Behavioral Health Services Division (BHSD) of the Human Services
Department (HSD) Response
to the
Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, 2014
BHSD appreciates the Legislative Finance Committee’s attempt to spotlight New Mexico’s serious problems with substance abuse and mental health issues. In the recent Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, it briefly highlighted New Mexico’s behavioral health (BH) needs and the many successful programs that are aiding in the promotion and sustainability of recovery for individuals with serious mental illness and chronic substance abuse. In line with this approach, the report takes the additional step of providing legislators with assessments of the Return-on-Investment (ROI) for many critical community BH services. The report promotes resource allocation, and reallocation, to prioritize spending on services with a high return and target efforts to high-risk, high-need areas of the state. Unfortunately, BHSD did not have an opportunity to respond to the report, and as a result, it is lacking important perspectives and provides an incomplete picture of the State’s problems related to: unmet needs for services, workforce issues, unique cultural challenges, critical impact of prevention efforts and environmental forces. For example:
o The report cites state and county BH related prevalence and other data but only reports on state spending and services for BH. However, there is no acknowledgment of the role of Medicare, VA, TriCare, and commercial insurance in addressing NM’s behavioral health needs;
o There is no reference to the role of the social determinants of health in NM which are some of the worst in the nation and therefore drive high incidences of BH-related conditions;
o There is no framing of BH within a public health model which requires effective and comprehensive environmental and agent specific strategies, not simply intervening in the lives of those who suffer from BH conditions;
o The report misses the fact that there are significant gaps in the continuum of BH care in most communities that include the lack of mobile crisis, crisis stabilization units, intensive-community-based services, transitional service options (supportive housing, supportive education and employment, group homes, respite, and therapeutic foster care) for those to be diverted or discharged from jails, prisons, hospitals, and residential settings. EBP implementation cannot be expected to make up for these significant service gaps;
o There is no reference to the ongoing needs of those with co-occurring (mental health and substance use conditions and/or developmental disabilities), and of those who represent the cultural diversity of NM but who have unique cultural needs (Spanish-speaking, Native Americans, and hearing-impaired) which EBPs often do not address;
o Behavioral health workforce challenges are dismissed in the report on the basis of national comparisons, but fails to examine how many practitioners are no longer practicing, are employed outside of the publicly funded BH system, or which of them carry an independent license to practice, and what the distribution of practitioners are to meet the needs in rural and frontier communities; and
o The report, in limiting its focus to EBPs has missed the broader context within which EBP adoption must occur to be successful: an adequate and qualified BH workforce, a streamlined BH regulatory environment, broad-based early and routine screening to identify those requiring intervention, implementation of primary prevention EBP strategies, and the provision of enhanced “systems of care,” instead of program specific strategies.
The report’s assessment of the ROI for individual evidence-based programs also lacks broad stakeholder input. In setting a monetary value on critical services, the report describes the method to calculate the return as: “incorporating NM statistics for cost, consequences, diagnosis rates and treatment rates.” This analysis does not consider the value to the individual of recovery from mental illness or addiction, the value of sobriety for a single mother, or the value of preventing a teen suicide. In addition, the report admits it “has not yet monetized the benefits of reduced homelessness which means the ROI likely understates the benefits” (Page 8). Publishing such assessments of ROI for critical public BH services without comprehensive methods, developed in consultation with a broad array of stakeholders, could mislead NM Legislators in budget decisions and hence impede the State’s effort to provide an effective array of both effective prevention and treatment services. HSD considers Centennial Care to be a major strategy to addressing New Mexico’s tremendous behavioral health needs -- and early reporting suggests it is working. Medicaid expansion and the integration of behavioral health services, with physical health and long-term care services, provides a potentially seamless system for 170,000 more Medicaid members. A uniform process of care coordination helps members with significant BH needs identify their needs and arrange for treatment. Behavioral health services are expanding to include more Opioid Treatment providers and Substance Abuse Intensive Outpatient (IOP) Treatment sites throughout the state, three new recovery services and a new focus on the need for trauma-informed care for children and youth. In the first six months, over 30% more Medicaid members are receiving needed BH services under the Centennial Care integrated model than received such care under the previous model.
