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Mental Health Transformation

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Mental Health Transformation A Long History of MH Transformation in Texas Prior to HB 2292 COPSD Jail Diversion Benefit Design Post HB 2292 Resiliency and Disease ... – PowerPoint PPT presentation

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Title: Mental Health Transformation


1
Mental Health Transformation
2
A Long History of MH Transformation in Texas
  • Prior to HB 2292
  • COPSD
  • Jail Diversion
  • Benefit Design
  • Post HB 2292
  • Resiliency and Disease Management
  • Consolidation of MH, SA and PH
  • MH Transformation Grant and TWG
  • POLR
  • Crisis Redesign

3
MENTAL HEALTH TRANSFORMATION THE FEDERAL VISION
  • We envision a future when everyone with a
    mental illness will recover, mental illnesses can
    be prevented or cured, mental illnesses are
    detected early, and 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.

4
MENTAL HEALTH TRANSFORMATION THE PROBLEM
  • In any given year, one in 4 Texans suffer from a
    diagnosable mental disorder.
  • Mental disorders are the leading cause of
    disability for ages 15-44.
  • The number of suicides in Texas has increased by
    15 in the last 5 years. This number is 55
    higher than homicides and 134 higher than those
    who died from HIV.
  • People with serious mental illness served by the
    public mental health system die, on average, 25
    years earlier that the general population.
  • 75 of all persons with mental illness smoke
    persons with mental illness consume 44 of all
    cigarettes nationally.

5
BEHAVIORAL HEALTH ISSUES IMPACT OTHER SYSTEMS
  • 75 of children placed in foster care have
    parents with behavioral health problems
  • 30 of adults in correctional institutions have
    received mental health
  • services
  • 26 of persons served through vocational
    rehabilitation have behavioral health problems
  • 48 of youth served by TYC have serious emotional
    disturbances
  • 26 of all hospital discharges are related to
    mental health or substance abuse problems
  • 46 of all ER visits have behavioral health
    issues as a basic or contributing factor

6
TEXAS MENTAL HEALTH TRANSFORMATION
PROBLEMS ADDRESSED BY TRANSFORMATION
  • Lack of Recovery/Resilience-focus
  • Fragmentation agency silos continuity of care
  • Disparities in servicesrace/ethnicity
    geographic
  • Lack of adequately trained human resources
  • Lack of Coordination of health and MH services
  • Use of technology/data not optimal

7
Bridging the Quality Chasm
Recovery/Resilience Promising and Evidence Based
Practice Information Technology
The behavioral health care that we know to be
effective
The behavioral health care that Americans receive
8
Information Technology The Electronic Bridge
  • Collaborative planning and record sharing across
    service systems
  • Increased access to services in underserved areas
  • Reduced fragmentation of services
  • Workforce development
  • Public information and education

9
TRANSFORMATION INITIATIVES
  • Consumer voice Policy, Practice, Evaluation
  • Partnerships - state agencies, local entities,
    consumers and family members
  • Special initiatives peer support, housing,
    employment, school-based services, criminal and
    juvenile justice, older adults
  • Workforce development
  • Technology / data
  • Community Collaboratives

10
Community Collaboratives
Tarrant Transformation Project
West Texas Community Coalition
Dallas County Unified Public Mental Health
Initiative
Nacogdoches County Mental Health collaborative
Terrell County Behavioral Health Collaborative
Williamson County Mental Health Task Force
Bexar County Safety Net Community Collaborative
Selected Urban Communities
Coastal Bend Rural Health Partnership
Selected Rural Communities
Selected Border Communities
11
Mental Health Transformation Website
  • www.mhtransformation.org

12
Crisis Services Redesign
13
Crisis Services Redesign Committee
  • Last year a Committee was formed which included
    representatives from
  • NAMI
  • Advocacy Groups
  • State and Private Hospitals
  • Mental Health Professionals,
  • Mental Health Support and Related Prevention
    Groups.
  • Physicians
  • Law Enforcement and Judiciary
  • DSHS
  • Community Mental Health Centers
  • The recommendations from that group are guiding
    the course for Crisis Redesign now in its
    Implementation Phase.

