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New Mexico Human Services Department

Presentation to the Behavioral Health Collaborative Wayne W. Lindstrom, Ph.D., Director, BHSD

CEO, Behavioral Health Collaborative

October 9, 2014

“The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” - Plato

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Statute Stipulates: The Collaborative shall submit an annual

report that provides information on the Collaborative’s progress towards achieving its strategic plans & goals

◦ Last Collaborative Strategic Plan was entitled: “Positioning BH for Health Care Reform: A Framework for Action FY11 – FY14

◦ The Plan called for the development of an Implementation Plan which appears to have not been developed

◦ There were however a series of actionable items that were expected to be achieved by June 30, 2014

◦ To serve as benchmark for a new Collaborative Strategic Plan, it is recommended that a report be issued regarding the degree to which these actionable items have been achieved.

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The framework for the FY11 – FY 14 Strategic Plan:

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Holistic Service Array for Children: ◦ Shift to more community-based care

◦ Assure that the needs of children are adequately addressed in healthcare reform

◦ Promote EBP

◦ Pilot IOP for transition age youth

◦ Assure that schools’ wellness policies address SU & violence prevention

◦ Integrate IEPs with BH

◦ Work to build complete service arrays in tribal communities

◦ Expand access to service

◦ Expand early detection & intervention for 1st episode of psychosis

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Holistic Service Array for Children: ◦ Develop a comprehensive IOP clinical model

◦ Assure a seamless transition to adult system

◦ Develop a “road map” for opportunities for transition youth

◦ Increase screening & assessments in schools

◦ Create a prevention & early intervention model in school-based health centers

◦ Expand school-based early interventions with community collaboration

◦ Develop a consistent risk & protection approach

◦ Expand community-based prevention

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Holistic Service Array for Children: ◦ Obtain funding for IOP adopted model implementation

◦ Implement a standardized SUD assessment

◦ Establish fulltime capacity for BH in school health centers

◦ Implement comprehensive school-based BH plans

◦ Expand full service community school model statewide

◦ Develop strategies for full prevention services implementation in communities

◦ Link primary care & BH across communities to address prevention & wellness

◦ Incorporate State facility BH expenditures into Collaborative

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Holistic Service Array for Adults: ◦ Shift to more community-based care

◦ Assure that the needs of adults are adequately addressed in healthcare reform

◦ Map all prevention, early intervention, & treatment resources in NM

◦ Increase supportive housing

◦ Increase consumer-operated services & improve PSR

◦ Fill service gaps & utilize least restrictive care

◦ Plan for more access prevention, screening & early intervention

◦ Increase utilization of SUD IOP

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Holistic Service Array for Adults: ◦ Create strategy to prevent & reduce SUDs

◦ Pilot a MH IOP model

◦ Educate & expand providers, including facilities, re: serving co-morbid needs of elderly & disabled BH consumers

◦ Expand community-based prevention & wellness services

◦ Invest non-Medicaid $ to fill service gaps

◦ Implement drinking reduction strategies

◦ Incorporate State facility BH expenditures into Collaborative

Infrastructure ◦ Develop a vision of integrated care

◦ Develop a practice model for integrated care

◦ Facilitate successful implementation strategies across CSAs

◦ Provide Wraparound & CCSS training to CSAs

◦ Develop CSA infrastructure to respond to acute crisis

◦ Assist communities with SAMHSA grant applications

◦ Develop strategic plan for expansion of telehealth

◦ Develop funding for telehealth in school-based health centers

◦ Develop PCP training to facilitate effective BH integration

◦ Pilot BH Health Homes

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Infrastructure ◦ Pilot Health Home approach in School-Based Health Centers

◦ Integrate sufficiently to address co-morbid conditions

◦ Develop competency-based CSA framework & training plan consistent with QSR

◦ Develop a strategy for deploying CSA staff in senior settings

◦ Expand Local Lead Agency/CSA partnerships to increase supportive housing

◦ Expand local Systems of Care

◦ Implement a statewide adult wraparound model

◦ Develop systems to use data to identify emerging trends

◦ Initiate transportation services

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Performance & Quality Improvement ◦ Establish a Dashboard to monitor key measures

◦ Expand QSR

◦ Implement CQI within CSAs

◦ Identify next steps in building a recovery/resiliency system

◦ Provide CAFAS training

◦ Trend services following IP & RTC

◦ Conduct fidelity & compliance monitoring

◦ Monitor access for seniors

◦ Develop standardized functional assessment tool for adults

◦ Implement IOP audit tool

◦ Implement lead agency audit tool & compliance monitoring

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Performance & Quality Improvement ◦ Implement SUD RTC concurrent review

