Transcript Gary Blau presentation - National Technical Assistance

Transforming Mental Health
in America
Sybil Goldman, M.S.W.
Special Assistant for Children
Office of the Administrator
Gary M. Blau, Ph.D.
Chief, Child, Adolescent & Family Branch
Center for Mental Health Services
Substance Abuse, Mental Health Services Administration
“Imagination is the
beginning of creation.
You imagine what you
desire, you will what
you imagine and at
last you create what
you will.”
~ George Bernard Shaw ~
The President’s New
Freedom Commission
on Mental Health
Achieving the Promise:
Transforming Mental Health
Care in America
Transforming Mental Health Care
in America
“We envision a future when everyone with a mental
illness will recover, a future when mental illnesses can be
prevented or cured, a future when mental illnesses are
detected early, and a future when everyone with a mental
illness at any stage of life has access to effective
treatment and supports - essentials for living, working,
learning, and participating fully in the community.”
~ Presidents New Freedom Commission on Mental Health –
Achieving the Promise: Transforming Mental Health Care in America ~
4
President’s New Freedom
Commission on Mental Health
The Goals of a Transformed System
Goal 1
Americans Understand that Mental Health Is Essential
to Overall Health
Goal 2
Mental Health Care Is Consumer and Family Driven
Goal 3
Disparities in Mental Health Services Are Eliminated
* Includes 19 Key Recommendations
President’s New Freedom
Commission on Mental Health
The Goals of a Transformed System
Goal 4
Early Mental Health Screening, Assessment, and Referral
to Services Are Common Practice
Goal 5
Excellent Mental Health Care Is Delivered and Research Is
Accelerated
Goal 6
Technology Is Used to Access Mental Health Care and
Information
* Includes 19 Key Recommendations
Defining Transformation:
 A continuous and complex process
 New behaviors, new competencies
 New sources of power
 New partners
 Profound changes in structure, culture,
policy and programs
 Will not happen over night
7
The process of Transformation includes
three distinct types of activities:
• Continuous small
steps
• A series of exploratory medium
jumps, and
• A few big
jumps
8
Goal 1:
Americans Understand That Mental
Health Is Essential to Overall Health
Recommendations
1.1
Advance and implement a
national campaign to
reduce the stigma of
seeking care and a national
strategy for suicide
prevention
1.2
Address mental health with
the same urgency as
physical health
Goal 2:
Mental Health Care Is Consumer
and Family Driven
Recommendations
2.1 Develop an individualized plan
of care for every adult with a
serious mental illness and every
child with a serious emotional
disturbance
2.2 Address mental health with the
same urgency as physical health
Goal 2:
Mental Health Care Is Consumer
and Family Driven
Recommendations
2.3 Align relevant Federal programs
to improve access and
accountability for mental health
services
2.4 Create a Comprehensive State
Mental Health Plan
2.5 Protect and enhance the rights
of people with mental illnesses
Goal 3:
Disparities in Mental Health Services
Are Eliminated
Recommendations
3.1—Improve access to quality
care that is culturally
competent
3.2—Improve access to quality
care in rural and
geographically remote areas
Goal 4:
Early Mental Health Screening, Assessment,
and Referral to Services Are Common Practice
Recommendations
4.1—Promote the mental health of young
children
4.2—Schools should have the ability to play
a larger role in mental health care for
children
Goal 4:
Early Mental Health Screening, Assessment,
and Referral to Services Are Common Practice
Recommendations
4.3—Screen for co-occurring mental and
substance abuse disorders and link
with integrated treatment strategies
4.4—Screen for mental disorders in primary
health care, across the lifespan, and
connect to treatment and support
Goal 5:
Excellent Mental Health Care Is
Delivered and Research Is Accelerated
Recommendations
5.1—Accelerate research to promote
recovery and resilience and,
ultimately, to cure and prevent
mental illnesses
5.2—Advance evidence-based practices
(EBPs) using dissemination and
demonstration projects and create a
public-private partnership to guide
their implementation
Goal 5:
Excellent Mental Health Care Is
Delivered and Research Is Accelerated
Recommendations
5.3 Improve and expand the workforce
providing evidence-based mental health
services and supports
5.4 Develop the knowledge base for…
– Eliminating mental health disparities
– Assessing long-term effects of
medications
– Reducing impact of trauma
– Improving acute care
Goal 6:
Technology Is Used To Access Mental
Health Care and Information
Recommendations
6.1
Use health technology and
telehealth to improve access and
coordination of mental health care,
especially for Americans in remote
areas or in underserved populations
6.2
Develop and implement integrated
electronic health record and
personal health information systems
Federal Partners for Transformation
U.S. Department of
Health & Human Services
AoA
ACF
AHRQ
CDC
CMS
HRSA
IHS
NIH/NIDA
NIH/NIMH
HHS/OS
- ASPE
- OCR
- OD
- OPHS
SAMHSA
Other Partners
Dept. of Education
Dept. of Housing and
Urban Development
Dept. of Justice
Dept. of Labor
Social Security Adm.
