Transcript HC Statewide Expansion

OMHSAS
Advisory Committee Update
May 3, 2007
OMHSAS Updates



Reorganization Highlights
Staff Changes
Retirement Challenges
Commonwealth of Pennsylvania - Department of Public Welfare
Office of Mental Health & Substance Abuse Services (OMHSAS)
ORGANIZATION CHART
Deputy Secretary
Bureau of Planning &
Program
Development
Division of
Behavioral Health
Policy
Bureau of Financial
Management &
Administration
Division of Medicaid
Finance
Division of
Substance Abuse
Services
Division of Budget &
Administration
Division of Planning
& Program
Development
Division of Hospital
Operations
Bureau of Children’s
Behavioral Health
Division of
Children’s Policy &
Program
Development
Division of Service
Delivery
Bureau of
Community &
Hospital Operations
Division of Eastern
Operations
Division of Western
Operations
Division of Hospital
Operations
Office of the
Medical
Director
Quality
Management
Utilization
Management
Info Systems
Supporting our Journey: Aging
Forums; Evidence of Progress





Two recent Aging and Behavioral
Health Forums Held
Good representation at each Forum of
Aging and MH
Profiled Aging and D&A issues
Profiled successful collaborations
Lessons Learned from Case Reviews
Highlighted
Continuing our Journey: School Based
Behavioral Health: Setting the Stage



Secretary of Department of Welfare and Secretary
of Pennsylvania Department of Education; regular
meetings to address the education and the
behavioral health needs of students using an
integrated approach
Deputy Secretaries and key policy personnel from
DPW and PDE attend
Identification of issues and priorities established
Core Principles




The best education for a child is in the “least
restrictive environment: inclusive setting in her or
his ”home school”
Students who must be placed out of their “home
school” environments should experience such
placements for as brief a time as possible
Operations and policy changes must address the
set of incentives and disincentives that result in
keep children out of their “home schools”
PDE and DPW must jointly support the program
and fiscal design of school based behavioral health
services
Priority Projects

Partial Hospitalization


Education Law Center, PCPA, and advocacy
community raised issue regarding access to
education for children and adolescents receiving
mental health partial hospitalization services
during the school day
DPW and PDE agreed to develop policies and
practice standards regarding access to intensive
behavioral health services including partial
hospitalization
Priority Projects ( cont)

Partial Hospitalization


DPW Bulletins; PDE School Code Change
DPW Bulletins

Partial Hospitalization as short term stabilization

Family Driven; Youth Guided; IEP and ISPT occurring
at same time when able

Interagency team meeting/notice requirements to
“home school”

Interagency team meeting/discharge planning/notice to
“home school”
Supporting our Journey:
Housing



1. Summary Of a CRRS Conversion Process in Cumberland County. Total Dollar
amount converted: $505,812
In an effort to provide maximum opportunity for persons with mental illness to choose
their preferred housing and successfully maintain the residence of their choice, the
provider agency New Visions will, in collaboration with the County MH Program, will
reduce the number of CRRS beds from 16 to ten, provide case management support
services to 18 additional persons in community apartments, and support 9 persons in two
Fairweather Lodges. A Consumer-Run Drop-In Center will be developed in
Shippensburg.
The changes in numbers of persons served:







CRRS beds are reduced from 16 to10,
Thirty-one persons will receive Supported Living services in community apartments – an increase
of 18 individuals.
Two Lodges will provide for another 9 consumers.
This represents a change from 29 to 50 total consumers supported – twenty-one additional
persons supported in housing.
15-20 persons will chose to participate in the Drop-In Center.
In addition, the Cumberland County Housing Authority will offer Section 8 rental v ouchers to all
persons leaving a CRRS , beginning in July 2007.
The Redevelopment Authority has donated a building for use as the second Fairweather lodge.
Supporting our Journey:
Housing



2. In the last three years of Fairweather Lodge operation in Erie
County, 50 separate individuals served in Lodges have moved to
successful employment.
3. In March 2007, 45 of 48 County MH Programs were represented
at an all day Conference in Harrisburg devoted to Training on how to
start and manage a Local Housing Options Team, a requirement for
all MH Programs for the current County Plan. It is anticipated that
the number of LHOTs that are fully operational will reach 35 by the
end of the 2007 calendar year.
4. Huntingdon, Juniata and Mifflin County MH Program is currently
converting a CRRS, to begin operation later in the 07/08 year. The
total budget for the CRRS is $322,000, and the conversion will
include conversion of that site to a Lodge and the development of a
new community based supportive living counselor/program, which,
will serve at least 20 new persons living independently in the
community.
Continuing our Journey: Peer
Supports