◦ Modify SUD criteria to allow for harm-reduction & self-directed recovery skills

◦ Develop & implement standards that address LOC transitions

◦ Expand CAFAS info to other delivery systems

◦ Implement functional outcomes for children & youth

◦ Increase access to CCSS for seniors

◦ Evaluate CSAs effectiveness in achieving recovery outcomes

◦ Conduct a study of CCSS effectiveness in achieving recovery outcomes

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Consumer, Youth, & Family Engagement ◦ Provide training on how to engage in advocacy, strategic

planning, policy development, priority setting, service implementation, resource allocation, & evaluation

◦ Increase number of Peer, Family, & Youth Specialists & promote their employment

◦ Revitalize LCs

◦ Actively distribute timely data to each LC

◦ Engage special populations in their natural settings

◦ Develop stakeholder friendly surveys & reports

◦ Design SOC capitalizing on local community resources

◦ Evaluate effectiveness on consumer engagement

◦ Implement peer run wellness & recovery centers

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Consumer, Youth, & Family Engagement ◦ Support peer-to-peer school-based & Peer Bridger housing

programs

◦ Increase recovery public awareness campaigns

◦ Implement consumer, youth, & family involvement standards

◦ Expand drop-in centers

◦ Engage youth & families in building community prevention programs

◦ Recruit & train consumers from special populations

◦ Increase awareness of early childhood development & effectiveness of early interventions

◦ Track data on BH outcomes to determine needs

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Workforce Development ◦ Augment with trained peer & family specialists

◦ Increase employment opportunities for specialists

◦ Identify successful efforts to serve with limited capacity

◦ Train in the Matrix Model for IOP

◦ Provide CCSS & wraparound training

◦ Sustain & expand prevention certification

◦ Evaluate funding opportunities for workforce development

◦ Adoption of cultural competency standards re: CEUs & professional schools

◦ Expand health interpreter training

◦ Develop web-based learning collaboratives

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Workforce Development ◦ Develop & implement a CSA integrated training curriculum

&that includes shared decision-making

◦ Provide training to Family Support Specialists for CCSS & wraparound

◦ Expand MH Treatment Guardians

◦ Create a curriculum for Veteran Peer Specialists

◦ Train school staff on BH issues

◦ Incentivize to increase number of Certified Prevention Specialists

◦ Train other disciplines & settings on BH

◦ Financially support peers, families, & providers participation in training

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Workforce Development ◦ Develop a Training Academy

◦ Address BH education needs of professionals in geriatrics & DD

◦ Improve recruitment & retention in challenged areas

◦ Pursue education & training grants under ACA

◦ Ensure that BH relevant content is integrated within professional curriculum

◦ Develop incentives to recruit BH graduates to NM

◦ Review & implement relevant recommendations from the Annapolis Coalition

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Financing Strategies ◦ Increase consumer & family involvement in allocation

discussions

◦ Develop a Strategic Plan for BH funding

◦ Pursue braided funding strategies

◦ Implement risk-sharing pilots with CSAs

◦ Implement case rate pilots with 3 SOC targets

◦ Use “money follows the person” approach to transition elderly into community-based care

◦ Incentivize providers on consumer outcomes & service system performance

◦ Conduct an analysis of the use of Medicaid reimbursement for school-based BH

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Financing Strategies ◦ Study BH service gaps in Medicaid benefit

◦ Seek additional funding for prevention

◦ Conduct a cost study for expanding BH in schools

◦ Conduct a cost study to expand SUD services for youth

◦ Develop financing for wraparound, respite, TLS, & early childhood services

◦ Finance mobile crisis statewide

◦ Incentivize CSAs to outreach to NAs, disabled, & elderly

◦ Have MCOs dedicate funds to support integrated care

◦ Reimburse IOP based on demonstration of co-occurring disorder treatment standards

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Financing Strategies ◦ Establish Medicaid billing codes to support treatment

integration

◦ Pursue federal grants & other options

◦ Develop incentives to serve those that are high-risk, high-need, & with complex needs

◦ Implement performance-based contracting

◦ Expand risk-sharing methodologies statewide

◦ Increase flex funds for wraparound

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Recommended Next Steps ◦ Prepare a draft report on achievements related to the FY11-

FY14 Strategic Plan

◦ Share the draft report at the next meeting of the Collaborative

◦ When approved by the Collaborative share the report with appropriate stakeholders

◦ Use the report as a benchmark for the creation of a new 3 year Strategic Plan

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Betty Downes Behavioral Health collaborative Fourth Quarter FY 2014 Performance Measures

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Behavioral Health Collaborative

Fourth Quarter FY 2014

Performance Measures

BH Collaborative Performance Measures

4th Quarter FY 2014 2

COLLABORATIVE: Children with Improved Level of Functioning at Discharge Strategic Goal: Improve Behavioral Health Services

Measure: Percent of readmission to the same level of care or higher for children or youth

discharged from residential treatment centers and inpatient care.

