OMHSAS

1. OMHSAS Advisory Committee Update May 3, 2007

2. OMHSAS Updates • Reorganization Highlights • Staff Changes • Retirement Challenges

3. Commonwealth of Pennsylvania - Department of Public Welfare Office of Mental Health & Substance Abuse Services (OMHSAS) ORGANIZATIONCHART Deputy Secretary Bureau of Financial Management & Administration Office of the Medical Director Bureau of Planning & Program Development Bureau of Children’s Behavioral Health Bureau of Community & Hospital Operations Division of Children’s Policy & Program Development Quality Management Division of Behavioral Health Policy Division of Medicaid Finance Division of Eastern Operations Utilization Management Division of Western Operations Division of Substance Abuse Services Division of Budget & Administration Division of Service Delivery Division of Planning & Program Development Division of Hospital Operations Division of Hospital Operations Info Systems

4. Supporting our Journey: Aging Forums; Evidence of Progress • Two recent Aging and Behavioral Health Forums Held • Good representation at each Forum of Aging and MH • Profiled Aging and D&A issues • Profiled successful collaborations • Lessons Learned from Case Reviews Highlighted

5. Continuing our Journey: School Based Behavioral Health: Setting the Stage • Secretary of Department of Welfare and Secretary of Pennsylvania Department of Education; regular meetings to address the education and the behavioral health needs of students using an integrated approach • Deputy Secretaries and key policy personnel from DPW and PDE attend • Identification of issues and priorities established

6. Core Principles • The best education for a child is in the “least restrictive environment: inclusive setting in her or his ”home school” • Students who must be placed out of their “home school” environments should experience such placements for as brief a time as possible • Operations and policy changes must address the set of incentives and disincentives that result in keep children out of their “home schools” • PDE and DPW must jointly support the program and fiscal design of school based behavioral health services

7. Priority Projects • Partial Hospitalization • Education Law Center, PCPA, and advocacy community raised issue regarding access to education for children and adolescents receiving mental health partial hospitalization services during the school day • DPW and PDE agreed to develop policies and practice standards regarding access to intensive behavioral health services including partial hospitalization

8. Priority Projects ( cont) • Partial Hospitalization • DPW Bulletins; PDE School Code Change • DPW Bulletins • Partial Hospitalization as short term stabilization • Family Driven; Youth Guided; IEP and ISPT occurring at same time when able • Interagency team meeting/notice requirements to “home school” • Interagency team meeting/discharge planning/notice to “home school”

9. Supporting our Journey: Housing • 1. Summary Of a CRRS Conversion Process in Cumberland County. Total Dollar amount converted: $505,812 • In an effort to provide maximum opportunity for persons with mental illness to choose their preferred housing and successfully maintain the residence of their choice, the provider agency New Visions will, in collaboration with the County MH Program, will reduce the number of CRRS beds from 16 to ten, provide case management support services to 18 additional persons in community apartments, and support 9 persons in two Fairweather Lodges. A Consumer-Run Drop-In Center will be developed in Shippensburg. • The changes in numbers of persons served: • CRRS beds are reduced from 16 to10, • Thirty-one persons will receive Supported Living services in community apartments – an increase of 18 individuals. • Two Lodges will provide for another 9 consumers. • This represents a change from 29 to 50 total consumers supported – twenty-one additional persons supported in housing. • 15-20 persons will chose to participate in the Drop-In Center. • In addition, the Cumberland County Housing Authority will offer Section 8 rental v ouchers to all persons leaving a CRRS , beginning in July 2007. • The Redevelopment Authority has donated a building for use as the second Fairweather lodge.

10. Supporting our Journey: Housing • 2. In the last three years of Fairweather Lodge operation in Erie County, 50 separate individuals served in Lodges have moved to successful employment. • 3. In March 2007, 45 of 48 County MH Programs were represented at an all day Conference in Harrisburg devoted to Training on how to start and manage a Local Housing Options Team, a requirement for all MH Programs for the current County Plan. It is anticipated that the number of LHOTs that are fully operational will reach 35 by the end of the 2007 calendar year. • 4. Huntingdon, Juniata and Mifflin County MH Program is currently converting a CRRS, to begin operation later in the 07/08 year. The total budget for the CRRS is $322,000, and the conversion will include conversion of that site to a Lodge and the development of a new community based supportive living counselor/program, which, will serve at least 20 new persons living independently in the community.