Fundamental element of Transformation; Consumer
Directed; Consumer Operated Services & Supports;
Choice in Peer Supports
Variety of Opportunities for Peer Work and Support










Mutual Support Groups
Community Support Programs
Recovery Specialists
Consumer Satisfaction Teams
Consumer- Run/Operated Services
Warm-lines
Drop-In Centers
Clubhouses
Patients’Rights Advocates
Certified Peer Specialists
Certified Peer Specialists




Five States and Washington DC have successfully developed
Medicaid funded peer supports (Georgia, South Carolina,
Hawaii, Arizona, and Iowa)
Pennsylvania submitted a State Plan Amendment to Center
for Medicaid /Medicare Services (CMS) which was approved
on February 22, 2007
Will provide for certified peer specialists to bill for specific
services to peers with mental illness
Finalizing:

Service Description Review & Approval Process

Licensing Process

Enrollment &Billing

Planning of Statewide Technical Assistance Days
Certified Peer Specialists





Certified Peer Specialist Bulletin will be issued May, 2007

Three Options

Existing MH Licensed Agency

Subcontract to MH Licensed Agency

Independent Peer Agency
Additional training and technical assistance ( Southeast
Mental Health Association current approved trainer) may be
available: Recovery Innovations Incl., formerly META
Services
Initiated discussion with OVR regarding funding of peer
specialist training and certification
Over 200 certified peers trained; billing will begin July 2007.
An array of peer supports and other consumer operated and
directed services to be maintained!
OMHSAS: Guiding Principles

The Mental Health and Substance Abuse Service system will
provide quality services that:

Facilitate recovery for adults and resiliency for children;

Are responsive to individuals’ unique strengths and needs
throughout their lives;

Focus on prevention and early intervention;

Recognize, respect, and accommodate differences as they
relate to culture/ethnicity/race, religion, gender identity and
sexual orientation;

Ensure individual human rights and eliminate discrimination
and stigma;

Are provided in a comprehensive array by unifying
programs and funding building on natural and community
supports unique to each individual and family;

Are developed, monitored and evaluated in partnership with
consumers, families and advocates;

Represent true collaboration with other agencies & service
systems
OMHSAS Objectives



Transform the children’s behavioral health
system to a system that is family driven and
youth guided.
Policy implementation of a “Call for Change”
to support recovery and resiliency in the
Adult Behavioral Health System
Assure that behavioral health services and
supports recognize and accommodate the
unique needs of older adults.
Children’s Objective
Transform the children’s
behavioral health system to a
system that is family driven
and youth guided.
Some Guiding Principles



Trauma informed culture should serve
as the background for all services to
children and adolescents
CASSP principles are assumed to be
part of the children’s Objective and
Supporting Projects
Youth and Family Teams will lead to a
transformation of the children’s
behavioral health system.
Children’s Supporting Projects
and Actions

Establishment of Child-Family Teams
to support Transformation


Establish an Institute to provide training,
support and monitoring of Youth and
Family Teams
Develop mechanism for Medicaid
payment of Youth and Family Team
process
Children’s Supporting Projects
and Actions

Create Home and Community Based
Alternatives to Residential Treatment




Develop a “White Paper” addressing current
environment, needs and recommendations for
creating alternatives to the current residential
treatment system
Change existing rules to permit small group
homes and therapeutic housing
Enroll Multi Dimensional Treatment Foster Care
as a Medicaid funded service
Maintain data base on RTF utilization
Children’s Supporting Projects
and Actions

Partner with Education to support the development
of effective school based supports and interventions







Have OMHSAS Children’s Advisory develop “White
Paper” on school based behavioral health services
Engage youth to get their perspective on school based
behavioral health services
Review and update the existing Memorandum of
Understanding with DOE, DOH, and DPW to detail
responsibilities for SBBH
Continue to build the relationship with DOE and
collaborate on projects such as SBBH Demonstration
Grants, Positive Behavioral Interventions and Supports,
etc.
Reduce admission to segregated programs
Identify efforts underway with BHMCOs on collaborative
efforts with schools
Enhance letters of agreement between Counties,
Children’s Supporting Projects
and Actions