Dept. of Veterans Affairs
White House Office of
Faith-Based Community
Initiatives
18
SAMHSA
Vision:
A Life in the Community for Everyone
Mission:
Building Resilience and Facilitating
Recovery for people with or at risk for
mental or substance use disorders
ACCOUNTABILITY
Measure and report
program performance
CAPACITY
Increase service
availability
“One SAMHSA”
EFFECTIVENESS
Improve service
quality
19
Each strand is individual
and unique. Woven
together they transform
into a strong and mighty
cloth.
Major SAMHSA Initiatives
 Implementing the Strategic Prevention Framework
 Building Substance Abuse Treatment Capacity:
Access to Recovery
 Addressing Needs of Youth and Adults with
Co-occurring Mental and Substance Use Disorders
 Transforming the Mental Health System
22
SAMHSA’s Children and
Families Workgroup
• Membership:
Key policy and program leadership for children across three
Centers & OA: CMHS, CSAP & CSAT
• Purpose:
Align SAMHSA vision, goals and activities to improve the
quality and availability of a comprehensive, integrated
continuum of services and supports — that includes
prevention, early intervention, and treatment —for children,
with or at risk for mental and/or substance use disorders, and
their families.
• Action Plan
23
More grows in the
garden than the
gardener sows.
~ Spanish Proverb ~
SAMHSA Matrix Action Plans
• Children and Families
• Strategic Prevention
Framework
• Mental Health
Transformation
• Co-occurring Disorders
Action Plans available online:
www.samhsa.gov
25
Children and Families two-year
Action Plan – Selected TA Strategies
• Resource/toolkit on SA and MH screening for use in
multiple settings
• TA document to help States use standardized screening
tools
• Resource document on primary care/behavioral health
interface: MH/SA screens of children 0 to 3 and their
caregivers, and facilitated referrals
26
Children and Families two-year
Action Plan – Selected TA Strategies
• Pilot project, “Transforming, Linking and Caring (TLC),”
links regional CMHS child-focused grantees to develop
continuum of care
• Financing guide on strategies for integrating funding
streams for SA and MH services and supports
• Prototype of individualized plan of care for children and
their families
27
Children and Families two-year
Action Plan – Selected Grant Opportunities
• Create and award Child and Adolescent State Infrastructure
Grants (SIG)
• Create new State Mental Health Transformation Grants (to
include children and families, and build on Child and Adolescent
SIG)
• Develop prototype grants to fund a State adolescent SA
treatment coordinator to build State infrastructure and capacity
for services integration
28
Children and Families two-year
Action Plan – Selected Collaborations
• Collaborate with Dept. of Education to expand schoolbased MH programs
• Collaborate with ASPE, ACF, CMS and Depts. of
Education and Justice on eliminating practice of
parents giving up custody for treatment
• National Child Traumatic Stress Initiative (increase
outreach to build new collaborative partnerships)
29
SAMHSA’s 4 Standard Grant
Announcements
• Services Grants – provide funding to expand and strengthen effective,
culturally competent mental health and substance abuse services
• Infrastructure Grants– support identification and implementation of
systems/structures, but not designed to fund services
• Best Practices Planning & Implementation Grants– help
communities and providers identify practices to effectively meet local needs,
develop strategic plans for implementing/adapting those practices, and pilottest practices prior to full-scale implementation
• Service-to-Science Grants – provide funds to document and evaluate
innovative—but not yet proven effective–practices that address service gaps
Note: Some funding opportunities do not fit standard announcements; separate standalone grant announcements will be published in those instances
30
“Frisbeetarianism is the
belief that when you die,
your soul goes up on
the roof and gets
stuck..”
