Growing up!: Georgia s Behavioral Health System of Care for Older Adults

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1 Growing up!: Georgia s Behavioral Health System of Care for Older Adults Georgia Department of Behavioral Health & Developmental Disabilities Judy Fitzgerald, Commissioner Jill D. Mays, MS, LPC, Director Office of Federal Grants and Cultural and Linguistic Competency

2 Behavioral Health Disorders in Older Adults: Costly, Disabling, and Deadly Late-life anxiety is related to increased risk of depression both affect memory Disabling symptoms and disorders impact selfcare, e.g. ADLs and IADLs Reduces quality of life sometimes becomes deadly Suicide risk Risk factor for serious illnesses (diabetes, hear disease) Complicates recovery (stroke, hip fracture, etc.) Depression and anxiety are costly: Higher healthcare costs (50-100%) Increased morbidity, mortality, nonadherence, recovery costs

3 Late-life Suicide: A Major Concern: Every 90 Minutes

4 Behavioral Health and Older Adults 1 Most common disorders: Depression, Anxiety, Irritability/Lability, Apathy/Indifference (suicide risk); Other conditions: Behavioral and Psychiatric Symptoms Associated with Dementia, Fear of Falling Persons aged years visited an ED and/or died from an opioid-involved overdose more frequently than persons in other age categories (36 deaths of persons 65 and older in 2016, compared to 808 deaths of persons 25-64) Persons aged years were most likely to be hospitalized because of an opioid-involved overdose. At least million (14-20%) of US older adult population has one or more mental health disorders; 700,000 are nursing home residents By 2030, as Baby Boomers age, the numbers of older adults in Georgia with behavioral health needs will increase by 80% (to 430, 837) IOM Report: In Whose Hands

5 Georgia Treatment Utilization Trends 83% Decrease after Age 65

6 Geriatric Behavioral Health Workforce While geriatric BH specialists are critical in caring for older adults with BH issues, the more broadly defined geriatric BH workforce (LPCs, SWs, LMFTs, psychologists, nurses, physicians assistants, etc.) has far greater contact with older adults who have or may be at risk for BH conditions. Awareness There are many shortages Key Nursing of personnel Administrative and gaps training across Nursing most professions. Most providers who are not geriatric BH specialists are required Contacts On-Call List Committees to have little knowledge or experiential training in mental health or substance use as related to older adults. Training general health care professionals and direct care workers is pivotal to improving the workforce because they are the most likely to have contact with older adults with BH conditions. Also essential to training are skills in cultural competence and interprofessional and interagency collaboration to meet the complex needs of older adults and better coordinate care.

7 Geriatric Behavioral Health Workforce Key Areas for Improvement Integrating geriatric behavioral health competencies into education for all health professionals, as well as family caregivers and Peers Training for existing providers Current Focus of DBHDD/DAS/Emory Fuqua Center/Carter Center Awareness Key Nursing Contacts Administrative On-Call List Nursing Committees collaboration (Georgia Coalition on Older Adults and Behavioral Health) Training in Cultural Competency Interprofessional Cross Training & Functionality Current Focus of DBHDD/DAS/Emory Fuqua Center/Carter Center collaboration (Georgia Coalition on Older Adults and Behavioral Health) Coordination of Care through Partnerships & Data Sharing Current Focus of DBHDD/DAS/Emory Fuqua Center/Carter Center collaboration (Georgia Coalition on Older Adults and Behavioral Health)

8 Where Can We Go from Here...Together?: Recommendations Data Analysis Workforce Development Conduct a systematic and trend analysis of the current and projected behavioral health care needs of older adults. Within the target population, consider the special needs of groups for which health disparities already exist, such as racial/ethnic groups, veterans, deaf/hard of hearing, nursing home residents, homeless persons, older inmates in correctional facilities, persons with chronic disease, etc. Based on analysis of the behavioral health needs of older adults, develop strategy for how Georgia should grow and prepare the behavioral health workforce to meet these needs. Promote interprofessional and interagency partnerships and data sharing agreements to improve systemic coordination of care.