11. Continuing our Journey: Peer Supports • Fundamental element of Transformation; Consumer Directed; Consumer Operated Services & Supports; Choice in Peer Supports • Variety of Opportunities for Peer Work and Support • Mutual Support Groups • Community Support Programs • Recovery Specialists • Consumer Satisfaction Teams • Consumer- Run/Operated Services • Warm-lines • Drop-In Centers • Clubhouses • Patients’Rights Advocates • Certified Peer Specialists

12. Certified Peer Specialists • Five States and Washington DC have successfully developed Medicaid funded peer supports (Georgia, South Carolina, Hawaii, Arizona, and Iowa) • Pennsylvania submitted a State Plan Amendment to Center for Medicaid /Medicare Services (CMS) which was approved on February 22, 2007 • Will provide for certified peer specialists to bill for specific services to peers with mental illness • Finalizing: • Service Description Review & Approval Process • Licensing Process • Enrollment &Billing • Planning of Statewide Technical Assistance Days

13. Certified Peer Specialists • Certified Peer Specialist Bulletin will be issued May, 2007 • Three Options • Existing MH Licensed Agency • Subcontract to MH Licensed Agency • Independent Peer Agency • Additional training and technical assistance ( Southeast Mental Health Association current approved trainer) may be available: Recovery Innovations Incl., formerly META Services • Initiated discussion with OVR regarding funding of peer specialist training and certification • Over 200 certified peers trained; billing will begin July 2007. • An array of peer supports and other consumer operated and directed services to be maintained!

14. OMHSAS: Guiding Principles • The Mental Health and Substance Abuse Service system will provide quality services that: • Facilitate recovery for adults and resiliency for children; • Are responsive to individuals’ unique strengths and needs throughout their lives; • Focus on prevention and early intervention; • Recognize, respect, and accommodate differences as they relate to culture/ethnicity/race, religion, gender identity and sexual orientation; • Ensure individual human rights and eliminate discrimination and stigma; • Are provided in a comprehensive array by unifying programs and funding building on natural and community supports unique to each individual and family; • Are developed, monitored and evaluated in partnership with consumers, families and advocates; • Represent true collaboration with other agencies & service systems

15. OMHSAS Objectives • Transform the children’s behavioral health system to a system that is family driven and youth guided. • Policy implementation of a “Call for Change” to support recovery and resiliency in the Adult Behavioral Health System • Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults.

16. Children’s Objective Transform the children’s behavioral health system to a system that is family driven and youth guided.

17. Some Guiding Principles • Trauma informed culture should serve as the background for all services to children and adolescents • CASSP principles are assumed to be part of the children’s Objective and Supporting Projects • Youth and Family Teams will lead to a transformation of the children’s behavioral health system.

18. Children’s Supporting Projects and Actions • Establishment of Child-Family Teams to support Transformation • Establish an Institute to provide training, support and monitoring of Youth and Family Teams • Develop mechanism for Medicaid payment of Youth and Family Team process

19. Children’s Supporting Projects and Actions • Create Home and Community Based Alternatives to Residential Treatment • Develop a “White Paper” addressing current environment, needs and recommendations for creating alternatives to the current residential treatment system • Change existing rules to permit small group homes and therapeutic housing • Enroll Multi Dimensional Treatment Foster Care as a Medicaid funded service • Maintain data base on RTF utilization

20. Children’s Supporting Projects and Actions • Partner with Education to support the development of effective school based supports and interventions • Have OMHSAS Children’s Advisory develop “White Paper” on school based behavioral health services • Engage youth to get their perspective on school based behavioral health services • Review and update the existing Memorandum of Understanding with DOE, DOH, and DPW to detail responsibilities for SBBH • Continue to build the relationship with DOE and collaborate on projects such as SBBH Demonstration Grants, Positive Behavioral Interventions and Supports, etc. • Reduce admission to segregated programs • Identify efforts underway with BHMCOs on collaborative efforts with schools • Enhance letters of agreement between Counties, BHMCOs and Schools

