Advancing Children s Behavioral Health through Systems Integration NASHP Conference October 25, 2017 Donna M. Bradbury, MA, LMHC Associate Commissioner
3 Medicaid Managed Care Transition 4 Vision for Transforming the Delivery of Children s Health Care Keep children on their developmental trajectory Focus on recovery and building resilience Identify needs early and intervene Maintain child at home with support and services Maintain the child in the community in least restrictive settings Prevent escalation and longer term need for higher end services Maintain accountability for outcomes and quality Maintain and expand access to services for children without Medicaid as a Household of One
5 Children and their families receive the right services, at the right time, in the right amount. Transformation Goals 6 Increase access to appropriate interventions Enhance service array Offer children Medicaid services within a Managed Care delivery system Integrate the delivery of physical and behavioral health services Integrate approaches to care planning and service provision Shift focus from volume to achieving quality outcomes
Children s Medicaid System Transformation 7 Transition of six 1915(c) waivers to 1115 Waiver authority Office of Mental Health (OMH) Serious Emotional Disturbance (SED) Waiver Department of Health (DOH) Care at Home (CAH) I/II waiver Office for People with Developmental Disabilities (OPWDD) Care at Home Waiver Office of Children and Families (OCFS) Bridges to Health (B2H) SED, Developmental Disability (DD) and Medically Fragile Waivers Alignment of 1915(c) HCBS under one array of Home and Community Based Services (HCBS) authorized under 1115 Waiver Remove the Managed Care exemption for children now in six 1915(c) waivers Transition to Health Home Care Management Care Management provided under 1915(c) Transition to Health Home Care Management Key Components 8 Transition of certain carved out Behavioral Health services into Managed Care benefit package Six New State Plan Services for Children Lifting the exemption of children in foster care with Voluntary Foster Care Agency (VFCA) to Managed Care (January 1, 2019) Expansion of Children s aligned HCBS eligibility to Level of Need Population (January 1, 2019) All services available to eligible members through both the fee-for-service and Managed Care delivery systems, based on the individual s enrollment
9 Current Service Delivery System Care Coordination limited to six 1915c Waiver Programs and OMH Targeted Case Management Slot limits Care planning is not integrated Limited array of Home and Community Based Services (HCBS) available only to 1915c Waiver Limited integration of behavioral health and physical health services System is underfunded After Transition 10 Health Home care management for children with two or more chronic conditions, serious emotional disturbance (SED), complex trauma, HIV (Children Health Home launched in December 2016) Current State Plan services PLUS Six new state plan services Expanded array of 12 HCBS based on expanded target, risk, and functional criteria with Health Home care management Integrate and transition behavioral health benefits to managed care plan Transition foster care population to managed care Encourage transitional care and continuity of care across children serving systems (education, child welfare, juvenile justice) Shift focus to quality, monitoring, and tracking and reward quality outcomes (value based payments)
11 Systems of Care Systems of Care 12 Rooted in a philosophy, set of values, and a framework through a coordinated network of community-based services and supports Organized to meet the physical, behavioral, social, emotional, educational, and developmental needs of children and their families Youth and family guide the process Supports are effective, build on the strengths of individuals and those that care about them, while addressing each person s cultural and linguistic needs Promoting wellness of children and youth across their lifespan
Project Goal NYS SOC will integrate evidence-based High Fidelity Wraparound (HFW) within NYS Medicaid Health Homes Serving Children (HHSC) High Fidelity Wraparound (HFW) a structured, team-based process that uses an evidencebased, nationally-recognized model that partners with families to use their voice and strengths to develop a family-driven plan that promotes self-advocacy.
Systems of Care Multi-system sharing of resources and responsibilities Array of necessary and appropriate services and supports Collaboration across systems and traditional funding silos Engage and support families in raising their children with health and resilience Helps children, youth, and families achieve success at home, in school, in the community, and throughout life 15 Systems of Care Values 1. Family driven 2. Youth guided 3. Community-based 4. Culturally and linguistically competent 5. Individualized and community based 6. Evidence based and community defined practices 16
17 Systems of Care 18 NYS ACHIEVE Project Partners
Integration of HFW in Health Homes 19 The ACHIEVE pilot creates opportunity to: evaluate outcomes associated with pairing HFW with Health Homes provide data for stakeholders, including Managed Care Plans, to assess the value of the HFW process develop best practices for integrating HFW process in Health Homes, within the context of the Children s Behavioral Health and Health Medicaid Redesign. 20 Substance Use Mental Health Child Welfare Juvenile Justice Managed Care Plan Education Six Core Services: Care Management, Care Coordination & Health Promotion, Transitional Care, Referral, Patient & Family Supports, HIT HH-HFW Care Manager, Family Peer and Youth Peer Child and Family Care Management Agency Health Home Primary Care Community
Wraparound-certified Team or Triad with caseload of 10 families each Care Manager NYS credentialed Youth Peer Specialist NYS credentialed Family Peer Support Specialist NYS ACHIEVE High Fidelity Wraparound TARGET CRITERIA In order for a child/youth to enroll in ACHIEVE in Erie, Rensselaer or Westchester County and receive High Fidelity Wraparound intervention, s/he has been determined: Health Home eligible by the NYS Health Home Serving Children criteria under the single qualifying condition of Serious Emotional Disturbance (SED), including enrollment in Medicaid; OR Health Home eligible by the NYS Health Home Serving Children criteria under the qualifying condition of Serious Emotional Disturbance (SED) but Medicaidineligible and cannot enroll in Health Home.