FY 14 Target: 7.0% HB 2 Measure

FY 14 3rd

& 4th

Quarters combined: 3.2% Annual average: 4.0%

FY 13 Actual: 6.74%

Comments: The statewide entity’s care coordination function changed with the advent of

Centennial Care. The first 6 months of data were generated before Centennial Care was initiated,

when OptumHealth New Mexico (OHNM) managed services for Medicaid and non-Medicaid

benefits. The 3rd

& 4th

quarters are combined and reflect the aggregate data across the four MCOs

in Centennial Care for Medicaid recipients only. Managed Care Fee for Services data are not

included in this report. As an overall FY14 pattern, the number of children discharged from

Residential Care Treatment (RTC) doubled in the second half of the year (from 314 to 622).

However, when compared to the first half of the year, there was a reduction in the percentage of

readmissions to the same or higher levels of care (from 5.4% to 3.2%) . The twelve-month

average of readmissions is 3.95%.

In comparison to FY13 at year end, FY14 year-end data shows a 34.3% increase in overall RTC

discharges (936 vs. 697 discharges) and a 21% decrease in persons readmitted (47 vs. 37

persons). This represents a decrease in readmissions from 6.7% to 4.0%. We will be watching

the Centennial Care data to determine whether the high number of discharges stabilizes because it

impacts the percentage calculations notably. This may be due to ongoing refinements in data

collection for Centennial Care reports during its first year.

SFY14 SFY 13 SFY12 SFY11 SFY10

Jul - Sep 5.30% 6.92% 7.80% 5.33% 11.30%

Oct - Dec 5.60% 7.60% 14.79% 7.25% 11.40%

Jan - Mar 0.00% 9.90% 3.60% 6.40% 6.90%

Apr - Jun 3.22% 3.06% 3.70% 6.26% 4.50%

0.00%2.00%4.00%6.00%8.00%

10.00%12.00%14.00%16.00%

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nt

% of readmissions for children discharged from residential or inpatient care



Collaborative: Improve Behavioral Health Services Strategic Goal: Improve Behavioral Health Services

Measure: Number of individuals served annually in substance abuse and/or mental health

programs administered through the Behavioral Health Collaborative statewide entity contract.

FY 14 Target: 85,000 HB 2 Measure

FY 14 3rd

& 4th

Quarter Combined: 114,314 (12 months)

FY 13 Actual: 87,723

Comment: The 4th

quarter data is a cumulative, unduplicated count for the year. The FY14

annual total persons served is 114,314, a 30.8% increase over the prior year’s persons served of

87,373. Individuals served by non-Medicaid funding represent 22% (25,095 persons) of all

individuals served. Medicaid recipients make up 78% (89,219 persons) of people served.



COLLABORATIVE: Improvement after Substance Abuse Treatment Strategic Goal: Improve Behavioral Health Services

Measure: Percent of people receiving substance abuse treatment who demonstrate improvement

in the alcohol domain.

FY 14 Target: 90.0% HB 2 Measure

FY 14 Bi Annual: 79.6%

FY 13 Actual: 79.5%

Comment: BHSD has changed the methodology and the instrument for measuring improvement

among substance abusers. This new measure was implemented in January 2013. Improvements

in treatment status are measured six months after initial evaluation. The data reflected here are

being drawn from a more targeted population in the Access To Recovery (ATR) program. The

data were captured from October 1, 2012 to September 20, 2013. This latest set of data is for 10

months, beginning October 1, 2013 to June 30, 2014. For FY15, an improved methodology is

being explored, and targets may need to be adjusted.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

SFY14 SFY13 SFY12 SFY11 SFY10 SFY09 SFY08

July - Dec ( 6 months) 73.4% 79.5% 87.9% 91.7% 95.0% 73.0% 77.0%

July - June (12 months) 79.6% 87.7% 90.6% 80.3% 69.9% 74.7%

Pe

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nt

% of persons receiving substance abuse services who are improving with alcohol problems




Measure: Percent of people receiving substance abuse treatment who demonstrate improvement

in the drug domain.