~ George Carlin ~
T = (V + B + A) 
2
(CQI)
The Transformation Equation
Transformation 
(Vision  Belief  Action)  ( Continuous Quality Improvement )2
• The primary strategy of the Child, Adolescent & Family Branch for
transforming mental health involves helping states, local communities &
tribal organizations build strong systems of care. Key elements of this
strategy include:
– Vision that provides direction for the work we do
– Belief that guides the work we do
– Action that is taken to make our vision and beliefs a reality; and
– Continuous Quality Improvement which helps ensure that our actions
reflect the wishes and needs of the community being served
Center for Mental Health Services
Child, Adolescent and Family Branch
Vision
– All children and their families live, learn, work, and participate fully in communities
where they experience joy, health, love, and hope.
Mission
– Through investment and partnerships in home and community-based systems
of care, the Child, Adolescent and Family Branch promotes potential and the
well-being of children and youth who have, or are at risk of having, a serious
emotional or behavioral disturbance, and their families.
Accomplished by…
•
•
•
•
•
Embracing families and their cultures,
Eliminating disparities and fostering cultural and linguistic competence,
Establishing effective service delivery models,
Collaborating with other public and private child-serving systems and organizations, and
Ultimately transforming children’s mental health care across America.
Context
• CASSP Program begins in 1993
A budget of 4.9 million in when the CASSP program was
initiated.
Context
Children’s
Program Federal
Funding
Dollar ($) in m illion
$122
$112
$102
$96. 3
$102. 4
$98. 7
$91. 7
$92
$82. 8
$78. 0
$82
$70. 0
$72
$73. 0
$60. 0 $60. 0
$62
$52
$42
$35. 0
$32
$22
$12
$4.9
04
20
03
FY
20
02
Fiscal Year (FY) 2004 budget:
$102,353,000
FY
FY
20
01
20
00
FY
FY
20
99
19
98
FY
FY
19
97
19
96
FY
19
95
FY
19
94
FY
19
FY
FY
19
93
$2
System-of-Care Communities of the Comprehensive Community Mental Health
Services Program for Children and Their Families
Northwoods Alliance, WI
Willmar, MN
Lancaster County, NE
Nebraska (22 counties)
Bismarck, Fargo, & Minot, ND
Sacred Child Project, ND
Oglalla Sioux Tribe, SD
Northern Arapaho Tribe, WY
Milwaukee, WI
Lyons, Riverside, & Proviso, IL
Illinois (Chicago area)
Lake County, IN
Sault Ste. Marie Tribe, MI
Marion County, IN
Detroit, MI
Cuyahoga County, OH
Passamaquoddy Tribe, ME
Maine (4 counties)
Southern Consortium &
Vermont 1 (statewide)
Stark County, OH
Vermont 2 (statewide)
New Hampshire (3 regions)
Allegheny
County, PA
Worcester, MA
u
Rhode Island 1 (statewide)
Rhode Island 2 (statewide)
u Connecticut (statewide)
Mott Haven, NY
New York, NY
Westchester County, NY
Burlington County, NJ
u
South Philadelphia, PA
Delaware (statewide)
Baltimore, MD
Montgomery County, MD
Washington, DC
u
Alexandria, VA
Charleston, WV
u
Edgecombe, Nash, &
Pitt Counties, NC
North Carolina (11 counties)
North Carolina (10 counties)
3 counties & Catawba Indian Nation, SC
Charleston, SC
Greenwood, SC
Gwinnett & Rockdale Counties, GA
u
King County, WA
u
Clark County, WA
Four Counties, OR
Clackamas County, OR
Lane County, OR
Idaho
u
United Indian Health
Service, CA
u
u
Montana
u
u
u
u
Iowa
Glenn County, CA
Sacramento County, CA
u
u
Napa & Sonoma Counties, CA
Contra Costa County, CA
u
Oakland, CA
u
San Francisco, CA
Monterey County, CA
u
California 5 (Santa Cruz,
San Mateo, Riverside Ventura, &
Arkansas
Solano Counties)
Santa Barbara County, CA
u
Clark County, NV
u
San Diego County, CA
Rural Frontier, UT
Pima County, AZ
Navajo Nation
Eastern
u
Las Cruces, NM
Kentucky u
El Paso County, TX
Birmingham, AL
