Expanded Mobile Response & Stabilization Services Peer Meeting: - - PowerPoint PPT Presentation

MAY 23-24, 2018 PISCATAWAY,NJ Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services

Expanded Mobile Response & Stabilization Services Peer Meeting: DAY 1

This peer small group meeting is hosted by the National Technical Assistance Network for Children’s Behavioral Health (TA Network), operated by and coordinated through the University of Maryland.

This presentation was prepared by the National Technical Assistance Network for Children’s Behavioral Health under contract with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Contract #HHSS280201500007C. The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

CMS/SAMHSA Joint Information Bulletin (May 2013)

Intensive Care Coordination: Wraparound Approach Parent and Youth Peer Support Services Intensive In-Home Services Respite Mobile Crisis Response and Stabilization Flex Funds Trauma Informed Systems and Evidence-Based Treatments Addressing Trauma

https://www.medicaid.gov/federal-policy-guidance/downloads/CIB-05-07-2013.pdf

MRSS Value to Systems of Care

Faculty/Staff Introductions

– Milwaukee County, Wisconsin:

Bruce Kamradt, Chris Morano, Chad Meinholdt

– New Jersey:

Ruby Goyal-Carkeek, Wyndee Davis, Stacy Reh

– Connecticut:

Tim Marshall, Jeff Vanderploeg

– TA Network:

Dayana Simons, Elizabeth Manley, Shannon Robshaw, Rhona Mutibwa, Jamila Savage

Agenda: Day 1

• State and Alumni Team Introductions
• Debrief of “Ride Along”
• Alumni Panel: Lessons Learned
• Lunch (on your own)
• Affinity Group Specialized TA Sessions
• Affinity Groups Report Out
• Q&A and Wrap Up

MRSS Resource Material Library: http://www.tanetworkmeetings.org/2018-mrss- resources

State / County Team Introductions

• Fairfax County, Virginia
• Hennepin County, Minnesota
• Ohio
• San Francisco, California

Fairfax County, VA

Participant Name Title/Role Organization (if applicable) Jim Gillespie Youth and Family Services Director, Healthy Minds Fairfax Director Fairfax-Falls Church Community Services Board (public MH, SUD, DD services) Belinda Massaro Manager CSB Mobile Crisis Response Mary Jo Davis Coordinator Fairfax County Public Schools Social Work Services Katherine Long Program Manager Children's Regional Crisis Response Liv Salvador Program Director Regional, Education, Assessment, Crisis Services, Habilitation Marie Thomas Leland House Manager United Methodist Family Services Jessica Jackson Manager CSB Youth Intensive Services

Fairfax County, VA

Participant Name Title/Role Organization (if applicable) Marla Zometsky Turning Point Manager CSB Melody Vielbig Foster Care and Adoption Supervisor Fairfax County Department of Family Services Katherine Hunter Child and Adolescent Program Specialist Virginia Department of Behavioral and Developmental Services Linh Nghe Supervisor Children's Behavioral Health Bureau/ Behavioral Health Wellness Services Arlington Department of Human Services

Fairfax County: Program Structure

• Most local programs are funded by a combination of state and county dollars, with the county usually

paying the larger share.

• The Children’s Regional Crisis Response Program is 100% state funded, although the county has approved

funding to support a 30% expansion.

• The Regional, Education, Assessment, Crisis Services, Habilitation Program, serving youth and adults with

developmental disabilities, is 100% state funded.

• The Leland House 45-day residential crisis stabilization program is county, state and Medicaid funded.
• Programming is generally targeted to all children, youth and families in the county.
• Several county services are located in schools, and for others, school staff are major referral sources.
• There is a small amount of funding targeted to serving youth through Diversion First, the county’s jail

diversion initiative, although those resources have not been strategically deployed.

• Healthy Minds Fairfax is the community’s partnership to improve access to and the quality of children’s

behavioral health services.

Fairfax County: Program Components

• Community Services Board (public mental health):
• Emergency services, mobile crisis response and same day access
• Turning Point services for youth and young adults with first psychotic episodes
• Intensive care coordination services
• Regional, Education, Assessment, Crisis Services, Habilitation provides in-home and community-

based crisis assistance services to individuals with intellectual and developmental disabilities

• Children's Regional Crisis Response program provides 24-hour rapid response to youth facing

mental health and/or substance use crises

• Leland House is a 45-day crisis care facility that serves youth ages 12-17 who are in a psychiatric

crisis or who need step-down services from an acute psychiatric setting

• CrisisLink is a local telephone and text crisis hotline

Fairfax County: Barriers/Challenges

• We currently have some elements of a crisis response system, but they are under-

resourced and not completely integrated.