Partner with Education to support the development
of effective school based supports and interventions







Have OMHSAS Children’s Advisory develop “White
Paper” on school based behavioral health services
Engage youth to get their perspective on school based
behavioral health services
Review and update the existing Memorandum of
Understanding with DOE, DOH, and DPW to detail
responsibilities for SBBH
Continue to build the relationship with DOE and
collaborate on projects such as SBBH Demonstration
Grants, Positive Behavioral Interventions and Supports,
etc.
Reduce admission to segregated programs
Identify efforts underway with BHMCOs on collaborative
efforts with schools
Enhance letters of agreement between Counties,
Children’s Supporting Projects
and Actions

Create Behavioral Health competency to honor the
strengths and address the unique individualized
needs of children and adolescents:









In the child welfare system
In, or at risk of entering, the Juvenile Justice system
In the drug and alcohol system
With Fetal Alcohol Syndrome Disorder
That are Deaf or Hard of Hearing
With Traumatic Brain Injury
With Autism Spectrum disorder or other Pervasive
Developmental Disorder
With Physical Disabilities
And infants and young children
Children’s Supporting Projects
and Actions

Develop a process for identifying and implementing
evidence based practices; promising practices and
culturally relevant practices



Utilize the SAMHSA National Registry of Evidence Based
Practice, the NASMHPD Research Institute, the National
Blue Print initiative and other sources to identify evidence
based and promising practices
Document the expansion of Multi Systemic Therapy,
Functional Family Therapy and other evidence based
practices in current practice
Develop the Youth and Family Team process as the
practice model for children’s behavioral health to support
evidence based practice
Children’s Supporting Projects
and Actions

Develop strategies to address the needs of
Transitional Youth





Support Youth involvement in the OMHSAS
Advisory Council
Obtain Youth input in identifying needs,
developing plans, implementing and monitoring
service development for Transition Youth
Summarize OMHSAS Transition Pilot projects
Identify existing initiatives in other agencies
Work with OMHSAS housing plan
Adult Objective
Policy implementation of
services to support recovery
and resiliency in the Adult
Behavioral Health System
Adult Supporting Projects and
Actions

Define and expand the range of and
financial commitment to consumer-run
services, supports and trainers



New Freedom Initiative Project
Gain baseline understanding of existing
consumer-run services, supports and trainers
statewide
Develop Centers of Innovation around
Evidence-based and Promising Practices

Review national models and define the
Pennsylvania model
Adult Supporting Projects and
Actions

Support community re-integration of
individuals who have been in state
hospitals over 2 years

Close at least 2 state hospitals by 2010
by


Development and implementation of
individual community support plans
Development of community infrastructure
Adult Supporting Projects and
Actions

Implement an integrated system of
services and support for co-occurring
mental health/drug and alcohol
recovery




Identify how to increase co-occurring and
substance abuse awareness and
activities within OMHSAS
Develop joint licensing standards
Issue guidelines around D&A
confidentiality
Develop practice standards for co-
Adult Supporting Projects and
Actions

Implement the recommendations of the
Housing Workgroup




Assure that every county/joinder have develop a
housing plan using the OMHSAS Housing Plan
template
Implement and evaluate the Allegheny SSI
Supplement Demonstration project and develop
plan for statewide implementation
Develop strategies and convert at least $1 mil in
CRR beds to supported housing
Policy development regarding use of public
mental health funds in Personal Care Boarding
Homes
Adult Supporting Projects and
Actions

Implement, monitor and expand peer specialist
services







Enroll providers statewide, assuring availability of at least
2 programs offering peer specialists in each county/joinder
Assure availability of peer specialist certification training
Assure formalized peer support structures are available for
peer specialists
Develop the capacity for certified peer specialists to serve
specific populations – older adults, individuals involved in
criminal justice system
Work in collaboration with the Bureau of Drug & Alcohol
Programs to develop use of certified peer specialists in the
drug and alcohol system
Examine the use of consumer run peer specialist
“employment agencies”
Identify specific outcome measures for Quality
Improvement monitoring
Adult Supporting Projects and
Actions