FY 14 Target: 80.0 % HB 2 Measure

FY 14 Biannual: 80.3%

FY 13 Actual: 70.6 %

Comment: BHSD has changed the methodology and the instrument for tracking improvement

among substance abusers. This new measure was implemented in January 2013. Improvements

in treatment status are measured six months after initial evaluation. The data reflected here are

being drawn on a more targeted population in the ATR program. The data were captured from

October 1, 2012 to September 20, 2013. This latest set of data is for 10 months drawn from

October 1, 2013 to June 30, 2014. For FY15, an improved methodology is being explored, and

targets may need to be adjusted.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

SFY14 SY13 SFY12 SFY11 SFY10 SFY09 SFY08

Jul - Dec (6 month) 72.2% 70.6% 70.1% 70.1% 90.0% 66.0% 66.0%

Jul - Jun (12 month) 80.3% 0.0% 72.0% 70.7% 64.3% 66.0% 68.0%

Pe

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nt

% of persons receiving substance abuse services who are improving with drug abuse problems



Collaborative: Youth Suicide Strategic Goal: Improve Behavioral Health Services

Measure: Number of youth suicides among 15 to 19 year olds served by the statewide entity.

FY 14 Target: 2 HB 2 Measure

FY 14 3rd

and 4th

quarter combined: 0 Annual total = 0

FY 13 Actual: 4

Comment: No suicides were reported during the last half of FY14 among this age group served

by either the statewide entity or across the four MCOs in Centennial Care.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

SFY14 SFY13 SFY12 SFY11 SFY10 SFY09 SFY08

Jul - Sep 0.0 0.0 0.0 0.0 0.0

Oct - Dec 0.0 3.0 0.0 0.0 0.0

Jan - Mar 0.0 0.0 0.0 0.0 1.0

Apr - Jun 0.0 1.0 0.0 0.0 0.0 0.0 0.0

Annual Tot 0.0 4.0 0.0 0.0 1.0 4.0 3.0

Axi

s Ti

tle

Youth suicides among 15-19 year olds served




Measure: Percent of individuals discharged from inpatient facilities who receive follow-up

services at seven days.

FY 14 Target: 38% at seven days

FY 14 3rd

and 4th

Quarters combined: 24.4 % 12 month average = 25.9%

FY 13 Actual: 39.63%

Comments: The 1,752 inpatient discharges in FY14 3rd

& 4th

quarters combined represents a

10.7% increase over the first half of FY14 (1,582 discharges). The Quality Improvement

Committee will engage in a Performance Improvement Project with the intent of meeting or

exceeding the established target. This measure may improve as additional claims data is received.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

7 Day 30 Day 7 Day 30 Day 7 Day 30 Day 7 Day 30 Day 7 Day 30 Day

SFY14 SFY 13 SFY 12 SFY 11 SFY 10

Qtr I* 27.60% 45.50% 39.90% 58.75% 35.50% 56.18% 35.41% 53.40% 33.90% 51.10%

Qtr II * 27.20% 44.20% 41.01% 63.05% 33.80% 53.70% 34.06% 58.30% 32.52% 51.98%

Qtr III 39.33% 59.98% 36.88% 58.02% 39.43% 59.70% 37.23% 55.79%

Qtr IV 24.43% 59.93% 38.01% 52.42% 36.08% 52.38% 36.97% 59.31% 34.79% 53.61%

Pe

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t

Inpatient discharges and community follow-up within 7 and 30 days




Measure: Percent of individuals discharged from inpatient facilities who receive follow-

up services at thirty days.

FY 14 Target: 60.0 % HB 2 Measure

FY 14 3rd

and 4th

Quarter combined 59.9 % 12 month average = 52.8%

FY 13 Actual: 58.76%

Comments: The 1,752 inpatient discharges in FY14 3rd

& 4th

quarters combined represents a

10.7% increase over the first half of FY14 (or, 1,582 discharges). The Quality Improvement

Committee will engage in a Performance Improvement Project with the intent of meeting or

exceeding the established target.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

