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Department of Mental Health

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Department of Mental Health Overview Presentation for the Autism Commission January 24, 2011 Barbara Leadholm, Commissioner * * * * * * * * * * * . * * * * * * * DMH ... – PowerPoint PPT presentation

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Title: Department of Mental Health


1
Department of Mental Health
  • Overview Presentation for the
  • Autism Commission
  • January 24, 2011
  • Barbara Leadholm, Commissioner

2
DMH Statutory Mandate
  • DMH operates pursuant to Massachusetts state
    statute, Mass. Gen. L. ch. 19, and DMH
    regulations
  • DMHs statutory mandate provide treatment and
    services to citizens with long-term or serious
    mental illness(es) and research into causes of
    mental illness
  • DMH
  • Provides or arranges for DMH services for adults
    and children for whom services authorized,
  • Establishes standards and policies to ensure
    effective and culturally competent care that
    promotes recovery and self-determination and
    protects human rights, and
  • Supports mental health training and research

3
DMH Vision/Mission
  • The Department of Mental Health vision is
    Community First
  • DMH ensures that individuals authorized for
    services have access to services and supports to
    enable them to live, work, attend school, and
    live and participate as independently as possible
    in their communities.
  • "Recovery Through Partnership" is the
    Departments guiding principle that supports our
    ability to attain this CF vision for adults,
    children, adolescents and families.

4
DMH Community First Focus
  • Accomplish vision by partnering with individuals,
    families, providers and communities.
  • Strive to ensure DMH delivery system
  • Is client/family-centered,
  • Driven by client outcomes and experience
  • Increasingly relies on a peer workforce
  • Promotes recovery
  • Meets individuals changing needs as move through
    community and inpatient systems of care

5
DMH StructureSince July, 2010, DMH organized
into 3 geographic regions Central-West,
Northeast-Suburban and Metro-Southeast
6
DMH Funding FY2011 Budget is 621.9M
7
DMH Allocation of FundsMajority for
Community-based Services
8
DMH Clients/Service Authorization
  • DMH provides services for approximately 22,000
    individuals (2,400 youth and 19,000 adults)
  • Determining whether to authorize DMH services for
    an individual depends on an assessment of
    whether
  • Individual meets the clinical criteria for DMH
    services
  • Individual requires DMH services and has no other
    means for obtaining them
  • DMH has available capacity.

9
Service Authorization Clinical Criteria
  • To meet clinical criteria for DMH services
    applicant must
  • Have qualifying mental disorder as primary
    disorder requiring treatment, and
  • Meet functional impairment and illness duration
    criteria
  • For Adults applicant must have serious and long
    term mental illness resulting in functional
    impairment that substantially interferes with or
    limits one or more major life activities
  • Serious and long term mental illness is disorder
    of thought, mood, perception, orientation, or
    memory that grossly impairs judgment, behavior,
    capacity to recognize reality, and results in
    inability to meet ordinary demands of life.
  • For Youth applicant must be 18 ¾ years of age or
    younger at time of application and have
    qualifying mental, behavioral or emotional
    disorder
  • DMH utilizes SAMHSA definition for Serious
    Emotional Disturbance) that substantially
    interferes with or limits his/her role or
    functioning in family, school, or community
    activities

10
Service Authorization - Clinical Criteria
  • Applicant diagnosed with one or more of following
    disorders/conditions must also have qualifying
    mental, behavioral or emotional disorder to meet
    clinical criteria for DMH services
  • Disorders usually first diagnosed in Infancy,
    Childhood or Adolescence
  • Conditions considered delirium, Dementia and
    Amnestic and other Cognitive Disorders
  • Conditions considered Mental Disorders due to
    general medical condition not elsewhere
    classified e.g., traumatic brain injury
  • Conditions considered Substance-Related
    Disorders
  • Conditions under the category of Attention
    Deficit/Disruptive Behavior Disorders Conduct
    Disorder, Oppositional-Defiant Disorder,
    Disruptive Behavior Disorder NOS

11
DMH Service Authorization Process
  • DMH acknowledges applications received within 7
    days of receipt.
  • DMH Clinical Service Authorization Specialist may
    request, as necessary, face-to-face meeting with
    applicant and/or legal representative, and with
    children, parents, to discuss and assess needs of
    applicant. Meetings occur at DMH offices, or, in
    the case of children, where family requests.
  • Area child Adolescent Psychiatric Medical
    Directors review applications and confirms
    clinical criteria met, there is need for
    DMH-specific services and there is service
    capacity.
  • Short-term services, which may include DMH case
    management or other DMH-operated or contracted
    services, may be provided to individuals who
    applied for DMH services while application
    processed (6-8 weeks typically)
  • Provision of short-term services does not
    indicate that application will automatically be
    approved, nor does it assure that short term
    services will continue if the application is
    approved.