In addition, LFC staff makes two conclusions that are highly misleading about this successful program that are not based in fact: o Report: “the state does not have a comprehensive grasp on how it spends the
estimated $209 million on adult behavioral health services, whether it is funding effective services, whether services are located in high need areas or whether services are producing expected results. This report estimates the state only spends 11 percent of its limited BH funding on proven and effective programs for adults.”(Page1). Contrary to the report, HSD has a detailed grasp on how it spends all of its BH dollars. For both Medicaid and non-Medicaid the state receives reports compiled by the five MCOs that address the quality and quantity of care. An extensive system of reports, on service utilization, access, financial and clinical practices, are gathered at regular intervals and reviewed by Medicaid staff to monitor the development of the system. Medicaid and non-Medicaid pays for encounters not programs. Many of the services LFC claims are not proven effective, actually wrap-around evidence-based programs, and include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), among many others. Because the claims payment system does not accommodate a unique billing code modifier for every EBP provided, does not mean that 81% of BH services are sub-standard. It simply means that we our systems are unable to capture all of the EBP delivery that occurs.
o Report says: “The transformation to Centennial Care brings the behavioral health system nearly full circle for the approach to paying for services used before 2000. (Page 5) This conclusion disregards the benefits of integrated care to the Medicaid member and the benefit to providers of assistance with care coordination. Medicaid now provides comprehensive medical, behavioral health and long-term care services to an increasing percentage of the population instead of the previous patchwork of separate payers and funding streams. Unlike 2000, in 2014, over 170,000 previous uninsured New Mexicans received comprehensive Medicaid coverage in 2014, instead of having to patch together a variety of state and federal grant funded programs. The Medicaid benefit package is enriched with more comprehensive services which address the Essential Health Benefits included in the ACA. New services include preventive care, dental services for adults, habilitative services and expanded substance abuse and BH recovery services. Behavioral health services must now be covered at parity with physical health.
New Mexico’s new Centennial Care 1115 Medicaid waiver provides for the true integration of medical, behavioral health and Long-term Care Services at all levels: financing, administration, reporting, and service provision. Members with both Medicaid and Medicare have access to integrated services and care coordination to negotiate the two systems. Unlike 2000, in 2014, four MCOs develop and manage a unified and integrated Medicaid program instead of the previous system of multiple MCOs administering multiple separate waiver programs. Multiple ‘protections’ have been included in the design of Centennial Care to ensure that the service and funding levels for behavioral health and long-term care services are not reduced due to the integration of services, due to lessons learned from 2000.
For the first time in state history, Medicaid’s Centennial provides a uniform Health Risk Assessment (HRA) by which every Medicaid member is contacted by their MCO to identify the member’s health, behavioral health, long-term care and social support needs. At no point in the past, has this attempt at universal screening for the needs of the “Whole Person” been implemented. Unlike 2000, in 2014, the HRA for each member is used to identify members with significant needs and assign them to a standard process of intensive care coordination. For those members who do not report significant health needs, the Health Risk Assessment is repeated annually and the care coordination system at each MCO monitors the member’s utilization to identify any increased needs. Each Centennial Care member, with significant BH needs, is being assigned to an individual Care Coordinator to visit the member in their home and perform an in-person comprehensive needs assessment and develop a service plan. Care coordination works with each member to coordinate all medical, BH and LTC services, as well as, dental and ancillary services like Durable Medical Equipment, Pharmacy and Transportation. They coordinate the member’s appointments with providers and facilitate communications between providers during transitions of care. Depending on the member’s level of need, the Care Coordinator will contract the member quarterly or monthly by phone and visit the member to update the comprehensive needs assessment semi-annually or quarterly or at any time the member’s needs change. Unlike 2000, in 2014 numerous structures are now in place to set policies to coordinate behavioral health services. Two state-level statutory committees provide for on-going assessment of the state’s needs and oversight of the system. The NM BH Purchasing Collaborative meets quarterly to coordinate the BH services each agency manages. The Collaborative issues a Consolidated Behavioral Health Services Budget annually to the Legislature to provide a state-wide picture of the behavioral health services. The Behavioral Health Planning Council is a federally required, Governor appointed council of representatives of consumers, families, and providers. State law charges the council with advising the Governor and state in identifying needs and planning services. Since 2001, the Council’s statutory
responsibilities have been expanded to include substance abuse. HSD’s Behavioral Health Services Division (BHSD) staff work closely with the Medicaid program to coordinate the management of the non-Medicaid services funded through HSD.