• We have a crisis residential service, but gaining entry in a true crisis can be difficult, and

with a length of stay of up to 45 days it is often at capacity.

• One of our major concerns is responding to children and youth presenting at the

emergency departments as a result of suicide ideation or attempts.

• Youth with developmental disabilities and behavioral health issues are particularly at risk
• f restrictive placement.
• Fairfax County youth needing psychiatric hospitalization are often placed outside the

Washington area, sometimes several hours away and/or in another state, hindering family participation in treatment. These facilities have little knowledge of Fairfax resources.

Fairfax County: Meeting Objectives

Learn about strategies to:

• Implement an effective crisis response that addresses both children and

youth at risk of hospitalization and other children, youth and families in crisis.

• Build a mobile response system that serves children, youth and families at a

time that best meets their needs, and ideally before risk factors have become extreme.

• Reduce number of youth hospitalized outside the community or

inappropriately placed in non-psychiatric beds.

Hennepin County, Minnesota

Participant Name Title/Role Organization (if applicable) Kay S Pitkin Manager Emergency Mental Health Services Hennepin Co Health and Human Services Public Health Department Tammy Doll Supervisor, Child Crisis 0-17 year olds Hennepin Co Health and Human Services Public Health Department Nicole Robbins Supervisor, Community Outreach for Psychiatric Emergencies (COPE) 18 years and above Hennepin Co Health and Human Services Public Health Department

Hennepin County: Program Structure

• Funding:
• 67% County
• 17% State Grant
• 16% Health Insurance (public and private)
• Strongly supported by County Board and Legislature
• At least 4:1 return on investment (MN Management and Budget 2015)
• Serve anyone present in Hennepin County today
• Partner widely across county health and human services and community

with services, training, joint partnerships, health projects

Hennepin County: Program Components

• 24-7 phone, mobile crisis, and stabilization services
• Caller defines the crisis
• Culturally/linguistically diverse staff and interns (15 languages spoken)
• Partnerships with schools, hospitals, corrections, community organizations,

protective services

• Suicide prevention, means restriction education, Zero Suicide
• Police Co-Responder teams
• Emergency Preparedness Response

Hennepin County: Barriers/Challenges

• County operated; new services developed through partnerships
• Co-responder model and Zero Suicide implementation
• Financial barriers – benefit set too low in spite of increase
• Demand for service outpaces program growth
• Lack of parity with medical services

Hennepin County: Meeting Objectives

• Learn other regions’ MRSS strategies and financial best practices

and consider how to apply in Minnesota

• Identify ways to improve partnerships with other agencies/groups
• Participate in ride along opportunities to compare program

designs and functions across communities

Ohio

Participant Name Title/Role Organization (if applicable) Heather Wells Engage 2.0 PD, Southwest Region, Ohio Butler County ESC Teresa Reed-McGlashan Engage 2.0 PD, Northwest Region, Ohio Lucas County Family and Children First Council Wilma Townsend Engage 2.0 Project Director Ohio Department of Mental Health and Addiction Services Ellen F. Harvey Director of Children’s Services Butler County MHARS Board Richard Shepler Director, Center for Innovative Practices Case Western Reserve University Amy Raynes Executive Director Preble County MHRB Laura Payne Researcher OhioMHAS

Ohio: Program Structure

Southwest Region (Butler, Clermont, Clinton, Preble and Warren Counties):

• Each county currently has county-funded

hotline and mobile crisis services.

• Services differ by county in terms of access

to mobile crisis services.

• All counties serve both youth and adults at

risk of harm to self or others.

• Created change team of cross-system

members. Northwest Region (Lucas, Erie, Hancock, Allen, Auglaize, Hardin, Putnam, Sandusky, Wood, Seneca and Wyandot Counties):

• State is providing technical assistance and

funding.

• Funded through Engage 2.0 SAMHSA Grant.
• Serving children between the ages of 0

through 21 years with behavioral health concerns.

• Created change team of cross-system

members.

Ohio: Program Components

Southwest program will include:

• 24/7 hotline access in all counties using 4

different numbers in 5 counties.

