Eastern Region Behavioral Health Initiative Improving Entry Recommendations for the ERBHI Access System Concept Proposal

Transcription

1 Eastern Regin Behaviral Health Initiative Imprving Entry Recmmendatins fr the ERBHI Access System Cncept Prpsal BACKGROUND The Imprving Entry Implementatin Team held three subcmmittee meetings ver the mnth f August t discuss hw t implement the visin f the Imprving Entry Task Frce (a task frce with representatives frm the Steering Cmmittee, the Behaviral Health Advisry Bard and the Imprving Entry Implementatin Team). The Task Frce visin is t create a behaviral health care system that prvides persns seeking infrmatin and/r services with ne cntact t access mental health and substance abuse services in the Eastern Regin; the system fcuses n the individual seeking behaviral health services, shares infrmatin, is efficient, and is value-added fr the Eastern regin. ERBHI ACCESS SYSTEM PROPOSAL HOPE Each f the subcmmittees lked in-depth at different areas related t access in the behaviral health system. Tgether, they prpse the develpment f HOPE, a reginal phne center that can be accessed (see Diagram A): By an agency staff member wh has determined that his/her agency cannt apprpriately serve the individual seeking services (either because f a waiting list r because the needed services are nt prvided by the agency), r By an individual seeking behaviral health services calling the phne center directly, r By a cmmunity rganizatin (such as United Way s 211 r a cmmunity prvider) that needs t prvide additinal assistance t an individual seeking behaviral health services. Regardless f hw the HOPE reginal phne center is accessed, it will prvide the individual seeking behaviral health services with: ERBHI screening 1 (if it has nt already been cmpleted r updated t prvide the mst current infrmatin), Referral 2, including wrking with the individual until an appintment is made and kept at the apprpriate agency, als making a cnnectin with immediate crisis services the cllabratins with crisis infrmatin and help lines in established rganizatins (i.e. NCADA help line) if needed, and Client engagement 3 until individual is linked t apprpriate services. 1 Defined as prviding the initial identificatin f the type f services an individual is seeking and identifying the reasn the individual is seeking services. A screening als assesses the type and degree f an individual s behaviral health cnditin t determine whether services are needed. 2 Defined as linking the individual t the mst apprpriate and available service. 3 Defined as the prcess f develping a trusting relatinship, reaching ut t the client, empathically understanding their situatin and gals, ffering practical assistance, and eventually helping them t understand that treatment can help him r her t reach thse gals. 1

2 The HOPE reginal phne center will be staffed using cnsumers and prvider staff a cmbinatin f peer specialists and supervising cmmunity supprt wrkers wh will prvide screening and engagement services fr individuals seeking services. These individuals will be supprted by staff frm CPS and ADA agencies (staff may have temprary assignments r serve n a rtating basis 4 ). All staff wrking in the HOPE reginal phne center will have apprpriate training t handle the calls that are received. A mre detailed staffing plan will be develped in the cming mnths. The peer specialists r cmmunity supprt wrkers will be reimbursable thrugh Medicaid. The Imprving Entry team recmmends that the HOPE reginal phne center be lcated within a facility that has the existing technlgy t supprt the center t leverage existing expertise and be crdinated with existing cnsumer rganizatins with warm lines that prvide similar services. The team will explre a variety f funding ptins pending apprval frm the Steering Cmmittee. HOPE Screening Prcess The ERBHI Access Tl (currently, the nline screening tl) will remain an nline database, but will be mdified t a shrt, cascading tl that cllects a minimal amunt f infrmatin at the beginning, but allws fr mre detailed data cllectin and screening as apprpriate (see Diagram B). Prpsed Prcedure fr Cmpleting the ERBHI Access Tl All calls - All pints f cntact, except United Way s 211, will be required t cllect a caller s basic infrmatin (eight demgraphic pints f infrmatin), identify if a caller is in crisis, and identify the primary purpse f all calls in the ERBHI Access Tl. Mental Health - If the caller has a mental health issue, the screener is required t cmplete the suicide risk assessment and ask if the caller has been seeing anyne fr help with mental health issues. If the caller has seen r is seeing smene fr help with mental health issues and apprpriate fr services, agencies will be required t cllect infrmatin n the presenting prblem, current diagnsis, treatment histry, mental health prvider and Cage Aid Substance Abuse Screening If the caller has NOT seen smene fr help with mental health issues and/r inapprpriate fr services, agencies have the ptin t cmplete the Mental Health Screening Tl (TBD) and the Cage Aid Substance Abuse Screening r transfer the call t HOPE (referral prcess utlined belw). Substance Abuse - If the caller has a substance abuse issue, the screener is required t cmplete the suicide risk assessment, cllect the client s treatment histry and cmplete the Cage Aid Substance Abuse Screening Tl and the Mental Health Screening Tl (TBD). If the call is determined inapprpriate fr the prvider s services, the prvider may cntinue t cmplete the screening r may transfer the client t the HOPE reginal phne center (referral prcess utlined belw). Other needs - The prcess fr calls received with ther primary purpses (infrmatin nly, supprtive services, etc.) will be utlined in detail in the cming mnths. Hwever, the basic 4 Supervisin f peer specialists will nt be a rtating respnsibility. 2

3 principle will cntinue t be that a prvider may refer a caller (referral prcess utlined belw) t the HOPE reginal phne center if/when the prvider realizes they are unable t serve the client. HOPE Referral Prcess (Warm Hand-ff) If an agency receives a call and determines that the caller cannt be served by the agency, the fllwing steps will ccur: Agency receiving the call cmpletes entering data in ERBHI, makes a call t HOPE, transfers the caller t a live persn and stays n the line t ensure the transfer is made. HOPE utilizes data cllected in ERBHI and cllects additinal infrmatin, as needed, t make an apprpriate referral, taking int cnsideratin available services. HOPE ffers several ptins fr services and prviders t the client and allws the client the pprtunity t make an infrmed decisin n the desired service prvider. HOPE transfers the caller t a live persn (at the agency f the client s chice) and stays n the line t ensure the transfer is apprpriate and a cnnectin is made. If apprpriate services are unavailable, HOPE remains engaged with the client and ffers interim services thrugh partnerships with peer-managed agencies (i.e. Self-help Center, Empwerment Center, NAMI help line) until the apprpriate services are available. Interim services may include, but are nt limited t: Cnnectin t the regin s warm-line hsted by the Empwerment Center Cnnectin with drp-in centers Cnnectin with supprt grups and/r self-help rganizatins such as Alchlics Annymus r ther similar rganizatins, Mental Health Assciatin grups, NAMI grups, prcvery circles, etc. Crisis riented services Cntacting the individual n a regular basis Interim case management All invlved agencies are respnsible fr updating respective dispsitins (utcmes f calls/transfers) in ERBHI. Additinal requirements t be determined. HOPE Business Case Benefit Fcuses n the individual seeking behaviral health services Facilitates access t care Invlves cnsumers in the prcess: Supprts the cnsumer chice mdel Aides in the reductin f stigma Develps career paths fr cnsumers Allws time fr the individual seeking services t tell their stry and experiences Prvides ne number and ne place fr them t tell their stry Has the ability t allw fr the identificatin and tracking f reginally identified high utilizers Cmmunicates hpe t individuals seeking services 3

4 Remains engaged with individuals seeking services until apprpriate services are available Is able t share infrmatin Allws fr the cllectin f reginal data Waiting List f individuals wh are in need but unable t receive services Identifies need fr behaviral health services in the regin Number and efficiency f referrals Is efficient Eases the burden f referral frm prviders Has the ability t identify cases/clientele fr agencies Prvides current and reliable infrmatin n available services acrss disciplines Is value added fr the Eastern Regin Allws individual agencies t retain cntrl f access Allws fr the pssibility f Medicaid funding. Builds n the regin s existing expertise and strengths Mdels a similar system in Maine Engages advcacy rganizatins Builds trust amng prviders Prvides reginal wnership and cllabratin Reginal integrated mdel fr access Barriers CIMOR interactin Lng-term sustainability Identifying the rle f existing call centers (BHR and BJC BH) Duplicative f existing services (i.e. NCADA infrmatin line, LifeCrisis, Prvident Call Center, etc.) Opening up access n the frnt end may highlight limited capacity n the back end HIPAA and 42 CFR Stigma, regarding staffing cnsumers Cnfusin and mistrust ver wnership and mnitring If the HOPE phne center des nt have the ability t schedule appintments in the lng term, it will be an additinal barrier t access instead f meeting its intended purpse f increasing access. Infrmatin captured in ERBHI tl must be viewed as reliable infrmatin t build frm r prviders will cntinue t duplicate screenings Shrt term gal Clearly defined prtcls shuld be established fr hw t track waitlists (bth HOPE phne center and prvider generated) t get individuals int care. Lng term gal there shuld nt be a waitlist t manage. The fee-fr-service up t a cap payment structure creates a need fr agreement n hw rganizatins will take referrals. 4

5 Diagram A Prpsed Mdel fr ERBHI Access System Screening, Referral and Client Engagement services Warm hand-ff* Screened using ERBHI** Unable t serve this client Warm hand-ff* Screened using ERBHI** Warm hand-ff* Able t serve the client Screened using ERBHI** Peer-managed Agencies: Self-help Center Empwerment Center NAMI help line Screening, Referral, Client Engagement services and Interim Services Warm hand-ff* Assessment and Intake prcess * Details n the referral prcess (warm hand-ff) are prvided n page 2 under the HOPE Referral Prcess sectin. ** Details n the screening prcess are prvided n page 2 under the HOPE Screening Prcess sectin. 5

6 Diagram B ERBHI Access Tl Flw Chart fr Screening Prcess Tier 1 (required n all calls) Demgraphics Required First Name Scial Security Number Date f Birth Phne Number Last Name Date f Birth Gender Zip Cde w/ hmeless bx Primary Purpse f Call Behaviral Health Physical Health Supprtive Services Other Tier 2 (required n all calls) MRDD Medicatins Suicide Risk Assessment Cunseling Mental Health Substance Abuse Health care prvider Medicatins Husing Fd Emplyment Transprtatin Family Supprt Financial Wrng number Infrmatin Only Presenting Prblem Current Diagnsis Treatment Histry Mental Health Prvider Yes Have yu been treated fr MH issues? N When was the last time yu used? Have yu been treated fr SA issues? Yes Were yu treated in an utpatient r inpatient setting? Tier 3 (ptinal t cmplete if agency is unable t serve client) N Cage Aid SA Screening (TBD) MH Screening Cage Aid SA Screening MH Screening (TBD) Tier 4 (ptinal t cmplete if agency is unable t serve client) 6