Overview of OMH and OASAS Behavioral Health Services

Presented by McSilver/MCTAC Technical Assistance Training Partners

Adult BH HCBS Roadmap Partners

November 16, 2016 3

Overview of OMH and OASAS Behavioral Health Services

• OMH

• OASAS

Important to remember that in addition to BH HCBS, recipients may also receive care through OMH and OASAS licensed programs.

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OMH and OASAS Behavioral Health Services

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Partial Hospitalization

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Partial Hospitalization

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Personalized Recovery Oriented Services (PROS)

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PROS

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Assertive Community Treatment (ACT)

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ACT

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CDT

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Comprehensive Psychiatric Emergency Program (CPEP)

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CPEP

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Intensive Psychiatric Rehabilitation Treatment (IPRT)

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IPRT

Note: There are 3 IPRTs in NYS, and this service is not be available in all regions.

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• Drop In Centers: Engage people who may not otherwise choose to participate in treatment services. Services are low demand, flexible and unstructured.

• Psychosocial Clubs: Promote recovery through self-help, community living, academic/vocational exploration and socialization

• Recovery Centers: A peer support program to help people work and fully participate in communities and can serve as a clearinghouse for community opportunities.

• Self Help: A peer support program providing rehabilitative and support activities through support groups, networks, etc.

Community Support Programs

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Vocational Services

• Supported Employment Services: intensive, ongoing support to enable people to work in regular work settings.

• Assisted Competitive Employment (ACE): assist with obtaining and maintaining employment. Services are intensive and ongoing.

• Transitional Employment Program (TEP): learning and work experiences to develop non-job-specific strengths and soft skills that contribute to employability.

• Affirmative Business/Industry (ABI): alternative to sheltered workshops • Enclave in Industry: initial and ongoing training activities on the job for

groups of people (3-8)

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Residential Services

• Community Residences: Transitional housing program with 24 hour staff support that provides skills training for successful reintegration into the community

• Treatment Apartments: High level of support and skills training in an apartment setting.

• Supported Housing: Person lives in the community with staff assistance as needed and wanted.

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OASAS SUD Services Substance Use Disorder Services Descriptions

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LOCADTR • Level Of Care for Alcohol and Drug Treatment Referral • Placement criteria based on the admission criteria and are

used within a clinical process • OASAS providers will administer the LOCADTR before

admission to a service

• If a different level of care is indicated, referral will be made.

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State Plan Services

Crisis Services

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Withdrawal Management Spectrum Severe

Withdrawal Withdrawal Symptoms that

may be life threatening including: Delirium Tremens; seizures, severe dehydration and vomiting

Physical Health Conditions that may be exacerbated by withdrawal or make withdrawal more serious.

Mental Health Conditions

that make stabilization more complicated –for example, severe anxiety, suicidal thoughts or intent.

Mild to Moderate or persistent withdrawal symptoms.

Admitted from another level of care, not in need of acute detox services.

Need for withdrawal symptom relief.

Mild/Minimal Withdrawal

Moderate Withdrawal

Symptoms of

withdrawal are present and cause significant discomfort or distress.

Need for medication with slow taper and observation to ensure that the individual is not worsening to severe withdrawal.

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Access to Withdrawal Management Services Across all Treatment Services of OASAS

Create a Comprehensive Treatment Settings

Crisis Services Medically Managed Withdrawal and Stabilization Medically Supervised Withdrawal and Stabilization Medically Supervised Outpatient Withdrawal and Stabilization Medically Monitored Withdrawal and Stabilization(phasing out)

Inpatient Rehab WMS provided

Residential Stabilization phase within the New Residential Redesign System

Outpatient Ancillary Withdrawal Management services

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Ancillary Withdrawal Services • Ancillary withdrawal services are the medical management of mild or

moderate symptoms of withdrawal within in an OASAS-certified setting. Medical staff monitor withdrawal symptoms.

• This is a service that seeks to stabilize the patient through safe and effective management of mild/moderate and protracted withdrawal symptoms

• Engage in treatment and improve treatment experience and outcomes

• Staffing will include a physician, physician extenders, registered nurse, and clinical staff.

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State Plan Services

Inpatient Services

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Inpatient Rehabilitation • OASAS-certified 24-hour, structured, short-term, intensive treatment

services provided in a hospital or free-standing facility. Medical and individualized treatment services are provided to individuals who have co-occurring medical or psychiatric conditions or are using substances in a way that puts them in harm.

• Treatment is provided under direction of a physician medical director

and the staff includes nursing and clinical staff 24 hours 7 days per week.