• Program components differ by county.

Current project aims to identify consistent program enhancements.

Northwest program will include :

• 24/7 hotline
• Mobile Response Team to respond face-

to-face within 30-60 minutes.

• 4-6 weeks intensive services determined

through clinical assessment and service coordination planning.

• Warm handoff to additional community

care coordination or wraparound services, as needed.

Ohio: Barriers/Challenges

Southwest:

• 4 different hotlines/numbers
• 4 different implementation models

with varying degrees of coverage

• Concerns about sustainability for

new programs

• Lack of clarity about which

components should be regionalized Northwest:

• How to implement MRSS in rural vs.

urban counties

• Geographical barriers- how to set a

goal of 30 minutes response time with a large area

• How to make MRSS regional with 11

counties

Ohio: Meeting Objectives

The top 3 learning objectives that we would like to discuss are:

• Day-to-day operation of MRSS
• Staffing
• Cost/reimbursement

San Francisco, California

Participant Name Title/Role Organization (if applicable)

Barrett Johnson Program Director Family and Children's Services Alison Lustbader Program Manager Intensive Services Community Behavioral Health Services Gary Levene Senior Supervising Probation Officer Juvenile Probation Department Dana E. Blackwell Senior Director Casey Family Programs Paula Hernandez Assistant Chief Probation Officer Juvenile Probation Department Sara Schumann Director of Probation Services Probation Department Linnea Koopmans Senior Policy Analyst The County Behavioral Health Directors Association of California (CBHDA) Lishaun Francis Senior Associate Children Now

Participant Name Title/Role Organization (if applicable)

Loc Nguyen CCR/ICWA Consultant The County Welfare Directors Association of California (CWDA) Nadia Sexton Consultant

San Francisco, California

San Francisco: Program Structure

San Francisco and California are in the exploration phase of implementation:

• San Francisco (child welfare, juvenile probation and children’s behavioral

health) will be implementing during FFY 2018/2019 using Title IV-E Waiver and mental health funding.

• Building an RFP for release in April or May of 2018.
• Multiple counties in the Bay Area region are exploring a regional system.
• California County Welfare Directors’ Association (CWDA) is exploring

legislation/funding for statewide system.

San Francisco: Program Structure (cont.)

• California is a county-administered system with state oversight for child

welfare, juvenile probation and behavioral health.

• Counties have various structures.
• San Francisco has a close partnership between the human services agency,

behavioral health and juvenile probation.

• Initial target population consists of children and youth in care who are

served by one of the three systems (CW, JP and BH).

• Specific components are not established at this stage.
• San Francisco is pursuing mobile response/care coordination/emergency

placements together

San Francisco: Barriers/Challenges

Challenges include:

• Securing long-term funding/legislation
• Identifying key components to develop
• RFP development (In SF and Bay Area region)

Barriers include:

• Developing a system that can serve multiple jurisdictions with

different structures and levels of partnership.

• Ensuring equitable coverage and care in a large, diverse state

with urban and rural areas.

San Francisco: Meeting Objectives

• Understanding how mobile response integrates with existing

services

• Understanding strategies for development of public/private

staffing structures to initiate and maintain mobile response

• Identifying potential funding methodologies and structures

Alumni Team Introductions

• Alaska
• Broward County, Florida
• Guam
• Indiana
• Kansas
• Muskegon County, Michigan
• Nevada
• North Carolina
• Oklahoma
• Philadelphia, Pennsylvania
• Stark County, Ohio
• South Carolina

Alaska: Alumni, December 2017

Participant Name Title/Role Organization (if applicable) Kacea Bjork Mental Health Clinician III/ Program Manager State of Alaska Division of Behavioral Health Marita Bailey Clinical Director Sitka Counseling Jim McLaughlin Mental Health Clinician III Alaska Div. of Behavioral Health Chris Byrnes Director of BH Emergency Services Yukon-Kuskokwim Health Corporation

Alaska: Program Structure

Alaska is in the Planning Stage

• Applied for an 1115 waiver which includes Mobile Crisis Response

for youth with SED, individuals with SUD, and adults with SMI

• Statewide service, with implementation rolling out in different

regional hubs over a 1-3 year period

• Division of Behavioral Health (DBH) hopes to develop partnerships

with child protection as the focus of the waiver is on early intervention for families involved in / referred to protective services

• Funded through Medicaid, there may be some grant funds available

but Alaska’s system is moving away from reliance on grant funding

Alaska: Program Components

As identified in the 1115:

• Mobile Response for youth, adults with SMI and youth/adults with SUD will include

the following:

• Clinical professionals meet face to face with individuals experiencing a crisis

wherever the crisis occurs

• Assessment and de-escalation of the situation
• Referral of the individual to appropriate services
• Goals:
• reduce ED visits, and psychiatric hospital admissions
• control transportation costs,
• develop regional capacity to provide psychiatric emergency residential services

and increase access to outpatient care.