21. Children’s Supporting Projects and Actions • Partner with Education to support the development of effective school based supports and interventions • Have OMHSAS Children’s Advisory develop “White Paper” on school based behavioral health services • Engage youth to get their perspective on school based behavioral health services • Review and update the existing Memorandum of Understanding with DOE, DOH, and DPW to detail responsibilities for SBBH • Continue to build the relationship with DOE and collaborate on projects such as SBBH Demonstration Grants, Positive Behavioral Interventions and Supports, etc. • Reduce admission to segregated programs • Identify efforts underway with BHMCOs on collaborative efforts with schools • Enhance letters of agreement between Counties, BHMCOs and Schools

22. Children’s Supporting Projects and Actions • Create Behavioral Health competency to honor the strengths and address the unique individualized needs of children and adolescents: • In the child welfare system • In, or at risk of entering, the Juvenile Justice system • In the drug and alcohol system • With Fetal Alcohol Syndrome Disorder • That are Deaf or Hard of Hearing • With Traumatic Brain Injury • With Autism Spectrum disorder or other Pervasive Developmental Disorder • With Physical Disabilities • And infants and young children

23. Children’s Supporting Projects and Actions • Develop a process for identifying and implementing evidence based practices; promising practices and culturally relevant practices • Utilize the SAMHSA National Registry of Evidence Based Practice, the NASMHPD Research Institute, the National Blue Print initiative and other sources to identify evidence based and promising practices • Document the expansion of Multi Systemic Therapy, Functional Family Therapy and other evidence based practices in current practice • Develop the Youth and Family Team process as the practice model for children’s behavioral health to support evidence based practice

24. Children’s Supporting Projects and Actions • Develop strategies to address the needs of Transitional Youth • Support Youth involvement in the OMHSAS Advisory Council • Obtain Youth input in identifying needs, developing plans, implementing and monitoring service development for Transition Youth • Summarize OMHSAS Transition Pilot projects • Identify existing initiatives in other agencies • Work with OMHSAS housing plan

25. Adult Objective Policy implementation of services to support recovery and resiliency in the Adult Behavioral Health System

26. Adult Supporting Projects and Actions • Define and expand the range of and financial commitment to consumer-run services, supports and trainers • New Freedom Initiative Project • Gain baseline understanding of existing consumer-run services, supports and trainers statewide • Develop Centers of Innovation around Evidence-based and Promising Practices • Review national models and define the Pennsylvania model

27. Adult Supporting Projects and Actions • Support community re-integration of individuals who have been in state hospitals over 2 years • Close at least 2 state hospitals by 2010 by • Development and implementation of individual community support plans • Development of community infrastructure

28. Adult Supporting Projects and Actions • Implement an integrated system of services and support for co-occurring mental health/drug and alcohol recovery • Identify how to increase co-occurring and substance abuse awareness and activities within OMHSAS • Develop joint licensing standards • Issue guidelines around D&A confidentiality • Develop practice standards for co-occurring screening and service provision

29. Adult Supporting Projects and Actions • Implement the recommendations of the Housing Workgroup • Assure that every county/joinder have develop a housing plan using the OMHSAS Housing Plan template • Implement and evaluate the Allegheny SSI Supplement Demonstration project and develop plan for statewide implementation • Develop strategies and convert at least $1 mil in CRR beds to supported housing • Policy development regarding use of public mental health funds in Personal Care Boarding Homes

30. Adult Supporting Projects and Actions • Implement, monitor and expand peer specialist services • Enroll providers statewide, assuring availability of at least 2 programs offering peer specialists in each county/joinder • Assure availability of peer specialist certification training • Assure formalized peer support structures are available for peer specialists • Develop the capacity for certified peer specialists to serve specific populations – older adults, individuals involved in criminal justice system • Work in collaboration with the Bureau of Drug & Alcohol Programs to develop use of certified peer specialists in the drug and alcohol system • Examine the use of consumer run peer specialist “employment agencies” • Identify specific outcome measures for Quality Improvement monitoring