14
Goals of Crisis Redesign
  • A state-wide system of crisis services
  • with the goal of improving
  • Accessibility
  • Standards of care
  • Community involvement
  • Consumer choice
  • Less restrictive treatment environments
  • Lessening burden on hospitals, jails law
    enforcement

15
Crisis Services Funding
  • REQUESTED DSHS requested 82 million from the
    80th Legislature to make significant progress
    toward improving the response to behavioral
    health crises
  • AWARDED Through the Legislature and Rider 69,
    the full 82 million was granted over Fiscal
    Years 2008/2009 to redesign and improve the
    mental health crisis system across Texas

16
Crisis Services Funding, contd.
  • 27.3 million will be allocated in FY 08
  • 54.7 million will be allocated in FY 09
  • Additional funds will be requested from the 81st
    Legislature
  • It is required that new crisis redesign general
    revenue funds will be used to improve crisis
    services provided and not replace the current
    crisis services.

17
Standards
  • Standards are set for all services in the crisis
    service array. Standards address
  • Description of service
  • What acuity is served in each service
  • Plant/facility requirements
  • Staff credentials and training requirements
  • Assessment parameters
  • Services provided and time frames for delivery
  • Continuity of care

18
Initial Crisis Services Hotline
  • Every LMHA will be required to provide a
    continuously available telephone hotline staffed
    by specially trained crisis counselors that
    provides information, screening and intervention,
    and support to callers 24 hours per day, 7 days
    per week.
  • Hotlines must be accredited by the American
    Association of Suicidology (AAS)
  • All callers to the hotline will be evaluated by a
    trained Qualified Mental Health Professional

19
Initial Crisis Services Mobile
Outreach
  • Mobile Outreach Services
  • are a combination of crisis services that
    provide emergency care, urgent care, and crisis
    follow-up to children, adolescents, or adults in
    the community. The Mobile Crisis Outreach Team
    will respond to individuals experiencing a mental
    health crisis in their homes, schools or other
    public areas.

20
  • Whats new about
  • Mobile Outreach?
  • Greater accessibility to Mobile Crisis Outreach
    Teams (MCOTs)
  • Specific MCOT standards regarding the delivery of
    services and the training experience required
    of Mobile Outreach Staff.

21
Roll Out of Crisis Redesign
  • Initial Services to be Implemented
  • Hotline
  • Mobile Crisis Outreach Team
  • Will be brought up to new DSHS standards first.
  • Any remaining funds will be available to LMHAs to
    spend on the following Enhanced Services.

22
Enhanced Services
  • Walk-In Services
  • Extended Observation Services
  • (up to 48 hours)
  • Crisis Stabilization Units (CSUs)
  • Crisis Residential/Respite
  • (Child or Adult)
  • Crisis Respite (Child or Adult)
  • Mental Health Deputies/Crisis Intervention Teams
  • Transportation

23
Enhanced Crisis Services
  • Walk-In Services
  • Office-based outpatient services for adults,
    children and adolescents providing immediate
    screening and assessment and brief, intensive
    interventions focused on resolving a crisis and
    preventing admission to a more restrictive
    setting such as a hospital or juvenile detention.

24
  • Extended Observation Services (up to 48 hours)
  • Emergency and crisis stabilization services
    provided to individuals in a secure and
    protected, clinically staffed (including
    medical and nursing professionals),
    psychiatrically supervised treatment environment
    with immediate access to urgent or emergent
    medical evaluation and treatment.
  • Crisis Stabilization Units (CSUs)
  • Short-term residential treatment (up to a stay of
    14 days) designed to reduce acute symptoms of
    mental illness provided in a secure and
    protected, clinically staffed, psychiatrically
    supervised treatment environment.

25
  • Crisis Residential (Child and Adult)
  • Crisis residential services treat individuals
    with high risk of harm and severe functional
    impairment who need direct supervision and care
    but do not require hospitalization.  Length of
    stay is generally less
  • than one week.
  • Crisis Respite (Child and Adult)
  • Treats individuals with no risk of harm, who have
    functional impairment and are in need of
    supervision but not hospitalization. Appropriate
    for individuals with stressful and/or
    unsupportive recovery environments and those who
    have had limited response to prior treatment.
    Length of stay is generally less than one week.

26
  • Mental Health Deputies/Crisis Intervention Teams
  • Funding used to assist local law enforcement
    agencies in providing specialized training for
    deputies on the recognition of mental illness and
    de-escalation of volatile situations
  • Transportation
  • Funding used to help pay for transportation costs
  • incurred by local law enforcement agencies
  • related to behavioral health crises

27
Additional Projects
  • Community Investment Incentive Approximately 30
    of the new crisis funds will be offered through a
    competitive process to communities willing to
    invest local resources in the development of
  • Psychiatric Emergency Services Center OR
  • Other community-based projects that focus on
    diverting individuals from incarceration or
    providing alternatives to State hospitalization. 

