Pennsylvania Transformation Update Office of Mental Health & Substance Abuse Services November 2007

1. A Call for Change Pennsylvania Transformation Update Office of Mental Health & Substance Abuse Services November 2007

2. OMHSAS News • Expanded Responsibility • FFS BH Utilization Review; Rate Setting • Special Pharmaceutical Benefits Program (SPBP) • Staff Changes • Lots of Retirements-over 600 individuals retired from state service • Turnover of Key Personnel • Forward Movement in Transformation Efforts • Stability, Direction, and Commitment

3. OMHSAS Special Pharmaceutical Benefits Program • Transfer of the atypical antipsychotic pharmaceutical under SPBP from OMAP to OMHSAS (October 1, 2007) • Transfer of one staff and budget from OMAP to OMHSAS

4. Psychopharmacology - Accountability • All BH medications, prescribed by HC or Access Plus providers, are reviewed for quality and safety of prescribing practices. • OMHSAS is convening a Behavioral Health Advisory Committee for P&T decisions • Will include consumer, family and professional participation

5. OMHSAS Program News • Transformational Agenda • Progress on Children’s, Adult and Older Adult Objectives • Cross System Partnerships • Striving for Performance, Accountability and Outcomes

6. OMHSAS Objectives 2007 - 2010 • Transform the children’s behavioral health system to a system that is family driven and youth guided. • Implementation of services and policy to support recovery and resiliency in adult BH system • Assure that BH services and supports recognize and accommodate the unique needs of older adults.

7. Transform the children’s behavioral health system to a system that is family driven and youth guided • Child & Family Teams • School Based Behavioral Health Agenda • Integrated Children’s Lessons • Elimination of Prone Restraint • Youth Advisory Capacity • Residential Treatment Regulations • Juvenile Justice Support

8. Implementation of services and policy to support recovery and resiliency in adult BH system • Implementation of Certified Peer Specialists • Issued co-occurring standards • Service Area Planning; Peer Assessments; CSP • Implementation of Housing Agenda • PHFA Partnership • PCH - Policy and Pilot • CRR Conversion • Employment, Employment, Employment…..

9. Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults. • Implement Mobile Mental Health Treatment • Targeted Case Reviews • MOU’s between County Behavioral Health & Aging • Regional Resource Forums • Money Follows the Person • SAMSHA Grant Submission • APPrise Initiative • www.OlderPennsylvanians.org

10. FY 07/08 Highlights! • Closure of Mayview State Hospital • Forensic Agenda including RFP to consider privatization of Forensic Services • Supportive Housing Agenda • Peer Specialist Implementation • NFI Strategic Plan

11. Recovery and Home “Without a place to call home, people with mental illnesses have trouble recovering their health, becoming self-sufficient, and reclaiming valued roles in their families and communities.” National Governors Assn. Briefing Document 2007

12. TRANSFORMATION BLUEPRINTING • Housing Work Group • Recommendations in 6 areas: • POLICY • HOUSING ASSESSMENT AND PLANNING • ADMINISTRATION • HOUSING DEVELOPMENT AND OPERATIONS • SUPPORTIVE SERVICES • TRAINING AND TECHNICAL ASSISTANCE

13. Supportive Housing is: • Safe and Secure • Affordable to consumers • Permanent, as long as the consumer pays the rent and honors the conditions of the lease. • Supportive Housing is linked to support services that are: • CRITICAL! People must be supported in their recovery. Support-rich community service structure • Optional. People are not required to participate in services to keep their housing, although they are encouraged to use services • Flexible. Individualized services are available when the consumer needs them, and where the consumer lives.

14. Housing First • Consumers identify “housing” as first priority • Immediate access to permanent independent housing, without requiring treatment compliance • Promote consumer choice, recovery and community integration • Scattered site, independent units • Addressing consumer needs first • Guiding principle: trusting, supportive clinical relationship

15. Supports That Work • Assertive Community Treatment Teams • Full or smaller “sub-ACT” with low caseload ratios • Composite teams – staff from various agencies • Intensive Case Manager • Mobile Treatment, Rehabilitation and Crisis Intervention

16. Philosophical Shift - Transformation • Challenges to traditional “provider-consumer” relationships – relinquishing of authority • Shift perspective from emphasis on mental health and substance abuse treatment to greater appreciation of housing needs • Mindful of long-held but erroneous bias equating psychiatric symptoms and/or substance use with inability to maintain housing

17. The Evidence Denver Housing First Collaborative • Emergency related costs declined 72.95% • Overall inpatient costs reduced 66% • Incarceration days and costs reduced 76% • Overall improvement in health status and residential stability • Ability to assist participants in accessing benefits increased monthly income from $185 at entry to $431

18. NFI Consumer-Driven SummitPeer Support Activities – Strategic Plan Objective 1: Establish statewide Peer Support Coalition Objective 2: OMHSAS continue development & implementation of Peer Support Services Objective 3:County/Provider Development & Implementation of Peer Support Services

19. Coordinate Peer Support Network • Coordinate/support local, regional and statewide peer networking and organizing • Establish link to other state/national organizations and efforts • Assure on-line networking forums • Provide employment support (i.e., job recruitment) • Provide mediation services

20. Develop and/or Coordinate Continuing Education/Awareness Activities • Collaborate with and make recommendations to training curriculum of OMHSAS approved vendors • Establish recovery-oriented peer support practice standards • Peer Leadership Training • Education about recovery-oriented principles and practices. • Address the misconception that work is a stressor as opposed to a support of personal wellness and recovery

21. Develop and/or Coordinate Continuing Education/Awareness Activities (cont) • Benefits counseling • Develop “in-service” training and education programs for providers • Support and promote the stories of individuals who receive peer support services, describing what positive changes have occurred and how they are linked to peer support • Dissemination of information regarding training opportunties • Work with local colleges and universities to create degree or certificate program

22. Advocate Towards • Funds to support non-medicaid funding of peer support services and expanded Medicaid reimbursement • Equivalency in salaries and benefits with others providing comparable service in direct care • Fair and equitable billing practices for Medicaid Peer Support Services. • Peer Support Specialists being available in all provider agencies, including hospitals and specialized services

23. Advocate Toward • Mandated provider education about Certified Peer Support Specialists and options for how to describe roles and functions within their particular program services. This should include mentoring by PCPA to encourage and educate the CEOs (peer to peer, videos, others) • Incorporation of statewide Peer Support “Code of Ethics”

24. Assist in development and provide ongoing support to freestanding consumer-run provider organizations

25. So What ????? • Incident Management • Peer Assessments, State Hospitals • Consumer and Family Satisfaction Teams • ROSI • County Plan Performance • Inpatient Study • Pay for Performance

26. You Will Hear More….. • Coordination of Care • Recovery Oriented Systems Indicators • Pay for Performance • MA State Plan and Regulation Reform • LGBT: Time to Recognize and Accommodate • Drug & Alcohol Confidentiality Standards Revision

27. Recovery is remembering who you are through the darkness and using your strengths to become all that you were meant to be. Support The Journey www.supportthejourney.com