Unlike other LFC reports, HSD was not offered an opportunity to attach it’s response to this Results First Report when it was published. Nor was HSD invited to testify when the report was presented to the LFC in public hearing. Providing our response would have assured that Legislators would have a more complete picture regarding the status of BH needs and services in NM.
2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 1
Comments By: __________________________
CHILDREN’S SERVICES No
Progress
Being Worked On By
Completed Comments
Actionable in 2011
Solicit input from the BH Planning Council and its
Subcommittees, consumers, family members,
and providers, on criteria and strategies to
expand and guide the sizing of the Children’s
Purchasing Plan – the services needed to build
out the array and the targets for shifting to more
community-based care
Work with the NM Health Care Reform Leadership
Team and other groups addressing health care
reform to ensure that children’s behavioral
health is part of their planning related to
prevention, wellness, health disparities,
consumer protection, education, outreach and
communication, and overall payment and
delivery system reform
Continue to promote and deliver training in evidence
based practices (e.g., train the Matrix Model and
the American Society of Addiction Medicine
(ASAM) placement criteria for implementation
of Intensive Outpatient Services (IOP) for
adolescents)
Pilot an Intensive Outpatient Program for youth ages
18-21 who are leaving the juvenile justice
system which includes transitional living and
independent skill development
Schools examine and revise, as needed,
comprehensive Safe School Plans and wellness
policies that address substance abuse and
violence prevention
Promote the integration of special education and IEPs
with behavioral health plans and services
2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 2
Work with tribal communities to identify needs to
build and balance service arrays including
increasing prevention, wellness, and community
supports
Mid-Range
Initiate shifts in the Children’s Purchasing Plan as
outlined below. These shifts will prioritize services
that are outcome-driven, use evidence-informed
practices, are culturally competent, and can be
developed in tribal, rural, and frontier communities.
Expand access to services across the array through
the investment of Children Youth and Families
Department (CYFD) funds (e.g., care
coordination using a wraparound approach,
respite services, infant mental health services,
and transitional living services)
Expand early detection and intervention services for
youth experiencing their first episode of
psychosis in order to decrease movement to
more seriousness
Based on the youth Intensive Outpatient Program
pilot project, develop a comprehensive clinical
model that utilizes a system of care philosophy;
and, include an evaluation component to
examine the model’s effectiveness
Youth with serious mental illnesses (SMI) will be
transitioned from the youth system to the adult
system in a seamless fashion. Incentives for the
providers will be developed to better ensure
participation
Develop a “ road map” for employment opportunities
for transitioning youth; partner with public
education, vocational rehabilitation, and
workforce solutions agencies; educate youth,
families & stakeholders in its use
Increase screening and assessment in school based
health centers
2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 3
Create a model for prevention and early intervention
systems within school based health centers
Expand school-based early intervention strategies in
school-community collaborations
Develop a consistent risk and protection approach to
a range of prevention issues, including
substance use (e.g., underage and binge
drinking), suicide, mental health, violence, teen
pregnancy, school dropout and delinquency
Expand community based prevention and wellness as
resources become available
Long Term (3 Years)
Continue shifts in the Children’s Purchasing Plan as
outlined below. These shifts will prioritize services
that are outcome-driven, use evidence-based
practices, are culturally competent, and can be
developed in tribal, rural, and frontier communities.
Seek funding to expand the evaluated youth
Intensive Outpatient Program (IOP) model for
regional access
Implement a standardized substance abuse
assessment for youth
Create full time capacity in school based health
centers to provide mental health and substance
abuse prevention, assessment, crisis
intervention, and early intervention services
Implement comprehensive school based plans that
address prevention and wellness especially as
related to substance abuse and violence
2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 4
Expand the full service community school model
statewide
Develop strategies to support movement towards a
full continuum of promotion and prevention
services within communities for universal,
selected, and indicated populations
Develop a coordinated effort linking primary care and
BH across communities, including tribal
communities, to address prevention and
wellness, including positive youth development
strategies
Incorporate expenditures in State facilities currently
not under the auspices of the Children’s
Purchasing Plan.