Alaska: Program Updates

• Increased focus on value of home-based services
• Service type included in waiver
• Medicaid rates set to be rebased 7/1/18 to ease financial burden
• f providing these services
• Continuing to identify gaps in services
• DBH will take on Autism services and continue providing services

to individuals with FASD or TBIs who do not meet criteria for disability support services

• Increasing attention on access to care issues and the role of

telemedicine in ensuring timely access to care

Alaska: Barriers/Challenges

• Size and Geography
• Will this service be available statewide?
• How can this service be adapted for rural/remote locations?
• System Redesign Considerations
• Government to government considerations in collaborating with

tribal partners

• Workforce development:
• Ensuring skills at crisis intervention for mental health,

substance use disorders and I/DD

Alaska: Meeting Objectives

• Develop a feasible plan for implementing Mobile Response in

rural/remote areas of Alaska

• Accessibility/availability of services
• Partnering with tribal health organizations
• Safety considerations
• Travel in adverse weather conditions
• Gain a better understanding of how Mobile Response can be applied

to serving individuals with an SUD or adults who experience SMI

• Learn from other states who have successfully implemented this

service

Broward County, Florida: Alumni, December 2016

Participant Name Title/Role Organization (if applicable)

Norma Wagner Director of Operations/ System of Care (fund the local mobile response team) Broward Behavioral Health Coalition Leilani Fandino Clinical Coordinator Henderson Behavioral Health Brittany Jacobs YES Team Supervisor Henderson Behavioral Health

Broward County: Program Structure

Mobile response is funded by:

• the Broward Behavioral Health Coalition (BBHC) - managing entity funded by

the state to contract for mental health and substance use services

• local county human services department

Mobile response provider (Henderson Behavioral Health) is a private non-profit agency There are two teams in Broward County:

• One primarily serves adults
• Youth Emergency Services (YES) responds to calls involving youth.
• YES works closely with the child serving systems including child welfare,

juvenile justice, school system, and the local providers

Broward County: Program Components

Mobile Response Teams:

• Are staffed by clinicians, some of whom are licensed
• Respond to calls and will go anywhere they are needed
• Work with local law enforcement, particularly with our CIT-trained
• fficers

Broward County: Program Updates

• The name has changed from Mobile Crisis Teams to Mobile

Response Teams

• No additional funding has been provided to expand these

teams - until recently due to the tragedy from the school shooting

Broward County: Barriers/Challenges

• Funding is an ongoing issue
• Recruiting qualified clinicians at the salary provided

Broward County: Meeting Objectives

• Learn how to incorporate peer specialists and family peers as

part of the response team

• Identify other sources of funding to expand teams
• Learn how to decrease response time

Guam: Alumni, December 2016

Participant Name Title/Role Organization (if applicable)

Annie F.B. Unpingco Administrator, Child Adolescent Services Division-I Famagu’on-ta Guam Behavioral Health and Wellness Center Elisa Duenas Care Coordinator Guam Behavioral Health and Wellness Center Paul Rolinski Emergency Medical Dispatcher Guam fire Department Daren Burrier Guam Fire Department Assistant Fire Chief Reina Sanchez Clinical Administrator Guam Behavioral Health and Wellness Center

Guam: Program Structure

MRSS is still in the planning/development phase, not yet operational

• Phase 1: Strengthen the existing crisis hotline located in the Child Inpatient Unit of GBHWC. Plan

to move it to a separate facility in the community and change name to “Helpline.”

• Phase 2: Mobile Response: Partnership between several government agencies; the Guam Fire

Department (manages the 911), the Guam Police Department (GPD), and other child serving

• rganizations; Child Welfare, GDOE, Judiciary, Sanctuary, non profit.
• Started using trained University students to help answer incoming calls.
• