adult s Service Array Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 9

16 NM BH Strategic Plan Review Infrastructure Section Comments By: INFRASTRUCTURE Actionable in 2011 Work with the NM Health Care Reform No Progress Being Worked On By Completed Comments Leadership Team and other groups addressing health care reform to develop a vision of integrated primary care and behavioral health infrastructure Establish a workgroup among primary care, Federally Qualified Health Centers (FQHC s), 638 s and behavioral health providers to agree on a practice model for clinical integration Develop mechanisms to share successful implementation strategies across CSAs Provide CCSS and Wraparound training to CSAs Work with CSAs to develop infrastructure for responding to community suicide crises Support local sites in SAMHSA grant to develop logic models, system designs, and strategic plans for local systems of care that can be replicated in other communities Develop a statewide strategic plan for the use and expansion of behavioral health telehealth services that starts with psychiatric services in FY11, then other clinical services in FY12, and then nonclinical services in FY13 Develop funding strategies to support telehealth infrastructure in school based health centers BHSD-HSD Strategic Plan Review December 8, Page 10

17 NM BH Strategic Plan Review Infrastructure Section INFRASTRUCTURE Mid-Range No Progress Being Worked On By Completed Comments Develop a training and technical assistance plan for primary care providers to incorporate behavioral health services in primary care settings, including topics such as: implementing Screening, Brief Interventions Referral and Treatment (SBIRT), use of Motivational Interviewing skills, administration of depression screening instruments, appropriate prescribing practices, treating opioid addiction in families Work with NM Health Care Reform Leadership Team and other groups addressing health care reform to develop at least one pilot project on clinically integrated primary care and behavioral health that incorporates medical homes and clinical homes Pilot and evaluate a health home approach in school based health centers in three to five sites; document successful components and outcomes of pilots incorporating health home operations within School-based Health Centers (SBHCs); develop process to expand in additional SBHCs Integrate physical health initiatives within the behavioral health consumer/recovery population to focus on health consequences related to major disease processes such as diabetes, heart disease, and emphysema Develop a competency based CSA framework and training plan with competencies framed in terms of Quality Services Review (QSR) principles Develop a strategy for deployment of staff from CSAs to screen, assess, and conduct referrals of the elderly within primary care clinics and senior centers BHSD-HSD Strategic Plan Review December 8, Page 11

18 NM BH Strategic Plan Review Infrastructure Section INFRASTRUCTURE No Progress Being Worked On By Completed Comments Expand Local Lead Agency partnerships with Core Service Agencies to increase access to supportive housing in local communities Provide education, training, and technical assistance based on lessons learned from SAMHSA sites to expand local development of systems of care for children, youth and their families in communities throughout the State Develop a system of care model incorporating wraparound approaches for adults, including adults over 65; provide education, training, and technical assistance in implementing the model statewide Develop systems to use data to identify emerging trends, e.g., the emergent use of opioids Develop strategies and seek grant funds to initiate transportation services for persons with BH issues in conjunction with Department of transportation (DOT), including the implementation of consumer-run services and the expansion of existing services Long Term (3 Years) Work with NM Health Care Reform Leadership Team and other groups addressing health care reform to rigorously evaluate a pilot on integrated primary care and behavioral health and develop a long term plan for expansion statewide Link school based health centers to primary care practitioners and CSAs and other community based providers in an integrated system that includes a medical home approach BHSD-HSD Strategic Plan Review December 8, Page 12

19 NM BH Strategic Plan Review Infrastructure Section INFRASTRUCTURE No Progress Being Worked On By Completed Comments Develop an integrated model for services and supports to elderly persons that incorporates behavioral health care with primary care and other services Develop processes that ensure that individuals receive screening and early intervention to minimize severity of illness, symptoms, and functional limitations New Priorities for Next Plan INFRASTRUCTURE Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 13