9 Wide Array of Community Mental Health Services Available to Older Adults

10 Core Services Community Service Boards (Comprehensive Community Providers-CCPs) Community mental health services Comprehensive psychosocial, psychiatric and nursing assessment Individual/Family/Group Therapy Medication management Peer support Case Management Psychosocial rehabilitation (skills-building)

11 Assertive Community Treatment (ACT) 22 state-funded teams 4 Medicaid reimbursement option (MRO)teams Provide community-based, recovery-oriented, consumer-driven, multi-disciplinary treatment team delivered, high-level service, reduction of re-admission, homelessness and incarceration, for persons meeting ADA Settlement criteria Service delivery includes nursing, psychiatry, psychology, social work, substance abuse, vocational rehabilitation and peer support In-reach to jails and hospitals following referral

12 Community Support Team (CST) 10 DBHDD contracted CST teams Located in rural communities Smaller team composition Community-based, recovery-oriented, consumerdriven, for persons meeting ADA Settlement criteria Goals to reduce ohospital re-admission ohomelessness oincarceration

13 Case Management 16 state-funded intensive case management teams 52 state-funded case management services Individual support to increase access to community- based services, care coordination Individual recovery plan implementation May be combined with other core services

14 Supported Employment 21 Supported employment providers Vocational assessment, rapid job search, competitive job placement, job maintenance support, benefits counseling, rehabilitative support Task Oriented Rehabilitation Services (TORS): new Medicaidreimbursable component for vocational rehabilitation support services

15 Crisis Services Crisis Stabilization Units (22 CSUs) Provide assessment, crisis stabilization, therapeutic education, referral/linkage to appropriate services Blended Mobile Crisis Services (BH/IDD) Time-limited, rapid crisis response, assessment, referral/linkage to appropriate services Multidisciplinary response team 159 counties covered Benchmark: regions 1 and 4 BHL: regions 2,3,5 and 6 Behavioral Health Crisis Centers (11 BHCCs; 2 more coming by 2020) 24/7 access, combines walk-in, crisis assessment and stabilization; referral/linkage to services

16 The picture can't be displayed. Mental Health Treatment Courts Seven (7) Accountability Court contractual partnerships that combine judicial supervision and community mental health treatment; many CSBs have direct contracts with the courts Diversion programs geared towards reducing criminal activity, improving stability Alternative to incarceration for persons with serious and persistent mental illness, substance use disorders or co-occurring disorders, who consent to treatment Region Provider 1 Cobb-Douglas CSB, Highland Rivers Health, Avita BHS 3 City of Atlanta 4 Aspire Behavioral Health and Developmental Disability Services, Georgia Pines Community Service Board, Albany ARC

17 Structured activities that are provided for individuals with common issues and needs Promote self-directed recovery and support individuals in developing and attaining individualized life, recovery and wellness goals Georgia is the first state in the U.S. to be able to bill Medicaid for whole health peer support Peer support and wellness centers: programs are led by certified peer specialists Peer Support Forensic peer mentor initiatives; partnership with Department of Corrections (GDC), Department of Community Supervision (DCS), and GA Mental Health Consumer Network

18 PATH and SOAR Projects for Assistance in Transition from Homelessness (PATH) 10 PATH teams throughout the state Case management Housing access Outreach and linkage to services for the homeless SSI/SSDI Outreach, Access and Recovery (SOAR) Provides increased access to Social Security disability benefits for people who are homeless or at risk of homelessness and who have mental health challenges or other co-occurring disorders

19 Community Transition Planning Transition Coordinators who work to support each state hospital in coordinating transition planning via: Reviewing transition plans Assisting with complex discharges Monitoring planning for persons with inpatient stays of +45 days Collaboratively coordinating care between state hospital and regional field office and community service provider

20 Supported Housing Initiatives

21 Crisis Respite Apartments Brief periods of crisis respite, support services, linkage to treatment and other community services Prevention of CSU, ER re-admission/re-hospitalization, reincarceration Transition from a higher level of care into the community Does not need extensive supervision; does well with periodic checks throughout the day

22 Community Residential Rehabilitation Staff support in residential settings, continuous monitoring and supervision Skills training, community integration activities and personal support services/activities to restore and develop skills in functional areas that interfere with the individual s ability to safely live in the community, continue with recovery and increase self-sufficiency o Level 1-24-hour/on-site supervised; 5 hours of skills training (awake over night staff) o Level 2 24 hour/on site supervised; 5 hours of skills training (non awake overnight staff) : o Level 3-36-hour/on-site supervised; 3 hours of skills training

23 Georgia Housing Voucher and Bridge Fund DBHDD Funding for rental assistance for the target population: Tenant based Linked to a DBHDD Community Mental Health Provider Bridge funding: provides initial, one time move in costs (i.e., deposits, furnishings, household goods) Serves as a housing safety net for individuals who do not qualify for other housing assistance Currently about 2,600 individuals statewide receiving this assistance Served over 4,000+ cumulatively

24 Team Work Makes the Dream Work BEHAVIORAL HEALTH PRIMARY CARE OLDER ADULTS & THEIR FAMILIES/CAREGIVERS AGING SERVICES COMMUNITY SERVICES & SUPPORTS

25 DBHDD 2 Peachtree Street NW Suite Atlanta, GA jill.mays@ dbhdd.ga.gov