NYS ACHIEVE High Fidelity Wraparound TARGET CRITERIA AND s/he must meet the following criteria: Be between the ages of 12 and 21; AND Live in the community in Erie, Rensselaer or Westchester County in settings allowable by HH guidelines. Children/youth may be at imminent discharge from out of home or out of state placement at the time of ACHIEVE referral, when engagement may begin 30 days before discharge; AND Be willing to participate in ACHIEVE and the HFW process; AND Is involved with two or more service systems in the last 6 months (e.g., child welfare, special education services, juvenile justice, mental health and/or substance use); AND Have a CANS-NY Health Home score of high acuity; NYS ACHIEVE High Fidelity Wraparound TARGET CRITERIA AND s/he demonstrates documented evidence of: Being in crisis and in emerging/imminent risk of out-of-home placement, due to challenges living in the home and community; OR Returning to their home and community from out-of-home placement; OR Inpatient hospitalization (mental health, substance use or physical health) within the past 6 months; OR Multiple (i.e., two or more) inpatient hospital stays, emergency room use and/or CPEP/crisis services in the last 6-12 months.
Formalize a State training model to Support HFW Build County Capacity to Provide HFW Enhance Statewide Workforce Development to Replicate and Sustain HFW Contact NYS SOC Co-Directors Angela Keller Angela.Keller@omh.ny.gov Joanne Trinkle Joanne.Trinkle@omh.ny.gov
Additional New York State Integration Initiatives 28 HealthySteps
What is HealthySteps? 29 HealthySteps is an evidence-based primary care prevention program that assists the pediatrician and other health care providers to expand the primary focus beyond physical health to emphasize social-emotional and behavioral health and support family relationships. This is facilitated by the addition of Healthy Steps Specialist who is a professional with an expertise in child and family development. It starts with a HealthySteps Specialist A Healthy Steps Specialist (HSS) becomes an integral part of the primary care team. The HSS partners with families during well-child visits, coordinates screening efforts, and problem-solves with parents for common and complex child-rearing and other challenges. HSS are trained to provide tailored guidance and referrals, ondemand support between visits, and even care coordination and home visits when needed. This ensures families have access to the expertise and personalized support often needed to give their children the best start to life. 30
Components of a HealthySteps Site Enhanced well-child screening following a periodic schedule Maternal Depression screening and ACE screening Parent Education Groups Home Visiting as indicated Access to support between visits Connections to community resources Care coordination/systems navigation Positive parenting guidance and information 31 The Evidence 32
Why HealthySteps Matters 33 How Brains Are Built: Core Story of Brain Development OMH HealthySteps Sites 34 17 Healthcare Practices
OMH Healthy Steps Sites 35 FQHC, Hospital-Based Clinics, Community Health Centers, Private Practices Urban and rural settings High need communities High poverty rates 85% of children receive Medicaid/CHP or are uninsured Children disproportionately at risk for social and emotional concerns HealthySteps Three Day National Training Institute 36 A highly interactive learning experience, focusing on applying relationship-building strategies, practicing a strengths-based, family-centered approach, and working on case scenarios.
37 Three Day National Training Institute The HealthySteps training covers the following topics: Overview of the key components of the HealthySteps model Implementation strategies for office visits, practice management, and community networking Social determinants of health Role of attachment, toxic stress, and temperament Parental mental health and its impact on child development The importance of building trusting relationships with families Supporting parents by providing anticipatory guidance on their child s development As of June 30, 2017 827 Children were enrolled into HealthySteps Quarter ending June 30, 2017 CHILDREN ENROLLED ON CASELOAD 17 SITES 38 900 800 700 600 500 400 827 300 530 200 100 0 26 172 43 32 14 6 4 Pre 0-4 months 5-11 months 12-17 month 18-23 months 24-29 months 30-36 months 37-60 months Total children on caseload
Healthy Steps Resources NYS Implementation of Healthy Steps (i-hs) RFP: http://www.omh.ny.gov/omhweb/rfp/ Governor Cuomo Press Release https://www.governor.ny.gov/news/governor-cuomo-announces- 65-million-expand-mental-health-services-children-across-newyork Healthy Steps Website: http://healthysteps.org/ Healthy Steps YouTube https://www.youtube.com/watch?v=qjuoiza7lt0 39 40 Project TEACH
Better Health. Brighter Future. Project TEACH is a program funded by The New York State Office of Mental Health
Child and Adolescent Psychiatrist (CAP) workforce issues and distribution Approximately 8300 practicing CAPs in the U.S. 83% direct patient care 6900 CAPS NYS has among the largest number of CAPs of any state--but there is a significant disparity in distribution Rural and underserved areas in NYS and elsewhere are particularly hard hit 20% of 58 surveyed counties in NYS have no CAP. Another 15% have only one CAP (Kaye et al, 2009). Nearly all counties (53 of 58 surveyed) reported the need for additional CAPs (Kaye et al, 2009) 43 The Primary Care Advantage Longitudinal, trusting relationship Family centeredness Unique opportunities for prevention and anticipatory guidance Understanding of common social-emotional and learning issues in the context of development Experience in coordinating with specialists in the care of Children with Special Health Care Needs (CSHCN) Familiarity with chronic care principles and practice improvement Comfort with diagnostic uncertainty Jane Foy, MD, FAAP 44