20 NM BH Strategic Plan Review Performance & Quality Section Comments By: PERFORMANCE & QUALITY No Progress Being Worked On By Completed Comments Actionable in 2011 Establish a Consumer and System Performance Dashboard that monitors gains in a limited set of key measures addressing: improved functioning, reduction in problems and achievement of recovery of resiliency goals in children and adult consumer lives. Promote practice improvement through expanding Quality Services Reviews with Adult and Children s Core Services Agencies (CSA s) statewide Implement quality improvement processes within CSA s to assure implementation of core functions and service to eligible populations Use results from statewide CCSS adult provider audits to create next steps in development of a recovery-and resiliency-based system of care Provide training and implement functional assessment (e.g. CAFAS) in Children s CSAs Improve continuity in the services array by trending services received 7 and 30 days after discharge from Adult Residential and Psychiatric Inpatient Improve quality through Fidelity Assessment and Compliance monitoring: Implement IOP Fidelity Tool for all adult IOP providers Strengthen current ACT Fidelity Tool utilization by ACT programs Monitor appropriate access to services for older consumers with behavioral health disorders by tracking services and diagnoses by age Mid-Range BHSD-HSD Strategic Plan Review December 8, Page 14

21 NM BH Strategic Plan Review Performance & Quality Section PERFORMANCE & QUALITY No Progress Being Worked On By Completed Comments Develop standardized functional assessment tool options for adults and older adults Standardize functional assessment tool for children (i.e., Child Adolescent Family Assessment Scale (CAFAS) Implement Intensive Outpatient (IOP) Audit Tool for Medicaid providers of IOP Improve quality by developing supportive housing and lead agency fidelity assessment tools and implementing a compliance monitoring process Implement concurrent review for residential substance abuse services Modify patient placement criteria for substance abuse services to incorporate harm reduction approaches and selfdirected recovery skills Develop and implement treatment standards that address appropriate transitions between levels of care; include incentive structures to support changes Long Term (3 Years) Expand access to functional assessment information (e.g., CAFAS) to other child serving systems (e.g., schools) Implement functional outcomes as the standard measure of child and youth BHSD-HSD Strategic Plan Review December 8, Page 15

22 NM BH Strategic Plan Review Performance & Quality Section PERFORMANCE & QUALITY No Progress Being Worked On By Completed Comments outcomes Develop strategies to increase access to community support services for older adults by designing pilot initiatives within CSAs to explore access issues Evaluate core service agency (CSA) effectiveness in achieving recovery outcomes, learning opportunities for improvement, and incorporating learning into practice. Conduct a study of comprehensive community support services (CCSS) to determine its effectiveness in supporting recovery-oriented outcomes. BHSD-HSD Strategic Plan Review December 8, Page 16

23 NM BH Strategic Plan Review Performance & Quality Section New Priorities for Next Plan PERFORMANCE & QUALITY Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 17

24 NM BH Strategic Plan Review Consumer Engagement Section Comments By: CONSUMER ENGAGEMENT Actionable in 2011 Identify strategies that support development of No Progress Being Worked On By Completed Comments consumer and youth resiliency in services and trauma-informed systems of care. Increase the number of Peer, Family and Youth Specialists throughout the state and promote their employment in community organizations as Community Support Workers (CSW) or Assertive Community Treatment (ACT) team members Provide leadership and advocacy training to ensure that consumers, youth, and family members are partners in strategic planning, policy development, priority setting, service implementation, resource allocation, and evaluation Revitalize LC s to welcome consumers, youth, and family members; and to ensure members are adequately trained in legislative advocacy, mental health first aid, etc. Increase LC s participation via telehealth and webinars to ensure that Local Collaboratives have a voice in decisionmaking Actively distribute timely data to each LC related to services and populations (i.e., persons served by gender, age, ethnicity) BHSD-HSD Strategic Plan Review December 8, Page 18

25 NM BH Strategic Plan Review Consumer Engagement Section To gather information on specialized behavioral health needs and engage special populations in natural settings, such as older adults in senior centers and people with disabilities in vocational programming Develop stakeholder-friendly surveys and reports on consumer, youth & family satisfaction; share findings broadly and identify relevant quality improvement measures Mid-Range Engage consumers, youth and family members in designing systems of care that capitalize on their local community resources and needs Ensure that LC s include schools, community programs, law enforcement, housing, employment, child welfare, juvenile justice, local governments, neighborhood assoc. and others in their systems of care Evaluate the mechanisms and effectiveness of consumer engagement for special populations including Native Americans, veterans, older adults, and people with disabilities Implement Community Wellness and Recovery Resource Centers as peer-run and peerdriven pilots tailored to the needs of communities Support peer-to-peer school based and Peer Bridger housing programs such as the Natural Helpers Increase public awareness by expanding the number of mental health focused public service announcements focused on recovery and stigma Implement statewide the New Mexico Consumer, Youth and Family Involvement Standards which focus on the role of state agencies, employment, media and marketing, and community providers. Long Term (3 Years) BHSD-HSD Strategic Plan Review December 8, Page 19