Colorado (3 counties)
Nashville, TN
Denver, CO
Yukon Kuskokwim
Louisiana (5 parishes)
Wichita, KS
Delta Region, AK
Jackson, MS
Oklahoma
Fairbanks, AK
St. Louis, MO
Travis County, TX
St. Charles County, MO
Ft. Worth, TX
Missouri
Parsons, KS
Wai'anae &
Guam
Choctaw Nation, OK
Leeward, HI
Puerto Rico
Hillsborough County, FL
West Palm Beach, FL
Broward County, FL
Funded Communities
Date
Number
Date
Number
9-1-93
2-1-94
9-1-94
11-1-94
u 9-1-97
u 10-1-98
4
7
9
2
9
13
u 11-1-98
9-30-99
5-1-00
7-1-00
10-1-02
9-30-03
1
20
1
1
18
7
Context:
System of Care Development Efforts
 Ninety-six systems of care grants and
cooperative agreements funded since 1993
 Each community funded for 6 years
 Forty-five communities have completed
federal funding phase (graduated)
Context:
System of Care Development Efforts
 Forty-eight States impacted by the
Children’s Program
 364 counties served by the Program
since 1993
 Number of children served:
More than 60,000
Philosophy of the Program
 Driven by the needs and preferences of the child
and family;
 Addressed through a strength-based approach;
 Focus and management of services occurs in multiagency and community base;
 Services, partners and programs are responsive to
cultural characteristics of the populations served and:
 Families are partners in all phases of the program.
Systems of Care as a Transformation Strategy
Beliefs
Family Involvement
Youth Involvement
Technical Assistance
Research
+
Actions
• Moving from family
involvement to family driven
• Fully embracing youth
involvement
• Integrating technical
assistance activities
x
(CQI)2
• Relentless
customer focus
• Council on
Collaboration
and
Coordination
• Opening the data set
• Establishing key benchmarks
• Family driven
System of Care
Transformation
• Recovery, resilience,
prevention - defining how
systems of care contribute
Cultural Competence
• Moving from concept to
reality. Tools & strategies
Site Improvement
• Improving the site visit
process
Council on Coordination & Collaboration
Priority Focus Areas
Continuous Quality
Improvement
Approach
Integrated & Coordinated
Technical Assistance
Research Agenda
Funded
Communities:
Transforming
Systems
of Care
Reducing Disparities
Transformation
Leadership
Family Driven
Youth Guided
Council for Coordination & Collaboration
Priority Focus Areas
1. Continuous quality
improvement
• Ensuring the
quality of outputs
and outcomes of
the sites, the
partners and the
Council.
Council for Coordination & Collaboration
Priority Focus Areas
2. Leadership to transform children’s
mental health
•
Synthesizing “lessons learned”
regarding best practices for
organizing and implementing
mental health services
to children and their families
with a focus on practical
outcomes of care.
•
Strengthen overall program goals and activities.
•
Move from “good” to “great.”
•
Define recovery and resilience for children and
families.
Council for Coordination & Collaboration
Priority Focus Areas
3A. Family Driven
• Define “family-driven”
• Strengthen roles of families in systems of
care
• Lessons learned about family
involvement
• Further develop concept of family choice
• Develop concept of youth guided care
Council for Coordination & Collaboration
Priority Focus Areas
3A. Family Driven
• Define “family-driven”
• Strengthen roles of families in systems of
care
• Lessons learned about family
involvement
• Further develop concept of family choice
• Develop concept of youth guided care
Council for Coordination & Collaboration
Priority Focus Areas
3B. Youth Guided
• Develop National
Youth Development
Board
• Protocols and
orientation for youth
attending local and
national meetings
Council for Coordination & Collaboration
Priority Focus Areas
4.