2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 5
New Priorities for Next Plan – Children’s Array of Services Section
Actionable in 2015:
→
→
→
Mid-Range:
→
→
→
Long-term (3 years):
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Adult’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 6
Comments By: __________________________
ADULT’S SERVICES No
Progress
Being Worked On BY
Completed Comments
Actionable in 2011
Solicit input from the BH Planning Council and
its Subcommittees, consumers, family
members, and providers, on criteria and
strategies to expand and guide the sizing
of the Adult Purchasing Plan – the
services needed to build out the array
and the targets for shifting to more
community-based care
Work with NM Health Care Reform
Leadership Team and other groups
addressing health care reform to ensure
that adult behavioral health is part of
their planning related to prevention,
wellness, health disparities, consumer
protection, education, outreach and
communication, and overall payment
and delivery system reform
Map all prevention, early intervention, and
treatment resources across the state –
Access to Recovery (ATR), Total
Community Approach (TCA), Substance
Abuse Prevention and Treatment (SAPT)
and Community Mental Health Services
(CMHS) Block Grant funds, compulsive
gambling, medication assisted
treatment, supportive housing programs
and resources as well as other General
Fund substance abuse expenditures
Mid-Range
Initiate shifts in the Adult Purchasing
Plan as outlined below. These shifts will
prioritize services that are outcome-
driven, use evidence-based practices,
are culturally competent, and can be
developed in tribal, rural, and frontier
communities.
2011-2014 NM BH Strategic Plan Review – Adult’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 7
Increase supportive housing to decrease
transitional living services
Increase consumer-operated services and
bolster improvement of psychosocial
rehabilitation services
Increase comprehensive community support
services and focus on evidenced-
informed outpatient therapies
Fill gaps in the continuum of available services
and ensure substance use residential
services are used only when that level of
care is appropriate
Increasing the utilization of substance abuse
Intensive Outpatient Programs (IOP)
Develop a plan for more access to prevention,
screening and early intervention, and
strategies that promote wellness
Create a comprehensive, evidence-informed
strategy to prevent and reduce
substance abuse, including binge and
chronic drinking by adults, including
adults over 65
Create an IOP model for mental health;
develop a strategy for piloting this model
Educate providers about appropriate services
for elderly and persons with disabilities
who also experience severe and complex
behavioral problems and co-occurring
acute medical issues
Expand community based prevention and
wellness as resources become available
2011-2014 NM BH Strategic Plan Review – Adult’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 8
Long Term (3 Years)
Continue shifts in the Adult Purchasing
Plan as outlined below. These shifts will
prioritize services that are outcome-
driven, use evidence-based practices,
are culturally competent, and can be
developed in tribal, rural, and frontier
communities.
Invest Behavioral Health Services Division’s
(BHSD) non-Medicaid funds in services
that will fill gaps in the service array
Implement broad, high risk drinking reduction
strategies using cross agency
coordination efforts to leverage greater
impact
Expand the capacity of community-based
providers that serve people who are
elderly and persons with physical
disabilities with severe and complex
behavioral problems and co-occurring
acute medical issues
Expand the capacity of facilities that serve
people who are elderly and persons with
physical disabilities with severe and
complex behavioral problems and co-
occurring acute medical issues
Incorporate expenditures in State facilities
currently not under the auspices for the
Collaborative, into the Adult Purchasing
Plan.
2011-2014 NM BH Strategic Plan Review – Adult’s Array of Services Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 9
New Priorities for Next Plan – Adult’s Service Array Section
Actionable in 2015:
→
→
→
→
Mid-Range:
→
→
→
→
Long-term (3 years):
→
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Infrastructure Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 10
Comments By: __________________________
INFRASTRUCTURE No
Progress
Being Worked On By
Completed Comments
Actionable in 2011 Work with the NM Health Care Reform
Leadership Team and other groups
addressing health care reform to develop
a vision of integrated primary care and
behavioral health infrastructure
Establish a workgroup among primary care,
Federally Qualified Health Centers
(FQHC’s), 638’s and behavioral health
providers to agree on a practice model
