Lessons Learned From Federal Programs

1. Lessons Learned From Federal Programs Neal Brown November 5, 2013

2. Community Support Program • NIMH response to problems of deinstitutionalization • Systems change initiative • Beyond just mental health treatment - concentration on rehabilitation • Small grants to states (most funding $150-$300K per year) • Contacts in each State • Established System of Care – “Community Support System” • National CSP Network • Consumer empowerment • Support to families • Most funding 1978-1987

3. CSP Accomplishments • Thousands of community rehabilitation programs established (e.g. ACT, clubhouses, supported housing) • Established SMI as a priority population • Helped states move resources from institutions to community care • Facilitated the expansion of the consumer movement • Helped launch and support the national family movement

4. Lessons from CSP • A small amount of strategic money can leverage major system changes • Supporting consumers and families facilitates system changes • People learn from others in a network

5. Community Action Grants • SAMHSA program to help communities adopt exemplary mental health practices by building community “buy-in” and support • Sponsors were primarily community and consumer/family organizations • Phase I – consensus building ($150K) • Phase II – training and preparation for implementation ($150K) • Best practices determined locally • Focus on adults with SMI and children with SED • Diversity of programs and populations involved • Program lasted five years (1997-2002)

6. CAG Accomplishments • Funded 137 sites for new programs in 48 states and territories • More than 70% achieved full consensus and implemented best practices • Supported a diversity of organizations and practices • Became a catalyst to change policies at the state and local levels • Promoted culturally competent services

7. Lessons Learned from CAG • Implementation of Best Practices is enhanced by consensus building • Community organizations can successfully manage a process leading to new program implementation • Consensus building process can lead to changes in policies and practices at the state level

8. Mental Health Transformation Grants • Mental Health Transformation State Incentive Grants (MHT-SIG) • SAMHSA supported infrastructure grants to states to improve service delivery, access to care and the provision of effective services • To implement President’s New Freedom Commission recommendations • Focus on adults and children • Grants to nine states (governors) of up to $2.7 million a year for 5 years • Connecticut, Maryland, New Mexico, Ohio, Oklahoma, Texas, and Washington (starting in 2005) • Hawaii and Missouri started in 2006

9. MHT Logic Model Transformation Working Group Needs Assessment and Inventory of Resources Comprehensive Mental Health Plan I Infrastructure Changes Service Improvements Improved Consumer Outcomes

10. State Transformation Highlights All states conducted infrastructure activities such as: • Creating and revising policies • Involving consumers, family members and youth in advisory bodies • Developing innovative financing strategies • Conducting public awareness campaigns • Engaging in workforce development activities

11. Practices Promoted Across All Nine States • Assertive Community Treatment (ACT) • Family Pschoeducation • Illness Management and Recovery (ILR) • Integrated Treatment for Co-Occurring Disorders • Multi-Systemic Therapy (MST) • Permanent Supportive Housing • Trauma-Informed Care • Supported Employment • Wellness Recovery Action Plan (WRAP)

12. MHT State Successes • CMHP implemented • New Freedom Commission goals achieved • Significant policy changes in each state • Political changes overcome (Ohio, Hawaii, Maryland) • Washington – significant gains in consumer involvement • Connecticut – maximized support for criminal and juvenile justice initiatives • Oklahoma – enhanced tribal – state relations • Missouri – implemented MH First Aid

13. Maryland Transformation Highlights • Promoting recovery and system change (through WRAP training, recovery training, Recovery Centers of Excellence) • Changing public perceptions of mental illness (focus on Mental Health First Aid training) • Strengthening the Public Mental Health System (pilot for Self-Directed Care; first state to launch Network of Care site for Veterans; workforce development; statewide implementation of EBPs – SE, ACT, FP; reduction in use of seclusion and restraint; coordination of primary and mental health care; increased access to high quality services through tele-psychiatry; increased housing resources; developed consumer quality teams (CQT);Outcomes Measurement System to track trends in services) • Services to Children, Youth, and Families (Systems of Care and Wrap-around Services, Transition-aged Youth activities)

14. Lessons from MHT-SIG • Engaging consumers, family members and youth in every step in the change process is fundamental to bringing about services that are consumer-driven, family-centered, youth-guided, and recovery oriented. • Possible to promote changes simultaneously at multiple levels. • Partnerships can be powerful vehicles for change at all levels. • Adoption of a recovery approach is fundamental to transformation.

15. Overall Lessons • Personal relationships make a difference • Significant consumer involvement is absolutely necessary