7 Day 30 Day 7 Day 30 Day 7 Day 30 Day 7 Day 30 Day 7 Day 30 Day

SFY14 SFY 13 SFY 12 SFY 11 SFY 10

Qtr I* 27.60% 45.50% 39.90% 58.75% 35.50% 56.18% 35.41% 53.40% 33.90% 51.10%

Qtr II * 27.20% 44.20% 41.01% 63.05% 33.80% 53.70% 34.06% 58.30% 32.52% 51.98%

Qtr III 39.33% 59.98% 36.88% 58.02% 39.43% 59.70% 37.23% 55.79%

Qtr IV 24.43% 59.93% 38.01% 52.42% 36.08% 52.38% 36.97% 59.31% 34.79% 53.61%

Pe

cen

t

Inpatient discharges and community follow-up within 7 and 30 days



COLLABORATIVE: 8th

Grade Math Proficiency Gap Strategic Goal: Improve Behavioral Health Services

Measure: Reduction in the gap between children in school who are receiving behavioral health

services and their counterparts in achieving age appropriate proficiency scores in math (eight

grade).

FY 14 Target: 12.1%

FY 14 4th Quarter: This is an annual measure.

FY14 data will be available November 2014

FY 13 Actual: 4.4%

Comments: The FY13 target of 13.3% was significantly exceeded. There was only a 4.4% gap

in age-appropriate mathematics proficiency scores among the 8th

graders who were receiving

behavioral health care as compared to their counterparts. We are narrowing the gap in

performance.

4.4%

10.2%

8.1%

10.4%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

FY14 FY13 FY12 FY11 FY10 FY09

8th grade mathematics proficiency gap % Goal=No gap



COLLABORATIVE: 5th

Grade Reading Proficiency Gap Strategic Goal: Improve Behavioral Health Services

Measure: Reduction in the gap between children in school who are receiving behavioral health

services and their counterparts in achieving age appropriate proficiency scores in reading (fifth

grade).

FY 14 Target: 7.8%

FY 14 3rd

Quarter: This is an annual measure.

FY14 data available November 2014.

FY 13 Actual: 5.7%

Comments: The FY13 target of 8.1% was exceeded. There was only a 5.7% gap in reading

among the 5th

graders who were receiving behavioral health care as compared to their

counterparts who do not receive behavioral health care. While we are narrowing the gap in

performance relative to the annual target, this is 2.2% higher than FY12. PED projects this

measure to reach 5% or lower by 2020.

5.7%

3.5%

6.7%

3.9%

9.8%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

FY14 FY13 FY12 FY11 FY10 FY09

5th grade reading proficiency gap % Goal=No gap



COLLABORATIVE: % of Adults Satisfied with Housing Supports Strategic Goal: Improve Behavioral Health Services

Measure: Percent of adults with mental illness and/or substance abuse disorders receiving

services who report satisfaction with staff’s assistance with their housing need.

FY 14 Target: 75%

FY 14 Annual: This is an annual measure due in October, 2014.

FY 13 Actual: 74.1%

Comments: The 2013 Annual Consumer and Family Satisfaction Report results indicate 74.1%

of the respondents were positive about their housing supports in treatment. This significantly

exceeds the FY13 goal of 47%. This is a subscale in the Annual Consumer and Family

Satisfaction Survey administered by the Behavioral Health Collaborative. The final combined

report for both Medicaid and Non-Medicaid will be available in early October.

74.1%

63.4% 65.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

FY14 FY13 Actual FY12 Actual: FY11 Actual

Percent of adults satisfied with housing supports



COLLABORATIVE: % of Children Served Who Demonstrate Improved Functioning Strategic Goal: Improve Behavioral Health Services

Measure: Percent of children served who demonstrate improved functioning as measured by the

Child and Adolescent Functional Assessment Scale (CAFAS).

FY 14 Target: 40%

FY 14 4th

Quarter: 41 % Annual (12 month) data: 42%

FY 13 Actual: 35.0% (based on 9 months of data)

Comments: Improvement in functioning is measured as a Total CAFAS Score of 40 or less by

the Child and Adolescent Functional Assessment Scale (CAFAS). The FY14 Annual data

indicate that 42% (or 1,294 children) had a total CAFAS score of 40 or less at follow-up.

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Q 1 Q 2 Q 3 Q 4 Annual Annual Annual

2014 2013 2012

Series1 15% 37% 14% 32% 18% 41% 16% 42% 14% 35% 15% 36%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Pe

rce

nt

% of children who demonstrate improved functioning



COLLABORATIVE: Number of Persons Receiving Services through Telemedicine Strategic Goal: Improve Behavioral Health Services

Measure: Increase in the number of persons served through telehealth in the rural and

frontier counties.

FY 14 Target: 1,250

FY 14 4th

Quarter: Annual (12 month) data: TBD

FY 13 Actual:

Comments: This measure will be updated in the FY15 1st Quarter Performance Measures.

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