for clinical integration
Develop mechanisms to share successful
implementation strategies across CSAs
Provide CCSS and Wraparound training to
CSAs
Work with CSAs to develop infrastructure for
responding to community suicide crises
Support local sites in SAMHSA grant to
develop logic models, system designs,
and strategic plans for local systems of
care that can be replicated in other
communities
Develop a statewide strategic plan for the use
and expansion of behavioral health
telehealth services that starts with
psychiatric services in FY11, then other
clinical services in FY12, and then non-
clinical services in FY13
Develop funding strategies to
support telehealth
infrastructure in school based
health centers
2011-2014 NM BH Strategic Plan Review – Infrastructure Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 11
INFRASTRUCTURE No
Progress
Being Worked On By
Completed Comments
Mid-Range
Develop a training and technical assistance
plan for primary care providers to
incorporate behavioral health services in
primary care settings, including topics
such as: implementing Screening, Brief
Interventions Referral and Treatment
(SBIRT), use of Motivational Interviewing
skills, administration of depression
screening instruments, appropriate
prescribing practices, treating opioid
addiction in families
Work with NM Health Care Reform
Leadership Team and other groups
addressing health care reform to develop
at least one pilot project on clinically
integrated primary care and behavioral
health that incorporates medical homes
and clinical homes
Pilot and evaluate a health home approach in
school based health centers in three to
five sites; document successful
components and outcomes of pilots
incorporating health home operations
within School-based Health Centers
(SBHCs); develop process to expand in
additional SBHCs
Integrate physical health initiatives within the
behavioral health consumer/recovery
population to focus on health
consequences related to major disease
processes such as diabetes, heart
disease, and emphysema
Develop a competency based CSA framework
and training plan with competencies
framed in terms of Quality Services
Review (QSR) principles
Develop a strategy for deployment of staff
from CSAs to screen, assess, and conduct
referrals of the elderly within primary
care clinics and senior centers
2011-2014 NM BH Strategic Plan Review – Infrastructure Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 12
INFRASTRUCTURE No
Progress
Being Worked On By
Completed Comments
Expand Local Lead Agency partnerships with
Core Service Agencies to increase access
to supportive housing in local
communities
Provide education, training, and technical
assistance based on lessons learned from
SAMHSA sites to expand local
development of systems of care for
children, youth and their families in
communities throughout the State
Develop a system of care model incorporating
wraparound approaches for adults,
including adults over 65; provide
education, training, and technical
assistance in implementing the model
statewide
Develop systems to use data to identify
emerging trends, e.g., the emergent use
of opioids
Develop strategies and seek grant funds to
initiate transportation services for
persons with BH issues in conjunction
with Department of transportation
(DOT), including the implementation of
consumer-run services and the
expansion of existing services
Long Term (3 Years)
Work with NM Health Care Reform
Leadership Team and other groups
addressing health care reform to
rigorously evaluate a pilot on integrated
primary care and behavioral health and
develop a long term plan for expansion
statewide
Link school based health centers to primary
care practitioners and CSAs and other
community based providers in an
integrated system that includes a
medical home approach
2011-2014 NM BH Strategic Plan Review – Infrastructure Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 13
INFRASTRUCTURE No
Progress
Being Worked On By
Completed Comments
Develop an integrated model for services and
supports to elderly persons that
incorporates behavioral health care with
primary care and other services
Develop processes that ensure that
individuals receive screening and early
intervention to minimize severity of
illness, symptoms, and functional
limitations
New Priorities for Next Plan – INFRASTRUCTURE Section
Actionable in 2015:
→
→
→
Mid-Range:
→
→
→
Long-term (3 years):
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Performance & Quality Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 14
Comments By: __________________________
PERFORMANCE & QUALITY No
Progress Being
Worked On By
Completed Comments
Actionable in 2011 Establish a “Consumer and System
Performance Dashboard” that monitors
gains in a limited set of key measures
addressing: improved functioning,
reduction in problems and achievement
of recovery of resiliency goals in
children and adult consumer lives.