26 NM BH Strategic Plan Review Consumer Engagement Section Expand drop-in centers as resources for consumers to continue growth and development in their lives Engage youth and their families in designing systems of care including prevention in their own communities Recruit and train consumers from special populations (i.e., Native Americans, veterans, older adults, and people with disabilities) to work as peer support specialists Increase awareness of early childhood development and the effectiveness of early intervention in terms of long-term health and mental wellbeing for children and families, including early intervention for psychosis Track data on behavioral health system outcomes (e.g., where referrals for behavioral health services are made) to determine greatest needs BHSD-HSD Strategic Plan Review December 8, Page 20

27 NM BH Strategic Plan Review Consumer Engagement Section New Priorities for Next Plan CONSUMER AND FAMILY ENGAGEMENT Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 21

28 NM BH Strategic Plan Review Workforce Development Section Comments By: WORKFORCE DEVELOPMENT Actionable in 2011 Augment the existing workforce to include No Progress Being Worked On By Completed Comments trained peer and family specialists as part of the paid workforce by: Continuing training for Peer and Family Specialists and assisting with job placement Improving the Peer and Family Specialist curriculum after quarterly reviews and feedback from participants to ensure that they are trained to enter the workforce Developing an internship process for Peer and Family Specialists to experience the workplace Conducting media campaigns to promote the benefits of Peer and Family Specialists as essential parts of the workforce Increase readiness of provider agencies to employ Peer and Family Specialists and identify funding strategies to support the work of these individuals Expand outreach and identify successful efforts to provide behavioral health services in areas of limited workforce capacity (e.g., rural and tribal communities) Deliver training in the Matrix Model to assist in the implementation of Intensive Outpatient Services (IOP) for adolescents and adults and aftercare placement in supportive housing where appropriate Provide Comprehensive Community Support Services and Wraparound training to ensure that the workforce is adequately trained to work in public and private nonprofit behavioral health settings Seek support to sustain and expand the prevention certification program BHSD-HSD Strategic Plan Review December 8, Page 22

29 NM BH Strategic Plan Review Workforce Development Section WORKFORCE DEVELOPMENT No Progress Being Worked On By Completed Comments Work with Health Care Reform Leadership group to evaluate funding opportunities for workforce development. Include the Dept. of Workforce Solutions in this process Work with licensing boards to encourage adoption of the NM developed cultural competency curriculum as the standard for all behavioral health continuing and higher education programs Expand mental health interpreter training, including language as well as deaf and hard of hearing, by offering additional training opportunities Mid-Range Develop new learning models, such as web-based trainings and web-based learning collaboratives to ensure that the workforce has the information to effectively implement evidence based. Training examples include: Specialized training on unique issues of older adults and persons with disabilities Education on the warning signs and appropriate responses to youth and adult suicide concerns Training to school personnel on behavioral health needs in school settings Develop and implement a Core Service Agency Integrated Training curriculum Develop training methods for Core Service Agencies workforce to support shared decision making and shared planning Provide training to Certified Family Specialists to serve as care coordinators/wraparound BHSD-HSD Strategic Plan Review December 8, Page 23

30 NM BH Strategic Plan Review Workforce Development Section WORKFORCE DEVELOPMENT facilitators and to provide family support services No Progress Being Worked On By Completed Comments Seek funding and mechanisms for expanding mental health treatment guardians Create a specialized curriculum for Veteran Peer Specialists focusing on trauma spectrum disorders Train school staff about behavioral health issues; signs and symptoms of substance abuse, depression, suicide, and appropriate methods of response, referral, etc. Create incentive strategies and policies to increase number of Certified Prevention Specialists Develop Training Initiatives to engage workforce outside of Behavioral Health. Training examples include: Behavioral health training for nursing home staff Mental Health First Aid for first responders Training to Primary Care staff on integrating care (CEUs) Long Term (3 Years) Develop and train the workforce in clinically integrated models to serve the general population as well as populations with Serious Emotional Disorders (SED) and Serious Mental Illness (SMI) Seek funding and develop mechanisms to support consumer, family member, and provider participation in trainings Develop a Training Academy, in conjunction with the Collaborative s Consortium for Behavioral Health Training and Research, for long-term statewide training delivery Develop strategies and incentives to encourage BHSD-HSD Strategic Plan Review December 8, Page 24