28
Psychiatric Emergency Service Centers
  • All LMHAs or communities will be eligible to
    apply for funds to establish PES Sites
  • Up to 6 sites will be funded and selected at the
    end of this year operational by next summer
  • Elements of PES Sites will include
  • Extended Observation Services (up to 48 hours)
  • Inpatient services in a Crisis Stabilization Unit
    (CSU) or hospital for up to 14 days

29
Outpatient Competency Restoration Services
  • Senate Bill 867
  • Allows for development of an Outpatient
    Competency Restoration program to help
    communities provide effective treatments and
    competency restoration to appropriate
    individuals with mental illness identified by the
    courts as incompetent to stand trial.

30
Outpatient Competency Restoration Services
  • Purpose
  • To treat mentally ill individuals accused of a
    crime in a less restrictive, more clinically
    appropriate setting than in jail or State
    Hospital.
  • Services Include
  • Psychiatric stabilization
  • Legal education and courtroom practice
  • Housing assistance

31
Crisis Service Local Planning
  • Community stakeholders are a vital part of the
    local planning process and will be key in
    successful implementation of crisis services.

32
Community Stakeholders Involved
  • Probation and parole department representatives
  • Judicial representatives from each county
  • Outreach, Screening, Assessment and Referral
    (OSAR) provider(s)
  • Substance abuse service providers
  • Others deemed appropriate by the LMHA (such as
    concerned citizens, private sector)
  • Client representatives
  • Client family member representatives
  • Child and adult advocates
  • Mental health service providers
  • Emergency healthcare providers
  • Local public healthcare providers
  • Law enforcement

33
Measuring Accountability
  • DSHS must report to the Legislative Budget Board
    (LBB) and the Governor on the implementation of
    crisis services

  • DSHS is adding Performance Measures to the
    Performance Contracts for all LMHAs

34
Strengthening Community Control and Consumer
Choice
  • Local Planning and Network Development

35
The Goal
  • Develop a local network of services to
  • Meet local needs and priorities
  • Maximize consumer choice
  • Improve access to services

36
Todays System
  • Single State Authority DSHS
  • Board members appointed by the Governor
  • State Advisory Committee members represent LMHAs
  • 37 Local Mental Health Authorities (LMHAs)
  • Board members appointed by local government
  • Local Planning and Network Advisory Committees
    (PNACs)

37
Characteristics
  • Community provides input during local planning
    process
  • PNAC makes recommendations
  • LMHA provides most services
  • LMHA chooses whether or not to contract with
    private providers for services
  • LMHAs not accountable to stakeholders for
    decisions
  • No consumer choice of providers

38
What Has Changed
  • State Advisory Committee members represent many
    stakeholder groups, including consumers
  • Consumers have a choice of providers
  • LMHAs provide services as a last resort under
    limited, defined conditions
  • LMHAs must justify contracting decisions

39
Local Planning and Network Development
  • What it is NOT
  • An effort to wholesale privatize MH services
  • What it IS
  • A standardized, transparent process for planning
    and developing a network of MH service providers.
  • Emphasizes choice of providers, whenever
    possible
  • Allows for local control through stakeholder
    input
  • Requires the network to be managed by LMHA

40
History
  • What happened?

41
The Law in 2003
  • The local authority shall consider public
    input, ultimate cost-benefit, and client care
    issues to ensure consumer choice and the best use
    of public money in
  • assembling a network of service providers and
  • making recommendations relating to the most
    appropriate and available treatment alternatives
    for individuals in need of health or mental
    retardation services.

42
New Provisions of HB 2292
  • In assembling a network of service providers, a
    local mental health and mental retardation
    authority may serve as a provider of services
    only as a provider of last resort and only if the
    authority demonstrates to the department that
  • the authority has made every reasonable attempt
    to solicit the development of an available and
    appropriate provider base that is sufficient to
    meet the needs of consumers in its service area
    and
  • there is not a willing provider of the relevant
    services in the authoritys area or in the county
    where the provision of the services is needed.