Promote practice improvement through
expanding Quality Services Reviews
with Adult and Children’s Core Services
Agencies (CSA’s) statewide
Implement quality improvement processes
within CSA’s to assure implementation
of core functions and service to eligible
populations
Use results from statewide CCSS adult
provider audits to create ‘next steps’ in
development of a recovery-and
resiliency-based system of care
Provide training and implement functional
assessment (e.g. CAFAS) in Children’s
CSAs
Improve continuity in the services array by
trending services received 7 and 30
days after discharge from Adult
Residential and Psychiatric Inpatient
Improve quality through Fidelity Assessment
and Compliance monitoring:
Implement IOP Fidelity Tool for all
adult IOP providers
Strengthen current ACT Fidelity
Tool utilization by ACT programs
Monitor appropriate access to services for
older consumers with behavioral health
disorders by tracking services and
diagnoses by age
Mid-Range
2011-2014 NM BH Strategic Plan Review – Performance & Quality Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 15
PERFORMANCE & QUALITY No
Progress Being
Worked On By
Completed Comments
Develop standardized functional assessment
tool options for adults and older adults
Standardize functional assessment tool for
children (i.e., Child Adolescent Family
Assessment Scale (CAFAS)
Implement Intensive Outpatient (IOP) Audit
Tool for Medicaid providers of IOP
Improve quality by developing supportive
housing and lead agency fidelity
assessment tools and implementing a
compliance monitoring process
Implement concurrent review for residential
substance abuse services
Modify patient placement criteria for
substance abuse services to incorporate
harm reduction approaches and self-
directed recovery skills
Develop and implement treatment standards
that address appropriate transitions
between levels of care; include
incentive structures to support changes
Long Term (3 Years)
Expand access to functional assessment
information (e.g., CAFAS) to other child
serving systems (e.g., schools)
Implement functional outcomes as the
standard measure of child and youth
2011-2014 NM BH Strategic Plan Review – Performance & Quality Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 16
PERFORMANCE & QUALITY No
Progress Being
Worked On By
Completed Comments
outcomes
Develop strategies to increase access to
community support services for older
adults by designing pilot initiatives
within CSAs to explore access issues
Evaluate core service agency (CSA)
effectiveness in achieving recovery
outcomes, learning opportunities for
improvement, and incorporating
learning into practice.
Conduct a study of comprehensive
community support services (CCSS) to
determine its effectiveness in
supporting recovery-oriented
outcomes.
2011-2014 NM BH Strategic Plan Review – Performance & Quality Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 17
New Priorities for Next Plan – PERFORMANCE & QUALITY Section
Actionable in 2015:
→
→
→
→
Mid-Range:
→
→
→
→
Long-term (3 years):
→
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Consumer Engagement Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 18
Comments By: __________________________
CONSUMER ENGAGEMENT No
Progress
Being Worked On By
Completed Comments
Actionable in 2011 Identify strategies that support development of
consumer and youth resiliency in services
and trauma-informed systems of care.
Increase the number of Peer, Family and Youth
Specialists throughout the state and
promote their employment in community
organizations as Community Support
Workers (CSW) or Assertive Community
Treatment (ACT) team members
Provide leadership and advocacy training to
ensure that consumers, youth, and family
members are partners in strategic
planning, policy development, priority
setting, service implementation, resource
allocation, and evaluation
Revitalize LC’s to welcome consumers, youth,
and family members; and to ensure
members are adequately trained in
legislative advocacy, mental health first
aid, etc.
Increase LC’s participation via telehealth and
webinars to ensure that Local
Collaboratives have a voice in decision-
making
Actively distribute timely data to each LC
related to services and populations (i.e.,
persons served by gender, age, ethnicity)
2011-2014 NM BH Strategic Plan Review – Consumer Engagement Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 19
To gather information on specialized behavioral
health needs and engage special
populations in natural settings, such as
older adults in senior centers and people
with disabilities in vocational programming
Develop stakeholder-friendly surveys and
reports on consumer, youth & family
satisfaction; share findings broadly and
identify relevant quality improvement
measures
Mid-Range
Engage consumers, youth and family members
in designing systems of care that capitalize
on their local community resources and
needs
Ensure that LC’s include schools, community
programs, law enforcement, housing,
employment, child welfare, juvenile justice,
local governments, neighborhood assoc.
and others in their systems of care
Evaluate the mechanisms and effectiveness of
consumer engagement for special
populations including Native Americans,
veterans, older adults, and people with
disabilities
Implement Community Wellness and Recovery
Resource Centers as peer-run and peer-
driven pilots tailored to the needs of
communities
Support peer-to-peer school based and Peer
Bridger housing programs such as the
Natural Helpers
Increase public awareness by expanding the
number of mental health focused public
service announcements focused on
recovery and stigma
Implement statewide the New Mexico
Consumer, Youth and Family Involvement
Standards which focus on the role of state
agencies, employment, media and
marketing, and community providers.