12
DMH Service Authorization Process (contd)
  • DMH Area Director or designee makes decisions
    regarding
  • service authorization determination
  • Timing
  • When applicant hospitalized at time of
    application, service authorization determination
    rendered within five (5) days after receiving
    necessary information
  • For other applicants DMH determines whether
    applicant meets clinical criteria within 20 days
    of receipt of completed application
  • If DMH determines applicant meets clinical
    criteria for DMH services, DMH determines within
    20 days from clinical determination whether
    applicant needs DMH services
  • All decisions must be made within 90 days after
    DMH receives application
  • Area Director or designee may extend time period
    for good cause
  • Applicant is informed of decision

13
DMH Services
  • Community-based Services include
  • Community Based Flexible Supports (CBFS)
  • Program of Assertive Community Treatment (PACT)
  • Clubhouses
  • Case Management
  • Recovery Learning Communities
  • Forensic - Court Clinic and Jail Diversion
    services
  • Respite Services
  • Homeless Support Services
  • Child and Adolescent Residential Services
  • Child and Adolescent Flexible Supports

14
DMH Services Brief Descriptions
  • Community Based Flexible Supports (CBFS)
  • CBFS was implemented in July 2009 via a
    competitive procurement process and replaced
    freestanding delivery of adult residential and
    community-based rehabilitation services. CBFS
    contractors work with clients to develop
    individual service plans that meet their
    individual level of service needs.
  • Program of Assertive Community Treatment (PACT)
  • PACT is a multidisciplinary team approach for
    providing ongoing, community-based treatment,
    outreach and rehab services often serving
    individuals who previously have been unable to
    engage in their treatment.
  • Clubhouses
  • Comprehensive, self-help community-based centers
    that provide support, outreach, psycho-social
    rehab services and a range of employment services
    including assistance with placement and
    maintenance of independent work.
  • Case Management
  • State-operated services that provide service
    authorization, screening, assessments,
    information and referral, family and caregiver
    support, and case management/monitoring services
    for those individuals in the community who are
    not enrolled in CBFS.
  • Recovery Learning Communities
  • Consumer-operated networks of self help/peer
    support, offering advocacy, certified peer
    specialist and other training, supportive groups,
    and information and referral services.
  • Respite Services
  • Temporary community-based living arrangements
    often used to help individuals transition from
    acute inpatient care and sometimes for diverting
    an acute admission.
  • Homeless Support Services
  • Comprehensive screening, engagement,
    stabilization, needs assessment and referral
    services for adults residing in shelters.

15
DMH Services Brief Descriptions (contd)
  • Child/adolescent services Childrens Behavioral
    Health Initiative (CBHI)
  • Pursuant to the settlement of a court case known
    as Rosie D, in the spring of 2009, the
    MassHealth Office of Behavioral Healths managed
    behavioral health contractor Massachusetts
    Behavioral Health Plan (MBHP) in conjunction with
    the other MassHealth-contracted managed care
    entities, selected provider agencies to serve as
    Community Service Agencies (CSAs) to provide
    Intensive Care Coordination (ICC) and family
    support services, as well as in-home behavioral
    services and therapeutic mentoring, based on the
    wraparound model, to youth and their families
    determined eligible. There are currently 29
    contracted CSAs operating statewide, including
    three that offer culturally specialized services.
  • Child and Adolescent Residential Services
  • These are community-based therapeutic services
    provided in supervised community-based
    residential settings, often provided in
    conjunction with treatment and rehabilitative
    services. DMH is in the process of reprocuring
    these services jointly with the Department of
    Children Families (DCF).
  • Child and Adolescent Flexible Supports
  • This is principally a set of services and funding
    to assist families with obtaining services and
    supports including therapeutic after school
    services, therapeutic groups and other family
    training and supports.

16
DMH Services Brief Descriptions (contd)
  • Forensic Court Clinic and Jail Diversion
  • Court Clinic services include court-based
    forensic mental health assessments and
    consultations for persons who are facing criminal
    or delinquency charges and civil commitment
    proceedings. These court-based services involve
    the provision of individual statutory and
    non-statutory evaluations regarding persons with
    mental health and substance abuse difficulties as
    well as mental health liaisons to adult and
    juvenile justice court personnel.
  • The Forensic Transition Team provides reentry
    services for DMH clients who are transitioning
    from prisons, jails and other places of detention
    to the community.
  • Jail Diversion DMH operates jail diversion
    activities in partnership with other agencies on
    federally-funded projects aimed at minimizing or
    preventing the involvement of persons with mental
    health histories in the criminal justice system