Implement recommendations of the
Forensic Workgroup




Partner with PMHCA to develop
resources to support Certified Peer
Specialists in serving individuals in the
Criminal Justice system
Work with the Governor’s Office on crosssystems task group
Inventory existing community diversion
and re-entry services
Support Allegheny county national
Adult Supporting Projects and
Actions

Develop plan for expanding Employment
opportunities to support recovery

Collaborate on the delivery of trauma
informed care


Work with Hospital Association of PA to eliminate
seclusion and restraint in community hospitals
Target resources to plan for the expansion of
trauma-informed care statewide for individuals,
including:

Transition age youth, returning veterans, individuals
involved with the criminal justice system
Adult Supporting Projects and
Actions

Restructure the Medicaid State Plan to
support recovery and resiliency

Review current regulations and
revise/develop regulations supporting
recovery/resiliency-oriented services
Older Adult Objective
Assure that behavioral
health services and
supports recognize and
accommodate the unique
needs of older adults.
Older Adult Supporting
Projects and Actions

Expand access to services for older
adults with the flexibility to provide
services wherever they are


Ensure that implementation of peer
services includes training of older adults
as providers of the service to older adults
as well as younger adults
Monitor access of peer specialist and
mobile mental health services to older
adults.
Older Adult Supporting
Projects and Actions

Increase awareness of and planning
for suicide prevention for older adults


Adopt at least one recommendation of
the Suicide Prevention Plan for Older
Adults.
Coordinate an annual Suicide Prevention
Day in Harrisburg
Older Adult Supporting
Projects and Actions

Review the impact of dual eligibility on
service provision




Compile Medicare and Medicaid inpatient and
outpatient date for older adults.
Develop information and resources to help older
adults better understand services under
Medicare and Medicaid
(OMHSAS/AGING/APPRISE)
Use regional behavioral health Older Adult
forums to share information on
Medicare/Medicaid
Increase collaboration with Area Offices of Aging
Older Adult Supporting
Projects and Actions

Expand access to the interagency
planning project for older adults with
complex needs


Compile information for case reviews
Encourage greater county participation
through access to training and continued
collaboration with Aging
Older Adult Supporting
Projects and Actions

Increase awareness of needs of older
adults for substance abuse treatment
and programs structured to
accommodate those needs in a
culturally competent manner


Identify facilities appropriate to serve
older adults
Define type of services older adults are
likely to use by getting their feedback
Older Adult Supporting
Projects and Actions

Ensure community consumer
involvement by providing support to
individuals transitioning from South
Mountain Restoration Center into
communities where they live.


Ensure consumer participation in
discharge planning teams.
Ensure consumer resources are
identified and utilized in community
where they return
Older Adult Supporting
Projects and Actions

Continue to assure appropriate mental
health services are available to older
adults experiencing dementia who
have behavioral health problems


Continue to monitor complaints or
concerns regarding access to care.
Engage in educational efforts with public
and managed care partners.
Older Adult Supporting
Projects and Actions

Develop a collaboration with physical
health partners (Home Health, Visiting
Nurses Assn, etc.) to promote
behavioral health screenings for older
adults

Assess willingness of MCOs/providers to
partner on provision of screenings
Older Adult Supporting
Projects and Actions

Ensure an active role for the Older
Adult Advisory Committee in the
Money Follows the Person (MFP)
project

Older Adult Committee will identify
representatives to serve on the MFP
Advisory Work Group anticipating receipt
of grant award.
Older Adult Supporting
Projects and Actions

Support efforts to promote a study of
Older Adults through the Legislative
Budget and Finance Committee
(LBFC)


When presented with a request for
legislative analysis, respond with positive
support and background research on the
bill soon to be introduced.
Advisory Committee members may
advocate for support, either as individuals
or members of their respective
What Will It Take to Support Our
Change?

Culture Change




Consumer and family voice is central to design,
implementation and oversight of system change
Opportunities must be made available for
consumers, families and advocates to challenge,
question, confirm assumptions of what is
meaningful to them.
A variety of options must be made available, to
include education, supported employment,
competitive employment
Stakeholder investment


Common Vision
Providers must be provided opportunity to
change practice
Recovery
Recovery
Recovery is remembering who you are
through the darkness and using your
strengths to become all that you were
meant to be
Support the Journey~
Transition from the past to the future.
Drawing by Brenda Wagner
“There are two ways to look at your life. One is as though nothing is a miracle; the other is as
though everything is.” – Albert Einstein