Mental Health and Supported Employment: Opportunities to Provide Incentives for Evidenced Based Supp

1
Mental Health and Supported Employment
Opportunities to Provide Incentives for Evidenced
Based Supported

• September 17, 2009
• Denise Sleeper, Granite State Employment Project
• Sara Kendall, OR Competitive Employment Project

2
New Hampshire Granite State Employment Project
3
Systems Challenge

• Significant budget cuts and unclear
  administrative rules around employment practice
  led to strained relationships between the Bureau
  of Behavioral Health and Community Mental Health
  Centers. Employment outcomes have been marginal
  as a result.
• A recent State Health Authority Yardstick (SHAY)
  report identified the challenges and laid out
  explicit recommendations.

4
Innovation Proposed Systems Change

• Revise Administrative Rule to promote EBSE to
  clearly define
• competitive employment
• evidenced based practice supported employment
• work preparation
• how to bill for EBSE and what it includes
• Functional Support Services rate drops on
  10/15/2009 , but the EBSE rate stays the same

5
Role of the MIG

• Convener of stakeholders
• Conduit to Technical Assistance
• Connecting the dots to how the MIG can support
  existing goals as outlined in a recent SHAY
  report.
• Funding for initiatives
• Provider of the higher level perspective
• (Sometimes you cannot see the forest through
  the trees)

6
Key stakeholders, Roles

• State agencies
• NH Vocational Rehabilitation clear
  understanding of the EBSE model and how to share
  funding responsibilities.
• Providers
• Community Mental Health Centers in 10 Regions
  throughout the state. Identifying who are the
  early adopters of endorsing EBSE (discrepancy
  between CEOs with without a clinical
  background).
• Individuals
• Building consumer demand for employment services
  through outreach with Office of Consumer Affairs,
  Peer Support Networks, NH NAMI CMHCs.

7
Key stakeholders, Roles

• NCHSD
• Barbara Otto worked with the GSEP BBH to get
  to the core issues affecting the employment
  infrastructure within NHs Mental Health Service
  delivery system. Developed clear strategies and
  action steps. Connected NH to relevant
  information from other states.
• CMS
• NH recognized the importance of working
  collaboratively with CMS from the beginning.
  Shawn Terrell provided support to find out what
  NH can and cannot do. Provided excellent advice
  on CMS policies and how to shape changes to
  Administrative Rules.
• Dartmouth-Hitchcock Psychiatric Research Center
• Collaborated with BBH to create thresholds for
  Fidelity Review to shift perception from
  punitive to a quality improvement process.
  PRC hired an additional staff person to
• separate training functions from fidelity
  review.

8
Strategies for moving forward

• MIG Supported Strategies
• ? Funding
• ? On-going Technical Assistance Support
• ? Convening meetings to build stakeholder buy-in
• ? Assistance with operationalizing identified
  goals
• ? Development of the Employment Data System
• ? Development of strategies to pay for the
  outcomes desired
• ? Intensive review of regional CMHC to identify
  consumers
• who are eligible for the Medicaid Buy-In
  (MEAD)
• ? Outreach Education on MEAD, Work Incentives
  New
• Ticket to Work
• ? Continually promoting sustainability
• ? On-going development of Employment
  Professionals
• 
  Competency Model
• Training, Technical support, Financial support
• Role of key stakeholders in moving forward

9
Strategies to Sustain the Innovation

• Revision of Administrative Rules around
  employment
• Development of thresholds for Fidelity Review
• Creation of an EBP Advisory Council
• Developing NHs capacity to provide effective
  EBSE (Competencies Trainers Bureau)
• Developed a three Year Plan for Supported
  Employment
• Exploring paying for performance
• Strong collaboration with VR

10
OregonCompetitive Employment Project Oregon
Supported Employment Center for Excellence
11
Systems Challenge

• How to assist people (including those without
  Medicaid and/or indigent) who are diagnosed with
  serious mental illness to obtain and maintain
  meaningful competitive employment.

12
Innovation Proposed Systems Change

• County mental health providers conversion from
  day treatment to supported employment using the
  evidence-based practice Individual Placement and
  Support (IPS model) and fidelity scale developed
  by Johnson Johnson Dartmouth Community Mental
  Health Program.
• Pay providers to cover true cost of the IPS model

13
Role of the MIG

• Partner, Funder, Technical Assistance,
  Cheerleader
• MIG does not provide any direct services.
• Built relationships with key players in the
  systems change including state Mental Health
  administration, management, Portland State
  University staff, county mental health providers
  and peer support groups.
• At different times able to step in and move the
  relationship between Addictions and Mental Health
  Division and the Oregon Supported Employment
  Center for Excellence forward.
• Participated in hiring panel for Mental Health
  staff actively participate on OSECE Advisory
  Board, individual county mental health and the
  OSECE quarterly supervisors meetings.
• Provide funding including SE Peer Support
  component.

14
Key stakeholders, Roles

• State agencies
• Office of Vocational Rehabilitation Services
  (OVRS) and AMHD Co-planners and funders. AMHD in
  collaboration with CMS created a payment code for
  SE for those who reached fidelity as per J J
  Dartmouth model.
• Providers
• 17 county mental health providers including the
  2 who run the OSECE
• Individuals
• Rollin Shelton, MH PeerLink America
• Individual members of Frontier Leadership Network
  (Eastern Oregon)
• Individual members of MIG Leadership Council

15

• CMS
• Joe Razes and Effie Shockley worked with the MIG
  to redefine goals and performance outcomes for
  the grant, and this helped us identify the areas
  in which MIG staff could assist the OSECE as well
  as give them some ideas for expansion of
  services.
• And.MIG-RATS helped us to understand the kind
  of data the OSECE and PSU needed to collect
  beyond that required by J J Dartmouth to ensure
  sustainability.

16
Strategies for moving forward

• MIG Supported Strategies
• Funding
• Planning and initial implementation of the OSECE
• Infrastructure planning
• Outreach and education about OSECE
• Reviewing monitoring reports and outcomes and
  making recommendations for changes
• Providing training opportunities for
  participating providers in Employment Outcomes
  Professional model and
• Providing Work Incentives Network staff as
  participants in fidelity reviews.
• Promoting service by MIG Leadership Council
  members on OSECE Advisory Board.

17
Strategies to Sustain the Innovation

• Role of key stakeholders in moving forward
• Identifying, planning and assisting in writing
  grants for sustainability
• Providing support in legislative efforts to
  obtain state general funding and
• Providing work group through MIG Leadership
  Council to plan for long term sustainability
  efforts.

18
Discussion

• How did community mental health centers respond
  to the fidelity review process?
• How do your states fund other supported
  employment models or even other employment
  services for people with psychiatric
  disabilities?
• What kind of time was involved in working with
  our federal partners either at the Baltimore or
  regional level to get your house in order?