System Transformation in Texas: Agenda for 2006-2007

1. System Transformation in Texas:Agenda for 2006-2007 Dave Wanser Ph.D. Deputy Commissioner for Behavioral and Community Health Department of State Health Services

2. Current Behavioral Health Care System “For too many Americans, the services and supports they need remain fragmented, disconnected, and often inadequate, frustrating the opportunity for recovery…. Instead of ready access to care, the system presents barriers that all too often add to the burden of mental illness (and substance abuse) for individuals, their families, and our communities.” Achieving the Promise: Transforming Health Care in America

3. The Texas Approach to Transformation • Overarching goal is to improve the mental health of all Texans and meet the President’s NFC goals. • New Freedom Commission Goals are shared by those participating on the TWG: • The Governor’s Office; Department of State Health Services; Texas Health and Human Services Commission (Medicaid); Department of Family and Protective Services; Criminal Justice Department; Juvenile Probation Commission; Texas Youth Commission; Consumers; Family Members; Texas Education Agency; Aging and Disability Services; Workforce Commission; Veteran’s Administration; etc.

4. TWGAgency Resources Spent on Mental Health

5. The Texas Approach to Transformation • The grant funding is seen as a catalyst to jump start some of the efforts of framing the public health approach. The 2 primary areas of focus: • Developing and supporting local behavioral health collaboratives • Using cutting edge technology to change work processes across agencies • Improvement of the system will be targeted to the IOM Quality Chasm principles: • Apply evidence to health care delivery; • Use information technology; • Align payment policies with quality improvement; • Prepare the workforce.

6. Adverse Childhood Experiences as a means to Understand the Public Health Approach Child Abuse or Neglect • Physical abuse • Sexual abuse • Abandonment • Trauma in Child’s Household • Substance Abuse • Parental divorce • Mentally ill or suicidal • household member • Violence to mother • Imprisoned household • member

7. Adverse Childhood Experiences Effects of Trauma • Difficulty controlling anger • Hallucinations • Depression • Panic reactions • Anxiety • Health Risk Behaviors • Smoking • Obesity • Suicide • Alcoholism • Drug abuse • Sexually transmitted disease • Self-injury • Eating disorders

8. Adverse Childhood Experiences Long-Term Consequences Disease and Disability • Heart disease • Cancer • Chronic lung disease • Emphysema • HIV/AIDS • Social Problems • Homeless • Prostitution • Delinquency, violence and criminal behavior • Re-victimizations: rape; domestic violence • Unemployment • Intergenerational transmission of abuse

9. Adverse Childhood Experiences & Attempted Suicide

10. Behavioral Health Issues Impact Costs and Outcomes in Other Systems • 75% of children placed in foster care have parents with behavioral health problems • 75% of kids in the juvenile justice system have behavioral health problems • 30% of kids in the juvenile justice system will end up in the adult justice system • 46% of all ER visits have behavioral health issues as a basis or contributing factor • 30% of all truancy is related to behavioral health problems

11. Potential of a Public Health Approach:What we will make a priority of all agencies • Focus on prevention and early intervention and adopt a family based approach • Implement national outcome measures and focus on how cultural issues impact disparities in access and outcome. • Expand the use of cutting edge technology • Demonstrate successful integration of physical and behavioral health • Seek public/private partnerships • Work to develop and maintain a shared transformation agenda with stakeholders at both the state and local level • Change minds, change systems, change behavior

12. Texas Transformation • 1. Texans understand mental health is essential to overall health • Build capacity of primary care providers to identify, treat and refer across disciplines • Use local behavioral health collaboratives to leverage policy change • 2. MH care is consumer and family driven • Reduce barriers to treatment and reduce stigma with new program and purchasing models • 3. Disparities are eliminated • Inter-operability of data systems creates a roadmap for opportunities • Leveraging lessons learned from other initiatives, e.g. work with faith community • 4. Early screening, assessment and referral are common practice • Use of technology • ACE framework shared by member agencies • Behavioral health/ primary care and public/private partnerships • 5., 6. Excellent care is delivered and research accelerated, technology is utilized • Demonstrate return on investment • System wide use of evidence based frameworks and practices

13. A Borrowed Approach to Community Collaboration • Community collaboratives have been very effective in mobilizing communities to address issues in access to healthcare for underinsured populations • Membership consists of business leaders, elected officials, community leaders, consumers. Providers • Follows a structured and facilitated process for needs assessment, planning and implementation • Linkages to other local collaboratives through statewide framework leverages political impact.

14. Use Technology to Transform the Mental Health System

15. Federated Data System