Long Term (3 Years)
2011-2014 NM BH Strategic Plan Review – Consumer Engagement Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 20
Expand drop-in centers as resources for
consumers to continue growth and
development in their lives
Engage youth and their families in designing
systems of care including prevention in
their own communities
Recruit and train consumers from special
populations (i.e., Native Americans,
veterans, older adults, and people with
disabilities) to work as peer support
specialists
Increase awareness of early childhood
development and the effectiveness of
early intervention in terms of long-term
health and mental wellbeing for children
and families, including early intervention
for psychosis
Track data on behavioral health system
outcomes (e.g., where referrals for
behavioral health services are made) to
determine greatest needs
2011-2014 NM BH Strategic Plan Review – Consumer Engagement Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 21
New Priorities for Next Plan – CONSUMER AND FAMILY ENGAGEMENT Section
Actionable in 2015:
→
→
→
→
Mid-Range:
→
→
→
→
Long-term (3 years):
→
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Workforce Development Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 22
Comments By: __________________________
WORKFORCE DEVELOPMENT No
Progress
Being Worked On By
Completed Comments
Actionable in 2011 Augment the existing workforce to include
trained peer and family specialists as part
of the paid workforce by:
Continuing training for Peer and Family
Specialists and assisting with job
placement
Improving the Peer and Family Specialist
curriculum after quarterly reviews
and feedback from participants to
ensure that they are trained to enter
the workforce
Developing an internship process for Peer
and Family Specialists to experience
the workplace
Conducting media campaigns to promote
the benefits of Peer and Family
Specialists as essential parts of the
workforce
Increase readiness of provider agencies to
employ Peer and Family Specialists and
identify funding strategies to support the
work of these individuals
Expand outreach and identify successful efforts
to provide behavioral health services in
areas of limited workforce capacity (e.g.,
rural and tribal communities)
Deliver training in the Matrix Model to assist in
the implementation of Intensive Outpatient
Services (IOP) for adolescents and adults
and aftercare placement in supportive
housing where appropriate
Provide Comprehensive Community Support
Services and Wraparound training to
ensure that the workforce is adequately
trained to work in public and private non-
profit behavioral health settings
Seek support to sustain and expand the
prevention certification program
2011-2014 NM BH Strategic Plan Review – Workforce Development Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 23
WORKFORCE DEVELOPMENT No
Progress
Being Worked On By
Completed Comments
Work with Health Care Reform Leadership group
to evaluate funding opportunities for
workforce development. Include the Dept.
of Workforce Solutions in this process
Work with licensing boards to encourage
adoption of the NM developed cultural
competency curriculum as the standard for
all behavioral health continuing and higher
education programs
Expand mental health interpreter training,
including language as well as deaf and hard
of hearing, by offering additional training
opportunities
Mid-Range
Develop new learning models, such as
web-based trainings and web-based
learning collaboratives to ensure that the
workforce has the information to
effectively implement evidence based.
Training examples include:
Specialized training on unique issues of
older adults and persons with
disabilities
Education on the warning signs and
appropriate responses to youth and
adult suicide concerns
Training to school personnel on behavioral
health needs in school settings
Develop and implement a Core Service Agency
Integrated Training curriculum
Develop training methods for Core Service
Agencies workforce to support shared
decision making and shared planning
Provide training to Certified Family Specialists to
serve as care coordinators/wraparound
2011-2014 NM BH Strategic Plan Review – Workforce Development Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 24
WORKFORCE DEVELOPMENT No
Progress
Being Worked On By
Completed Comments
facilitators and to provide family support
services
Seek funding and mechanisms for expanding
mental health treatment guardians
Create a specialized curriculum for Veteran Peer
Specialists focusing on trauma spectrum
disorders
Train school staff about behavioral health issues;
signs and symptoms of substance abuse,
depression, suicide, and appropriate
methods of response, referral, etc.