17
DMH FacilitiesDMH also provides and directly
funds Inpatient Continuing Care services (143M
in FY10)
18
Other DMH Functions
  • Quality Management/Contract Performance
    monitoring
  • Facility Licensure
  • Investigations
  • Training (e.g. trauma-informed care, restraint
    reduction, wellness promotion)
  • Mental Health Services Research DMH contracts
    with two academic Centers for Excellence
  • Collaboration with MassHealth Office of
    Behavioral Health regarding
  • management of managed behavioral health services
    and
  • implementation of Childrens Behavioral Health
    Initiative

19
DMHs Quality/Performance Management Vision
Better Utilize Data and Consumer Experience to
Continuously Improve Program and Fiscal
Performance and Accountability
  • Strategy
  • Identify person-level outcomes and system-level
    performance measures for all state-operated and
    contracted services.
  • Develop mechanisms for providers to submit
    person-level data to DMH.
  • Routinely solicit consumer input into policy and
    program development and improvement
  • Implement wide-scale mechanisms for effectively
    measuring consumer experience with specific
    services delivery system
  • Enhance DMH data capabilities to produce reports
    on performance
  • Establish Area and Statewide Performance
    Management teams to monitor performance, and
    recommend program and policy changes for
    improvement.

20
DMHs Quality/Performance Management Process
Measurement Examples
  • DMH Inpatient System
  • Decrease number of reported incidents of
    restraints in DMH inpatient facilities per 1000
    patient days
  • Increase number of DMH patients in continuing
    care facilities on antipsychotic mono-therapy
  • Increase percentage of individuals discharged
    from DMH continuing care facilities within 180
    days of admission
  • Increase percentage of people who report
    satisfaction with quality of care
  • Community Based Flexible Supports (CBFS)
  • Increase percentage of people served who are
    employed
  • Increase percentage of people served who remain
    in the community (without hospital, de-tox,
    skilled nursing facility admissions or
    incarceration)
  • Decrease number of people served who are arrested

21
DMH Private Facility Licensure
  • Facility Licensure
  • DMH Inpatient Continuing Care beds (656
    including 30 adolescent beds) represent less than
    25 of the total inpatient psychiatric beds
    operating in the Commonwealth of Massachusetts.
  • DMH oversees the licensure of approximately 2407
    beds in 65 private psychiatric facilities
  • private acute psychiatric hospitals and
    behavioral health units in general hospitals
  • intensive residential treatment programs for
    children
  • DMH ensures that licensed hospitals are in
    compliance with regulatory requirements based on
    bi-annual licensing survey

22
DMH Investigation Functions
  • The Office of Investigations
  • Investigates allegations of abuse by DMH
    providers/employees and at DMH licensed
    facilities pursuant to DMH regulations 104 CMR
    27.00 and 32.00 through investigatory work in
    response to complaints and critical incidents.
  • Investigates issues related to workplace
    violence, stalking and hostile workplace violence
    complaints.
  • Is responsible for providing all local Police
    Departments with mental health background checks
    on individuals applying for FID cards, LTCs and
    all other applications for Firearms Permits.
  • Submits CORI requests to the Massachusetts
    Department of Criminal Justice Information
    Services on behalf of DMH on all DMH applicants
    to whom a conditional offer of employment has
    been made.

23
DMH Contracts with Research Centers of Excellence
  • UMASS Center for Mental Health Services Research
  • BIDMC Commonwealth Research Center for clinical
    neuroscience and psychopharmacological research
  • DMH Guiding Priorities for Research
  • Culturally competent research and evidence-based
    practices
  • Consumer Involvement in Research
  • Dissemination of Research Finding to Accelerate
    the adoption of evidence-based practices

24
DMH and Individuals with ASDs
  • DMH provides linkages or educational advocacy
    during application process before applicant
    ultimately denied for DMH services
  • There are many instances in which children are
    approved for services but it becomes evident that
    they have an autism spectrum illness and
    different set of services needed. In these
    instances, as long as DMH feels providing our
    services is helpful to the youth/family we
    strongly consider continuing them.
  • System tailored to individuals with primarily
    serious and persistent mental illness/serious
    emotional disturbance. Majority of clients are
    those with
  • schizophrenia and other psychotic disorders
    (66),
  • bipolar/psychotic depression (30) and
  • others, such as those with problematic sexual
    behaviors (4)
  • Individuals without these diagnoses often unable
    to benefit from DMH service system/clinical
    services.

25
Improving EOHHS Delivery System for Persons on
Autism Spectrum
  • See opportunity for EOHHS agencies to collaborate
    to create services, including residential,
    specifically tailored to needs of individuals on
    ASD spectrum.
  • DMH, as mental health authority, can provide
    expert consultation to ensure that EOHHS delivery
    systems meet behavioral health needs of
    individuals served.

26
Resources
  • For information about DMH, including services
    covered and how to apply for them, human rights,
    and contact information go to www.mass.gov/dmh.
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