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State Plan Services

Outpatient Services

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Brief Intervention • This service is a one to three session brief intervention provided to

people who do not meet the diagnostic criteria for admission to SUD services, but meet at least one criteria for an SUD based on DSM 5, or who have screened as high risk through an agency screening process.

• The intervention educates them about their substance use, alerts

them to possible consequences, and motivates them to change their behavior.

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Medication Supported Recovery

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treatment substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication-assisted treatment (MAT) is clinically driven with a focus on individualized patient care." (Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA CSAT) Division of Pharmacologic Therapies) While MAT is well-known, NYS OASAS would like to introduce the language of Medication-Supported Recovery (MSR).

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Outpatient Clinic • Multi-disciplinary teams

• Outpatient services may be delivered at different levels of intensity

responsive to the severity of the problems presented by the patient. • Treatment includes the following procedures: group and individual

counseling; education about, orientation to, and opportunity for participation in relevant and available self-help groups; alcohol and substance abuse disorder awareness and relapse prevention; HIV and other communicable disease education, risk assessment, supportive counseling and referral; and family treatment.

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Outpatient Rehabilitation • OASAS-certified services designed to assist individuals with chronic

medical and psychiatric conditions. These programs provide an array of rehabilitative services. Individuals initially receive services three to five days a week for at least four hours per day.

• There is a richer staff to client ratio for these services compared to other

outpatient levels.

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Problem Gambling Outpatient • Services that assist individuals who are affected by problem and

pathological gambling including family members and/or significant others. • These services may be provided in free-standing settings or may be co-

located in chemical dependency clinics or other mental health settings. • Each problem gambling outpatient service provides the following: group

and individual counseling, education about, orientation to and opportunity to participate in problem gambling awareness and relapse prevention, self-help groups and family treatment. In addition, financial counseling is provided either directly or through outside referral.

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Intensive Outpatient Service • For individuals who require a time-limited, multi-faceted array of services,

structure, and support to achieve and sustain recovery. • Minimum of 9 service hours per week delivered during the day, evening or

weekends. • The treatment program consists of, but is not limited to: individual, group

and family counseling; relapse prevention and cognitive and behavioral interventions; motivational enhancement; and the development of coping skills to effectively deal with emotions and environmental stressors.

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Opioid Treatment Program (OTP)

• Methadone or other approved medications are administered to treat opioid dependency following one or more medical treatment protocols as defined by 14 NYCRR Part 822 OTPs offer medical and support services including counseling and educational and vocational rehabilitation.

• Patients are prescribed and delivered medication assisted treatment which

is expected to be long term medication management of a chronic disorder.

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State Plan Services

Residential Services

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Residential Services • OASAS residential system has been redesigned and providers are

in process of transitioning to the newly designed service. Many are still providing service in the original model as they prepare their organizations for the change.

• New Model provides three separate elements of care that can be accessed independently. Ancillary Withdrawal and MAT must be available to all residents. Individualized lengths of stay, person-centered, trauma-informed treatment and planning is a must.

• Original model includes three levels of care: Intensive Residential Rehabilitation, Community Residential and Supportive Living.

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Stabilization Services in a Residential Setting • Residential Stabilization Services seeks to provide a safe and supportive environment for

individuals who cannot effectively utilize out-patient services at time of referral nor require inpatient rehabilitation.

• Individuals will receive medically-directed care to treat acute problems and adjust to early recovery.

• OASAS-certified providers of residential programs that provide medical and clinical services including:

• medical evaluation;

• ongoing medication management and limited medical intervention;

• ancillary withdrawal and medication assisted substance use treatment;

• psychiatric evaluation and ongoing management;

• and group, individual and family counseling focused on stabilizing the individual and increasing coping skills until the individual is able to manage feelings, urges and craving, co-occurring psychiatric symptoms and medical conditions within the safety of the residence.

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Rehabilitative Services in Residential Setting

• Certified OASAS providers of residential programs which provide rehabilitative services for individuals who are stable enough to manage emotional states, urges and cravings, co-occurring psychiatric symptoms and medical conditions within the safety of a residential setting.

• Services include medical monitoring of chronic conditions including routine

medication management and individual, group and family counseling focused on rehabilitation.

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Reintegration Services in a Residential Setting • Reintegration services to transition from structured treatment

environments to more independent living. • This setting does NOT require a physician to serve as medical director

and staff COORDINATE treatment services but do not provide direct clinical care.