Create incentive strategies and policies to
increase number of Certified Prevention
Specialists
Develop Training Initiatives to engage workforce
outside of Behavioral Health. Training
examples include:
Behavioral health training for nursing
home staff
Mental Health First Aid for first
responders
Training to Primary Care staff on
integrating care (CEUs)
Long Term (3 Years)
Develop and train the workforce in clinically
integrated models to serve the general
population as well as populations with
Serious Emotional Disorders (SED) and
Serious Mental Illness (SMI)
Seek funding and develop mechanisms to
support consumer, family member, and
provider participation in trainings
Develop a Training Academy, in conjunction with
the Collaborative’s Consortium for
Behavioral Health Training and Research,
for long-term statewide training delivery
Develop strategies and incentives to encourage
2011-2014 NM BH Strategic Plan Review – Workforce Development Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 25
WORKFORCE DEVELOPMENT No
Progress
Being Worked On By
Completed Comments
cross-agency and cross-system
collaboration
Strengthen licensure, re-licensure, and
certification requirements; develop a
Continuing Medical Education (CME) for
professionals with Geriatric specialty or
developmental disability specialty
Improve recruitment and retention efforts in
rural, frontier and tribal communities by
increasing access to telehealth or
enhancing availability of peer and family
specialists
Pursue education and training grants for
behavioral health service providers as they
become available under health care reform
Work with institutions of higher education to
ensure that issues relevant to public
behavioral health are integrated into
existing non-medical and medical
curriculum
Develop tax or educational incentives to
increase the recruitment of potential BH
students as well as prescribing
professionals practicing in New Mexico
Review the recommendations from the
Annapolis Coalition Workforce
Development report and prioritize steps
2011-2014 NM BH Strategic Plan Review – Workforce Development Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 26
New Priorities for Next Plan – WORKFORCE DEVELOPMENT Section
Actionable in 2015:
→
→
→
→
Mid-Range:
→
→
→
→
Long-term (3 years):
→
→
→
→
Other Comments:
2011-2014 NM BH Strategic Plan Review – Financing Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 27
Comments By: __________________________
FINANCING No
Progress
Being Worked On
BY
Completed Comments
Actionable in 2011 Increase consumer and family involvement in funding allocation discussions
Review the State’s Behavioral Health
Purchasing Plan and develop a
strategic plan for funding that takes
into account the limited dollars
available
Move toward equitable access to services
across the major funding streams (i.e.,
Medicaid, state general funds and
federal block grant funds) through
braided funding strategies
Demonstrate flexible payment strategies
within the Provider Network by
implementing risk-sharing pilots in
three areas of the state with children
and adult Core Services Agencies.
Support implementation of wrap-around
supports in the three anchor sites of
the Systems of Care initiative by
testing case rates.
Use the “Money Follows the Person”
federal planning grant to move elderly
adults from institutional care to
community-based care
Evaluate providers on performance and
target incentives for improvements in:
Consumer Outcomes
Service System Performance
Conduct a system analysis of the use of
Medicaid reimbursement for school
based BH services (ie. in school-based
health centers, special education, and
other school personnel)
Develop a workgroup with state, provider,
tribal, consumer, youth and family
representation to address expected
Medicaid shortfalls
2011-2014 NM BH Strategic Plan Review – Financing Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 28
FINANCING No
Progress
Being Worked On
BY
Completed Comments
Seek new funding streams for community
based prevention programs
Mid-Range
Develop a cost study resulting in
recommendations for expanding
behavioral health services in schools
by school-based health centers,
special education, and other school
personnel
Develop a cost study resulting in
recommendations for expanding
substance abuse services for
adolescents
Develop financial strategies to support
vulnerable services such as: care
coordination/wraparound facilitation,
respite services, transitional living
services, and early childhood/infant
treatment services
Develop financial strategies to establish
uniform crisis mobile outreach services
statewide
Implement pay-for-performance and
shared-risk payment methodologies as
research indicates
Develop financial incentives for CSAs to
develop outreach strategies and
implement integrated models that
reach Native American populations,
the elderly and adults with disabilities
Rigorously evaluate risk sharing pilots and
develop a plan for modification and/or
expansion
Pilot efforts in the use of flexible funds in
wraparound plans in the three anchor
sites of the System of Care initiative
2011-2014 NM BH Strategic Plan Review – Financing Section
BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 29
FINANCING No
Progress
Being Worked On
BY
Completed Comments
In accordance with Health Care Reform,
work with Medicaid and managed
care organizations to dedicate funds to
promote the clinical integration of
behavioral health and primary care
when appropriate
Reimburse Intensive Outpatient (IOP)
services based on demonstration of
Co-Occurring Disorder treatment
competencies established through the
Co-Occurring System Improvement
Grant (COSIG)
Long Term (3 Years)
Develop policy and financing
strategies for adult and child
wraparound approaches and other
peer and family support services
Establish Medicaid codes to support
treatment integration across service
sectors (e.g., BH, developmental
disability, primary care) so that
needed services can be provided
efficiently rather than in silos
Actively seek opportunities for
communities and the state increase
funding in New Mexico through
federal grants and other options
Develop incentives to serve populations
who are high-need, high-risk and have
complex needs
Develop models to reimburse services
based upon provider performance
Expand proven risk-sharing methodologies
statewide
Increase availability of flexible funds for
wraparound plans