31 NM BH Strategic Plan Review Workforce Development Section WORKFORCE DEVELOPMENT cross-agency and cross-system collaboration No Progress Being Worked On By Completed Comments Strengthen licensure, re-licensure, and certification requirements; develop a Continuing Medical Education (CME) for professionals with Geriatric specialty or developmental disability specialty Improve recruitment and retention efforts in rural, frontier and tribal communities by increasing access to telehealth or enhancing availability of peer and family specialists Pursue education and training grants for behavioral health service providers as they become available under health care reform Work with institutions of higher education to ensure that issues relevant to public behavioral health are integrated into existing non-medical and medical curriculum Develop tax or educational incentives to increase the recruitment of potential BH students as well as prescribing professionals practicing in New Mexico Review the recommendations from the Annapolis Coalition Workforce Development report and prioritize steps BHSD-HSD Strategic Plan Review December 8, Page 25

32 NM BH Strategic Plan Review Workforce Development Section New Priorities for Next Plan WORKFORCE DEVELOPMENT Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 26

33 NM BH Strategic Plan Review Financing Section Comments By: FINANCING Actionable in 2011 Increase consumer and family involvement in funding allocation discussions No Progress Being Worked On BY Completed Comments Review the State s Behavioral Health Purchasing Plan and develop a strategic plan for funding that takes into account the limited dollars available Move toward equitable access to services across the major funding streams (i.e., Medicaid, state general funds and federal block grant funds) through braided funding strategies Demonstrate flexible payment strategies within the Provider Network by implementing risk-sharing pilots in three areas of the state with children and adult Core Services Agencies. Support implementation of wrap-around supports in the three anchor sites of the Systems of Care initiative by testing case rates. Use the Money Follows the Person federal planning grant to move elderly adults from institutional care to community-based care Evaluate providers on performance and target incentives for improvements in: Consumer Outcomes Service System Performance Conduct a system analysis of the use of Medicaid reimbursement for school based BH services (ie. in school-based health centers, special education, and other school personnel) Develop a workgroup with state, provider, tribal, consumer, youth and family representation to address expected Medicaid shortfalls BHSD-HSD Strategic Plan Review December 8, Page 27

34 NM BH Strategic Plan Review Financing Section FINANCING No Progress Being Worked On BY Completed Comments Seek new funding streams for community based prevention programs Mid-Range Develop a cost study resulting in recommendations for expanding behavioral health services in schools by school-based health centers, special education, and other school personnel Develop a cost study resulting in recommendations for expanding substance abuse services for adolescents Develop financial strategies to support vulnerable services such as: care coordination/wraparound facilitation, respite services, transitional living services, and early childhood/infant treatment services Develop financial strategies to establish uniform crisis mobile outreach services statewide Implement pay-for-performance and shared-risk payment methodologies as research indicates Develop financial incentives for CSAs to develop outreach strategies and implement integrated models that reach Native American populations, the elderly and adults with disabilities Rigorously evaluate risk sharing pilots and develop a plan for modification and/or expansion Pilot efforts in the use of flexible funds in wraparound plans in the three anchor sites of the System of Care initiative BHSD-HSD Strategic Plan Review December 8, Page 28

35 NM BH Strategic Plan Review Financing Section FINANCING No Progress Being Worked On BY Completed Comments In accordance with Health Care Reform, work with Medicaid and managed care organizations to dedicate funds to promote the clinical integration of behavioral health and primary care when appropriate Reimburse Intensive Outpatient (IOP) services based on demonstration of Co-Occurring Disorder treatment competencies established through the Co-Occurring System Improvement Grant (COSIG) Long Term (3 Years) Develop policy and financing strategies for adult and child wraparound approaches and other peer and family support services Establish Medicaid codes to support treatment integration across service sectors (e.g., BH, developmental disability, primary care) so that needed services can be provided efficiently rather than in silos Actively seek opportunities for communities and the state increase funding in New Mexico through federal grants and other options Develop incentives to serve populations who are high-need, high-risk and have complex needs Develop models to reimburse services based upon provider performance Expand proven risk-sharing methodologies statewide Increase availability of flexible funds for wraparound plans BHSD-HSD Strategic Plan Review December 8, Page 29

36 NM BH Strategic Plan Review Financing Section New Priorities for Next Plan Financing Section Actionable in 2015: Mid-Range: Long-term (3 years): Other Comments: BHSD-HSD Strategic Plan Review December 8, Page 30