Reduce disparities and enhance cultural and
linguistic competence among policy-makers,
administrators and service providers
• Emphasize essential role of
cultural & linguistic competence
in achieving the vision &
mission of the Branch and the
Program.
• Enhance organizational capacity
for cultural and linguistic
competence.
Council for Coordination & Collaboration
Priority Focus Areas
4.
Reduce disparities and enhance cultural and
linguistic competence among policy-makers,
administrators and service providers
• Increase awareness and
knowledge of factors that
contribute to disparities.
• Develop specific approaches
that contribute to the goal of
eliminating disparities.
Council for Coordination & Collaboration
Priority Focus Areas
4.
Reduce disparities and enhance cultural and
linguistic competence among policy-makers,
administrators and service providers
• Support Branch efforts to
implement principles and
concepts of cultural and
linguistic competence.
Council for Coordination & Collaboration
Priority Focus Areas
5.
Develop a research agenda to enhance the understanding of how to
develop and provide effective, efficient and coordinated services
within systems of care.
• Priority list of research areas to guide the national evaluation
• Searchable electronic knowledge management system
• Infrastructure for supporting activities of a National Evaluation
Data Users Group
• CQI report card
Council for Coordination & Collaboration
Priority Focus Areas
6.
Provide an integrated and coordinated approach to
technical assistance to CMHS system of care sites
• Develop a single coordinated
technical assistance plan and
feedback mechanism to meet
the needs of the community.
• Clarify for funded sites the
roles and assistance provided
by Federal Partners
Council for Coordination & Collaboration
Priority Focus Areas
6.
Provide an integrated and coordinated approach to
technical assistance to CMHS system of care sites
• Develop peer-to-peer network
• Review strategies for reducing
paperwork requirements of
sites. Identify areas of
duplication of effort.
8
• Create CQI plan for Technical
Assistance Partners –
Consumer Technical Assistance
Program
Individualized Plans of Care
• Identify and promote the development of
guidelines for individualized planning of care that
focus on developing comprehensive, consumer
and family-driven service plans -with an
outcome of recovery and resiliency - that cross
various systems and funding sources.
Individualized Plans of Care
• Two-phase process
– Phase I, SAMHSA/CMHS will identify evidence-based
approaches to service planning and develop
guidelines for the implementation of such models.
– Phase II will include the convening of regional policy
academies for State-based teams to encourage the
implementation of such approaches and to refine the
guidelines based on State experiences.
Individualized Plans of Care
• Collaboration
– Collaboration between the CMHS Associate Directors
for Consumer and Medical Affairs, and the Child,
Adolescent, and Family Branch of the Division of
Services and Systems Improvement along with
consultation with the SAMHSA Medical Director.
Next Stage of Development for
Transforming Systems of Care
1) Strengthen the language regarding
implementing family involvement in
systems of care. This includes asking
applicants to operationalize how they
will address “family-driven” care.
2) Include additional requirements regarding
collaboration (e.g. identify priorities that are
consistent with the Action Agenda, including
Child Welfare and Juvenile Justice.
Collaboration
Language
Next Stage of Development for
Transforming Systems of Care
3) Develop specific requirements to ensure strong
linkages between local systems of care and
statewide transformation efforts. Require
applicants to provide examples and develop
a plan for how they will address this issue.
4) Require applicants to demonstrate how they will
coordinate with other relevant federally funded
initiatives, including the Mental Health Block
Grant, Safe Schools, Healthy Students…etc.
Coordination
Linkages
Collaboration
Language
Next Stage of Development for
Transforming Systems of Care
5)Add language requiring the
development of youth involvement
and youth leadership. Require Youth
Coordinator position.
Youth
involvement
Coordination
Linkages
Collaboration
Language
A problem can not be solved with the
same consciousness that created it.
~ Albert Einstein ~