Transcript Outpatient Transformation

Outpatient
Transformation Updates:
- Recommendation Implementation
- Transformation Incentive Program
October 2011
Overview
 Background
 Goals
 Update Summaries
 Next Steps
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Background
 4 Workgroups comprised of 54 stakeholders
met from September 2010 – April 2011
(Clinical, Regulatory, Training & Workforce
Development, Finance)
 Generated 17 transformation
recommendations (combination of long &
short-term)
 OTIP advanced the implementation of some
recommendations. E.g., incorporating peer
personnel
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Goals
 Transform outpatient services into recovery &
resilience focused resources designed to creatively
address individualized needs
 Ensure outpatient services embrace & reflect service
domains & guiding values endorsed by DBHIDS
Practice Guidelines
 Achieve short & long-term operational improvements
& enhanced outcomes
 Frame the Health Choices commitment required to
support Outpatient services in 2011 & beyond
 Generate focused advocacy positions to serve as the
basis for discussions with the State & others
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Creating peer positions
 Focus
 Create peer staff positions in MH and D&A outpatient clinics to advance
recovery & resilience, promote peer culture & enhance engagement
 Create peer staff positions to support families of treatment recipients
 Update
 25 peer positions were added via OTIP. An analysis of these positions
will be conducted (structure, roles, effectiveness, etc.)

Additional OTIP contributions to peer culture
 Encouraged organizational readiness strategies among agencies
that have not begun to employ peers
 Encouraged hiring strategies among agencies prepared to employ
peers

A waiver request has been submitted to the State

40 additional peers will be trained by February 2012 (Certified Peer
Specialists/Behavioral Health Specialists)

A Certified Specialist/Behavioral Health Specialist Job Fair will be
convened in April 2012
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Expand Evaluation Options
 Focus
 Allow for a traditional psychiatric evaluation as an
alternative to the CBE for some service recipients
 Review & clarify current policies that allow for flexibility
regarding the incremental administration of the CBE
 Update
 Consideration is being given to the types of
assessments & evaluations to include in standard, innetwork, contract menus. E.g., CBE, MH Assessment,
Psych Eval, etc.
 A provider workgroup will be convened to address this
issue later in 2011.
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Centers of Excellence
 Focus

Establish specialized outpatient services tailored to address
the unique needs of specialized populations

Establish rate differentials
 Update

Two RFPs have been reissued for Centers of Excellence
initiatives. RFPs:



Develop a continuum of services for Children/Youth with Autism
Expansion of services for individuals exhibiting sexually
aggressive behaviors
A mobile mental health waiver (children & families) was
submitted to DPW in 2010 & subsequently rejected. The
waiver request will be reviewed, revised as needed, &
resubmitted to DPW.
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Centers of Excellence, cont.
 Upcoming Initiatives

Dialectical Behavioral Therapy (DBT) Training

Web-based tool allowing recovering persons
to convey status updates to providers prior to
treatment sessions.
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Annual “medication only”
recovery/service plans
 Focus

Recovery/service plans for adults who are
receiving “medication-only” services should
be required on an annual basis rather than
every 120 days or 15 visits.
 Update

Awaiting feedback and approval from
OMHSAS to start a Medication-Only pilot
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Same Day Determination
 Focus
 Review, clarify, reinforce &, if necessary, revise
existing regulations that promote rapid access to
outpatient services & discourage the establishment of
waiting lists

Establish an accountability protocol to monitor
compliance with this policy
 Update
 Reviewing current CBH contract requirements

Determine how to share this expectation with
providers. E.g., determine if clarification &
enforcement of current contract expectations is needed
or if a new contract stipulation is required
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Collateral contact reimbursement
 Focus

Amend MA regulations to allow collateral
contacts to be billed when service recipients
are not present but have given consent. E.g.,
contacts with family members/significant
people & other professionals.
 Update

A waiver request has been submitted to the
State
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Collateral contact training
 Focus

Outpatient providers will be trained to make
collateral contacts during therapy sessions
 Update

Trainers will be identified by January 2012
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Allow professional staff to sign
recovery/service plans (non-psychiatrists)
 Focus
 Trained, licensed/certified professionals with
at least a Master’s degree in mental health or
a related field who meet the minimum
standards set by their respective professional
organizations should be allowed to review &
sign recovery/service plans independent of
psychiatrists
 Update
 A waiver request has been submitted to the
State
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Workforce supervision
 Focus
 Provide direct service outpatient staff with regularly
scheduled, documented, high quality clinical &
administrative supervision
 Ensure outpatient supervisors are credentialed & have
mastered core competencies required to provide high
quality supervision
 Establish clinical supervision certification training &
credentials
 Develop strategies to verify & acknowledge high quality
supervision.
 Update
 Developing a work plan to review & evaluate current
Outpatient supervision practices
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Workforce education & training
 Focus


Partnerships should be developed with local educational
systems to create curriculums emphasizing recovery,
resilience & other priorities reflected in the DBHIDS Practice
Guidelines
Promote best practice training including demonstrated
competency
 Update


Establish an Education Workforce Steering Committee by
December 2011 that will include 5 local universities & focus
on developing behavioral health related degrees
Develop Practice Guideline Training for Outpatient Providers
by December 2011
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Integrated physical
& behavioral healthcare
 Focus
 Behavioral health outpatient services should
be co-located/integrated with physical health
services
 Update
 New initiative: Enhanced behavioral
healthcare in federally qualified health centers
 14 agencies are developing relationships &
protocols with primary healthcare practitioners
& health centers via OTIP
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Integrate behavioral healthcare
in non-traditional settings
 Focus:

Increase communication & collaboration
between primary care & behavioral health
providers to facilitate holistic care & promote
higher quality service
 Update

Community Coalition Initiatives
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Outpatient Care Coordinators
 Focus

Care Coordination positions should be
established to facilitate service linkages for
persons without case management & people
entering the system with urgent social &/or
physical needs
 Update

A waiver request has been submitted to the
State
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Mobile MH treatment
 Focus

Mobile outpatient treatment should be an
option for children & families not enrolled in
BHRS
 Update

A waiver request has been submitted to the
State
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Routine MH and D&A screening
 Focus
 Mental Health outpatient clinics should provide routine
D&A screenings for new applicants & refer people for
addictions outpatient services as needed. Conversely,
D&A outpatient providers should routinely screen for
mental health issues & initiate referrals for mental
health treatment when necessary.
 Update
 Several providers indicated their intention to employ
co-occurring screening tools via the OTIP initiative.
The OTIP evaluation will include an analysis of these
screening strategies.
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D&A Regulatory & Policy Issues
 Focus



DOH regulations should be revised to allow 1:35 caseloads
to be comprised of “active” versus “enrolled” participants.
DOH regulations should be revised to allow programs the
flexibility to establish their own governing structures
DBHIDS monitoring criteria should be revised to eliminate
redundancy with DOH expectations
 Update



Dialogue regarding State regulatory issues has been
initiated with the Director of the DOH Division of D&A
Waiver requests have been submitted to both DOH and
BDAP.
DBHIDS will review and revise local monitoring expectations
in coordination with the PIP Project
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Next Steps
 Pursue implementation of locally controlled
recommendations
 Continue collaboration with DPW and DOH
regarding recommendations requiring State
involvement
 Provide future updates to Executive Directors
& other stakeholders
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