31. Adult Supporting Projects and Actions • Implement recommendations of the Forensic Workgroup • Partner with PMHCA to develop resources to support Certified Peer Specialists in serving individuals in the Criminal Justice system • Work with the Governor’s Office on cross-systems task group • Inventory existing community diversion and re-entry services • Support Allegheny county national conference

32. Adult Supporting Projects and Actions • Develop plan for expanding Employment opportunities to support recovery • Collaborate on the delivery of trauma informed care • Work with Hospital Association of PA to eliminate seclusion and restraint in community hospitals • Target resources to plan for the expansion of trauma-informed care statewide for individuals, including: • Transition age youth, returning veterans, individuals involved with the criminal justice system

33. Adult Supporting Projects and Actions • Restructure the Medicaid State Plan to support recovery and resiliency • Review current regulations and revise/develop regulations supporting recovery/resiliency-oriented services

34. Older Adult Objective Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults.

35. Older Adult Supporting Projects and Actions • Expand access to services for older adults with the flexibility to provide services wherever they are • Ensure that implementation of peer services includes training of older adults as providers of the service to older adults as well as younger adults • Monitor access of peer specialist and mobile mental health services to older adults.

36. Older Adult Supporting Projects and Actions • Increase awareness of and planning for suicide prevention for older adults • Adopt at least one recommendation of the Suicide Prevention Plan for Older Adults. • Coordinate an annual Suicide Prevention Day in Harrisburg

37. Older Adult Supporting Projects and Actions • Review the impact of dual eligibility on service provision • Compile Medicare and Medicaid inpatient and outpatient date for older adults. • Develop information and resources to help older adults better understand services under Medicare and Medicaid (OMHSAS/AGING/APPRISE) • Use regional behavioral health Older Adult forums to share information on Medicare/Medicaid • Increase collaboration with Area Offices of Aging

38. Older Adult Supporting Projects and Actions • Expand access to the interagency planning project for older adults with complex needs • Compile information for case reviews • Encourage greater county participation through access to training and continued collaboration with Aging

39. Older Adult Supporting Projects and Actions • Increase awareness of needs of older adults for substance abuse treatment and programs structured to accommodate those needs in a culturally competent manner • Identify facilities appropriate to serve older adults • Define type of services older adults are likely to use by getting their feedback

40. Older Adult Supporting Projects and Actions • Ensure community consumer involvement by providing support to individuals transitioning from South Mountain Restoration Center into communities where they live. • Ensure consumer participation in discharge planning teams. • Ensure consumer resources are identified and utilized in community where they return

41. Older Adult Supporting Projects and Actions • Continue to assure appropriate mental health services are available to older adults experiencing dementia who have behavioral health problems • Continue to monitor complaints or concerns regarding access to care. • Engage in educational efforts with public and managed care partners.

42. Older Adult Supporting Projects and Actions • Develop a collaboration with physical health partners (Home Health, Visiting Nurses Assn, etc.) to promote behavioral health screenings for older adults • Assess willingness of MCOs/providers to partner on provision of screenings

43. Older Adult Supporting Projects and Actions • Ensure an active role for the Older Adult Advisory Committee in the Money Follows the Person (MFP) project • Older Adult Committee will identify representatives to serve on the MFP Advisory Work Group anticipating receipt of grant award.

44. Older Adult Supporting Projects and Actions • Support efforts to promote a study of Older Adults through the Legislative Budget and Finance Committee (LBFC) • When presented with a request for legislative analysis, respond with positive support and background research on the bill soon to be introduced. • Advisory Committee members may advocate for support, either as individuals or members of their respective organizations

45. What Will It Take to Support Our Change? • Culture Change • Consumer and family voice is central to design, implementation and oversight of system change • Opportunities must be made available for consumers, families and advocates to challenge, question, confirm assumptions of what is meaningful to them. • A variety of options must be made available, to include education, supported employment, competitive employment • Stakeholder investment • Common Vision • Providers must be provided opportunity to change practice • Hard Work

46. Recovery Recovery 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~

47. Transition from the past to the future. Drawing by Brenda Wagner “There are two ways to look at your life. One is as though nothing is a miracle; the other is as though everything is.” – Albert Einstein