Project TEACH Expand, Enhance, Coordinate First launched in 2010, Project TEACH has enrolled nearly 2,700 pediatric PCPs, providing consultation for over 11,000 children. Through a $1.4 million expansion, Project TEACH is set to: Enroll an additional 3,800 providers, and Provide an additional 24,500 New York children with behavioral health consultations by 2020. Recent RFPs help support this goal: Re-bid contracts for the Regional Providers who provide consultations, Created a Statewide Coordination Center to promote Project TEACH, increasing the utilization its services by practitioners, and to expand training opportunities and add specialty consultation. 45 46 Project TEACH Numbers Cumulative through 7/30/2017 Physicians Enrolled 2,682 Trainings 136 Phone Consults 11,218 Face to Face evaluations 1,671 Total Phone + Face-Face Consultations 12,889 Linkage Calls 3,808 46
VISION A New York State where children and families receive skillful, prompt and compassionate care for mental health conditions. 47 MISSION To strengthen and support the ability of New York s pediatric primary care providers (PCPs) to deliver care to children and families who experience mild-to-moderate mental health concerns. 48
The Way it Works Project TEACH provides consultation, education, training, and referrals and linkages to other key services for pediatricians, family physicians, psychiatrists, nurse practitioners, and other prescribers. 49 Telephone Consultations Project TEACH allows pediatric primary care providers (PCPs) to speak on the phone with child and adolescent psychiatrists. Ask questions, discuss cases, or review treatment options. Whatever they need to support their ability to manage their patients. 50
Face-to-Face Consultations PCPs can also request face-to-face consultations with child and adolescent psychiatrists for the children and families in their practice. If a PCP office would like to offer consultations via videoconference, Project TEACH regional provider teams can work with them to make this service available. It is our expectation that face-to-face consultations will occur within two weeks of PCP requests. All face-to-face consultations are followed by written reports to the referring prescriber(s). 51 Referrals and Linkages Linkage and referral services help pediatric primary care providers and families access community mental health and support services. This includes clinic treatment, care management, or family support. Project TEACH can refer PCPs to appropriate and accessible services that children and families in their practice need. 52
Training Project TEACH offers training in several different formats for pediatric primary care providers (PCPs). These programs support their ability to assess, treat and manage mild-to-moderate mental health concerns in their practice. 53 Core Trainings The core trainings are led by our regional provider teams on-site at PCP s practice or at a nearby location. Core trainings can be provided through a series of 2-3 hour sessions or in one longer program depending on PCP needs. Our regional provider teams cover assessment and management of the important mental health issues that children and adolescents face.
Intensive Trainings Project TEACH also offers specialized, in-depth programs in each region. These trainings address how to recognize, assess, and manage mild-to-moderate mental health concerns in children and adolescents. Online Training When possible, we provide access to on-demand content from our live trainings. Beginning in 2018, Project TEACH plans to offer more online training opportunities on a variety of topics.
Services Services are available throughout all of New York State. Simply locate your county on the map. Then use the contact information for your region to request a consultation. see map 57 Regional Map 58
Region 1: CAP PC Regions 1 and 3 University at Buffalo Jacobs School of Medicine and Biomedical Sciences University of Rochester School of Medicine and Dentistry SUNY Upstate Medical University Region 3: CAP PC Hofstra Northwell School of Medicine Columbia University Medical Center/ New York State Psychiatric Institute 59 C.A.P.E.S (844) 892-5070 Four Winds Saratoga Four Winds Westchester Region 2 60
Why Use Project TEACH Services? Services are easy to access just call! All consultations, trainings and referrals are at no cost for pediatric primary care providers and other prescribers who provide ongoing treatment to children.* It helps a PCP practice provide the best possible care to the children and families they serve. It improves the health of children and families in New York State. *Families with insurance may be billed for face-to-face consultations. 61 Statewide Coordination Center Operated by the Massachusetts General Hospital Psychiatry Academy Internationally renowned for education 65,000+ members in 125+ countries Live conferences, online courses, books, & more Provides clinical services, telehealth, & interim leadership to hospitals & health systems LEARN MORE www.mghcme.org 62
Statewide Coordination Center Includes the Expertise of the MGH Clay Center for Young Healthy Minds Blogs Podcasts E-Newsletter Social Media mghclaycenter.org 63 Project TEACH For further information: https://www.omh.ny.gov/omhweb/project_teach/