• Services include medical and clinical oversight of chronic but stable medical and psychiatric symptoms and conditions in a community treatment program including an outpatient Substance Use Disorder treatment program. Services also include: community meetings; activities of daily living (ADL) support; case management; and vocational support and clinical services to support transition to independent living.

• Reintegration services may be provided in a congregate or scatter-site setting.

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Residential Rehabilitative Services for Youth (RRSY)

• In July 2007, all short-term and long-term RCDY programs began converting to a new residential service that includes the following enhanced staffing pattern:

• Medical Director, • on-site medical staff, • provision for psychological and psychiatric services • and a community support specialist to help with case management

and discharge planning • The staff to patient ratio is 1:8 and all programs are required to have a

family therapist and/or a social worker with family therapy experience.

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State Plan Services

Recovery Support and Housing Services

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Recovery Support Recovery supports may enable a person who lacks social, emotional and community resources in the natural environment to maintain community based living if the additional supports help stabilize them and provide enough support to enable them to manage early recovery in an ambulatory or community setting. • Individuals and families can access recovery supports through:

peer services in outpatient clinics, opioid treatment programs (OTP), and Home and Community Based Services

Recovery Community and Outreach Centers case management associated with supportive housing Clubhouses (adolescents/young adults) Family Support Navigators (in development) Mutual Aid groups (self-help) FOR-NY (Friends of Recovery – state-wide)

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Recovery Support

• The Recovery Community and Outreach Centers provide a community-based, non-clinical setting that is safe, welcoming and alcohol/drug-free for any member of the community. The centers promote long-term recovery through skill building, recreation, wellness education, employment readiness, civic restoration opportunities, and other social activities. The centers provide an opportunity for individuals and families to connect with peers so that they can benefit from shared experiences and commitment to common goals for recovery. Services will be accessible during the daytime, evening and weekends.

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Recovery Support

• Peer Engagement Services (in development). The primary goal of the Peer Engagement program is to utilize expertise associated with addiction and recovery experience and become a resource to individuals and families that present in various settings such as emergency departments due to their substance use. It is the goal of the Peer Engagement to understand service delivery within an emergency room and other settings and to effectively engage and partner with the target populations within that setting.

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Recovery Support

• Substance use disorder community-based clubhouses focus on prevention and provide a safe environment for adolescents/young adults (including age 21) in recovery or at risk for substance use disorders by promoting peer-driven supports and services in a non-clinical setting

• Family Support Navigators (in development) assist families and individuals

with gaining an increased understanding of the progression of addiction and how to navigate insurance and treatment systems. (The term family refers to persons or group of people an individual sees as significant in their life. It may include none, all, or some members of the individual’s family of origin).

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Permanent Supportive Housing • Permanent Supportive Housing includes all housing with an expected length of stay

beyond 24 months. OASAS' Shelter Plus Care, New York/ New York III and Upstate Permanent Supportive Housing Program are considered permanent housing.

• All of OASAS' permanent housing programs include rental subsidies and provide access

to supportive services which assist individuals and families to achieve greater independence and self-sufficiency.

• Permanent Supportive Housing may be organized as a scatter-bed setting in small

clusters of 5-10 units in a building with case management and employment counseling services coming to the housing sites or as a congregate care setting in one building with one or several different special need populations.

• Permanent Supportive Housing can also lead to "turn-key", whereby the lease may be

turned over to a tenant who has reached a level of income that is sufficient to assume full rental responsibility.

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State Plan Services

Prevention Services

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Prevention Programs and Strategies • OASAS prevention strategies for children and families include the provision of accurate, age

appropriate and culturally competent information, and educational curricula including social skills development.

• Environmental strategies for schools and communities include improving policies, regulations and

their enforcement to reduce the availability of drugs and improve social norms. Counseling and Early Intervention services may also be provided to those identified at higher risk for substance abuse.

• All OASAS funded prevention services must address individual and/or family risk and protective

factors and/or community level risk and protective factors. • Prevention Resource Centers (PRC) support the infrastructure in the implementation of evidence-

based prevention strategies by disseminating current prevention science, through training and technical assistance, to community coalitions and prevention providers to bring science to practice. PRCs provide regional training and technical assistance to foster and support community coalitions; assist communities with a focus on building community capacity and resources to change community attitudes; provide technical assistance to coalitions and providers on the Strategic Prevention Framework.

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For additional questions, please follow-up with an email to the appropriate state office: • OASAS: PICM@oasas.ny.gov • OMH: OMH-Managed-Care@omh.ny.gov