Idaho BGTWG Panel Presentation: Response to Key Questions

1. Idaho BGTWG Panel Presentation: Response to Key Questions Carol Bianco Advocates for Human Potential, Inc. Albany, NY cbianco@ahpnet.com

2. Panel Questions/Responses What are your thoughts respective to when and how to integrate substance use and mental health from a structural perspective? • Structural integration has limited impact without major changes at the agency and program levels. Use the Four Quadrant framework to map each regional system. • Develop a plan for routine and standard screening and assessment. • Assess Dual Diagnosis capability in all BH programs – use existing tools (COMPASS, CODECAT, DDCAT, DDCMHT). • Use results to develop training schedules and learning collaboratives.

3. Panel Questions/Responses • What oversight structure would you recommend to sustain our transformation? • Consistency and commitment are key. Members of TWG should have a clear stake (resources or personal) in success, be actively invested in one or more key transformation initiatives. • Should have substantial consumer, family, provider, and local representation on the TWG and through committees, work groups, etc. • Must have trusted and empowered leader who is supported by experienced and skilled staff. • Must provide political cover – transformation requires boldness and risk-taking, and mistakes

4. Panel Questions/Responses What systems and structures must be in place in order to implement an outcome-based/managed care system? • Strong state leadership with clear quality and performance standards • Locally-driven priorities, plans, and flexible resources to create incentives for innovation. • Simplified intake/access structures and processes, information sharing among providers • Clear and accessible information for Consumers & families • Empowered, independent care managers • Real-time consumer feedback on quality of services • See Scott Miller www.talkingcure.com session rating scale

5. Panel Questions/Responses • What experience can you share/advice can you provide regarding managing for quality assurance and accountability? • Measure progress frequently and visibly • track changes, • analyze outliers (good and bad), • communicate lessons learned, • course correct promptly • Monitor practice fidelity, incorporate into compliance or credentialing standards • Assess System and Program Recovery Orientation • Recovery Oriented System Indicators (ROSI) • Recovery Enhancing Environments (REE)

6. Panel Questions/Responses • What specific recommendations do you have regarding the elements of our draft approach, and what specific steps would you take to implement those recommendations? • One person-centered treatment plan should include all services in the network (See Michigan’s PCP model used by county MBHOs) • Core service definitions are fairly comprehensive - consider also: • Specialized services for co-occurring disorders, as well as co-occurring capability throughout the system • Psychiatric Rehabilitation • Age Specific services, especially older adults, transition-age youth • Health and Wellness promotion • Personal Assistance Services (Aging and disability model)

7. Panel Questions/Responses Service Recommendations continued • Illness Management and Recovery – adopt EBP Toolkit and implement systematically with fidelity. • Medication Management – incorporate Shared Decision-Making approaches adapted from general medicine. • See upcoming SAMHSA Medication Decision Aid or Pat Deegan’s Common Ground web-based shared decision-making software • Peer support – can be Medicaid reimbursable • Include Respite as core service (not optional under early intervention) • Psychotherapy – promote use of evidence based approaches • Supported Housing – use rehab option to fund support and housing retention services. Create bridge subsidy to move people out of group homes. See upcoming SAMHSA toolkit on Supportive Housing • Supported Employment – leverage VR and WIA funds for short term customized employment – Medicaid rehab option for follow-along support

8. Panel Questions/Responses • The underlying goal of all this work is to better and more effectively serve people. How do we assure our collective efforts are moving toward that end? • Focus on both process and outcomes - set goals and measure both • Identify a few key metrics of successful outcomes • Go beyond “absence of …(symptoms, crises) to measurable quality of life and recovery indicators (eg. employment and income, housing stability, graduation rates, aging in place) • Align incentives with metrics • Use existing data sources whenever possible to reduce reporting burden • See WA TSIG evaluation: Measures of Statewide performance created by TWG (Eric Bruns)

9. Parting thoughts • Make the business case for transformation • Show the human face of transformation • Describe, disseminate, replicate and go to scale with successes quickly (before you lose momentum or priorities shift) • Honor the past while building the future