Outpatient Transformation Updates:

1. OutpatientTransformation Updates: - Recommendation Implementation - Transformation Incentive Program October 2011

2. Overview • Background • Goals • Update Summaries • Next Steps

3. Background • 4 Workgroups comprised of 54 stakeholders met from September 2010 – April 2011 (Clinical, Regulatory, Training & Workforce Development, Finance) • Generated 17 transformation recommendations (combination of long & short-term) • OTIP advanced the implementation of some recommendations. E.g., incorporating peer personnel

4. Goals • Transform outpatient services into recovery & resilience focused resources designed to creatively address individualized needs • Ensure outpatient services embrace & reflect service domains & guiding values endorsed by DBHIDS Practice Guidelines • Achieve short & long-term operational improvements & enhanced outcomes • Frame the Health Choices commitment required to support Outpatient services in 2011 & beyond • Generate focused advocacy positions to serve as the basis for discussions with the State & others

5. Creating peer positions • Focus • Create peer staff positions in MH and D&A outpatient clinics to advance recovery & resilience, promote peer culture & enhance engagement • Create peer staff positions to support families of treatment recipients • Update • 25 peer positions were added via OTIP. An analysis of these positions will be conducted (structure, roles, effectiveness, etc.) • Additional OTIP contributions to peer culture • Encouraged organizational readiness strategies among agencies that have not begun to employ peers • Encouraged hiring strategies among agencies prepared to employ peers • A waiver request has been submitted to the State • 40 additional peers will be trained by February 2012 (Certified Peer Specialists/Behavioral Health Specialists) • A Certified Specialist/Behavioral Health Specialist Job Fair will be convened in April 2012

6. Expand Evaluation Options • Focus • Allow for a traditional psychiatric evaluation as an alternative to the CBE for some service recipients • Review & clarify current policies that allow for flexibility regarding the incremental administration of the CBE • Update • Consideration is being given to the types of assessments & evaluations to include in standard, in-network, contract menus. E.g., CBE, MH Assessment, Psych Eval, etc. • A provider workgroup will be convened to address this issue later in 2011.

7. Centers of Excellence • Focus • Establish specialized outpatient services tailored to address the unique needs of specialized populations • Establish rate differentials • Update • Two RFPs have been reissued for Centers of Excellence initiatives. RFPs: • Develop a continuum of services for Children/Youth with Autism • Expansion of services for individuals exhibiting sexually aggressive behaviors • A mobile mental health waiver (children & families) was submitted to DPW in 2010 & subsequently rejected. The waiver request will be reviewed, revised as needed, & resubmitted to DPW.

8. Centers of Excellence, cont. • Upcoming Initiatives • Dialectical Behavioral Therapy (DBT) Training • Web-based tool allowing recovering persons to convey status updates to providers prior to treatment sessions.

9. Annual “medication only”recovery/service plans • Focus • Recovery/service plans for adults who are receiving “medication-only” services should be required on an annual basis rather than every 120 days or 15 visits. • Update • Awaiting feedback and approval from OMHSAS to start a Medication-Only pilot

10. Same Day Determination • Focus • Review, clarify, reinforce &, if necessary, revise existing regulations that promote rapid access to outpatient services & discourage the establishment of waiting lists • Establish an accountability protocol to monitor compliance with this policy • Update • Reviewing current CBH contract requirements • Determine how to share this expectation with providers. E.g., determine if clarification & enforcement of current contract expectations is needed or if a new contract stipulation is required

11. Collateral contact reimbursement • Focus • Amend MA regulations to allow collateral contacts to be billed when service recipients are not present but have given consent. E.g., contacts with family members/significant people & other professionals. • Update • A waiver request has been submitted to the State

12. Collateral contact training • Focus • Outpatient providers will be trained to make collateral contacts during therapy sessions • Update • Trainers will be identified by January 2012

13. Allow professional staff to sign recovery/service plans (non-psychiatrists) • Focus • Trained, licensed/certified professionals with at least a Master’s degree in mental health or a related field who meet the minimum standards set by their respective professional organizations should be allowed to review & sign recovery/service plans independent of psychiatrists • Update • A waiver request has been submitted to the State

14. Workforce supervision • Focus • Provide direct service outpatient staff with regularly scheduled, documented, high quality clinical & administrative supervision • Ensure outpatient supervisors are credentialed & have mastered core competencies required to provide high quality supervision • Establish clinical supervision certification training & credentials • Develop strategies to verify & acknowledge high quality supervision. • Update • Developing a work plan to review & evaluate current Outpatient supervision practices

15. Workforce education & training • Focus • Partnerships should be developed with local educational systems to create curriculums emphasizing recovery, resilience & other priorities reflected in the DBHIDS Practice Guidelines • Promote best practice training including demonstrated competency • Update • Establish an Education Workforce Steering Committee by December 2011 that will include 5 local universities & focus on developing behavioral health related degrees • Develop Practice Guideline Training for Outpatient Providers by December 2011

16. Integrated physical& behavioral healthcare • Focus • Behavioral health outpatient services should be co-located/integrated with physical health services • Update • New initiative: Enhanced behavioral healthcare in federally qualified health centers • 14 agencies are developing relationships & protocols with primary healthcare practitioners & health centers via OTIP

17. Integrate behavioral healthcarein non-traditional settings • Focus: • Increase communication & collaboration between primary care & behavioral health providers to facilitate holistic care & promote higher quality service • Update • Community Coalition Initiatives

18. Outpatient Care Coordinators • Focus • Care Coordination positions should be established to facilitate service linkages for persons without case management & people entering the system with urgent social &/or physical needs • Update • A waiver request has been submitted to the State

19. Mobile MH treatment • Focus • Mobile outpatient treatment should be an option for children & families not enrolled in BHRS • Update • A waiver request has been submitted to the State

20. Routine MH and D&A screening • Focus • Mental Health outpatient clinics should provide routine D&A screenings for new applicants & refer people for addictions outpatient services as needed. Conversely, D&A outpatient providers should routinely screen for mental health issues & initiate referrals for mental health treatment when necessary. • Update • Several providers indicated their intention to employ co-occurring screening tools via the OTIP initiative. The OTIP evaluation will include an analysis of these screening strategies.

21. D&A Regulatory & Policy Issues • Focus • DOH regulations should be revised to allow 1:35 caseloads to be comprised of “active” versus “enrolled” participants. • DOH regulations should be revised to allow programs the flexibility to establish their own governing structures • DBHIDS monitoring criteria should be revised to eliminate redundancy with DOH expectations • Update • Dialogue regarding State regulatory issues has been initiated with the Director of the DOH Division of D&A • Waiver requests have been submitted to both DOH and BDAP. • DBHIDS will review and revise local monitoring expectations in coordination with the PIP Project

22. Next Steps • Pursue implementation of locally controlled recommendations • Continue collaboration with DPW and DOH regarding recommendations requiring State involvement • Provide future updates to Executive Directors & other stakeholders