43
The Question Does HB 2292 Apply to Mental
Health?
  • Extended controversy
  • May 2005 Governor issues Executive Order RP 45
  • March 2006 Attorney General rule that HB 2292
    applies to MH
  • June 2006 HHSC orders DSHS to conduct negotiated
    rulemaking per RP 45

44
The Process
  • October 2006 Negotiated Rulemaking Committee
    convenes
  • March 2007 Draft rule proposed for public
    comment (none received)
  • June 2007 Final rule adopted with no change

45
The Committee
  • LMHAs
  • Clients
  • Family members
  • Advocates
  • Private providers
  • Local government
  • DSHS
  • Other stakeholders

46
The Governors Order
  • Protect and prioritize consumer choice
  • Strengthen and maintain safety net
  • Ensure local involvement in system development
  • Recognize local differences
  • Protect funds for services

47
The SolutionA System of Checks and Balances
48
The Committees Framework
  • A public and transparent process
  • Flexibility to respond to local needs and
    resources
  • Boundaries for LMHA decision-making
  • Multiple opportunities for stakeholder input
  • LMHA accountable for how it responds to community
    input
  • DSHS monitors LMHA decisions and response to
    stakeholders

49
The Rule
  • Where are we going?

50
The Content of the Rule
  • Consumers choose from two or more providers of a
    service when possible
  • Conditions under which LMHA can provide a service
    are limited and defined
  • LMHA develops 2-year local plan for developing
    external provider network
  • Consumers and other stakeholders participate in
    planning
  • DSHS provides oversight

51
Stakeholders
  • Consumers, current and former
  • Family members
  • Advocacy organizations
  • Providers (external)
  • Community organizations
  • Local officials
  • Interested citizens

52
Consumer Choice Defined
  • Two or more qualified provider organizations for
    each service package AND
  • Two or more qualified individual practitioners
    for specific services
  • Exceptions may be made if it would be too
    expensive to have multiple providers Choice may
    be limited by provider availability

53
The Process
  • DSHS provides website for private providers to
    express interest
  • LMHA obtains community input
  • LMHA publishes draft plan for public comment
  • LMHA publishes final plan and submits to DSHS
    with summary of response to public input
  • DSHS reviews and approves plan

54
The Process, cont.
  • LMHA publishes draft documents used to purchase
    services from external providers for public
    comment
  • LMHA conducts formal service procurement
  • LMHA provides consumers with information about
    all service providers
  • Consumers choose their providers

55
Key Content of the Plan
  • Community stakeholder input
  • Assessment of available service providers
  • Local plan for network expansion with LMHAs
    rationale
  • Services to be provided by one provider due to
    economic factors
  • How consumer choice and access will be addressed

56
Key Content of the Plan, cont.
  • Past efforts and results to expand network
  • Barriers to network expansion and efforts to
    address them
  • How service dollars will be preserved
  • Procurement plans, addressing specific service
    packages and populations
  • Future plans for network expansion

57
Three Opportunities for Input
  • Before LMHA develops local plan
  • When LMHA publishes draft plan
  • When LMHA publishes draft procurement tools

58
When Can an LMHA Provide Services?
  • No qualified providers
  • Insufficient consumer choice (must have two or
    more providers)
  • Diminished access to services (DSHS to determine
    baseline)
  • Insufficient capacity in external network

59
When Can an LMHA Provide Services?
  • Need to protect critical infrastructure
  • Phased transition permitted
  • LMHA judges capacity of external providers to
    re-establish lost capacity
  • Existing agreements limit ability to contract or
    circumstances that would result in substantial
    source of revenue to support services

60
Consumer Selection of Providers
  • LMHA maintains standardized list of basic
    information about each provider
  • List given to consumers with options
  • Provider assigned on rotating basis if no choice
    made within specified timeframe
  • Consumers offered choice at every treatment plan
    review

61
Implementation
  • How do we get there?

62
Current Status
  • DSHS is ready to launch the website
  • Stakeholder information
  • Forms for service providers to sign up
  • LMHA planning process begins Nov 1st
  • Three groups of LMHAs
  • Staggered planning period
  • 6 month planning cycle
  • Stakeholder training conducted with initiation of
    the local planning process

63
Planning Timelines
  • November 2007 Cohort 1 (East Texas, including
    Harris County)
  • January 2008 Cohort 2 (South/Central Texas,
    including Austin and the Valley)
  • February 2008 Cohort 3 (North/West Texas,
    including Ft. Worth, El Paso, and the Panhandle)
  • July - September 2008 Plans approved by DSHS

64
Things to Remember
  • Changes will happen gradually
  • Every local service area will evolve differently
  • Implementation will be a learning process for all
    parties

65
You Have a Voice
  • Direct input during planning
  • Local Planning and Network Advisory Committee
    representation (50)
  • State Advisory Committee representation (2
    consumer and 2 family members)

66
You Have a Responsibility
  • Local stakeholders, LMHAs, and DSHS share
    responsibility and control
  • System of checks and balances relies on
    stakeholder participation

67
Information
  • www.dshs.state.tx.us
  • Community Mental Health
  • Local Planning and Network Development
  • LPND_at_dshs.state.tx.us
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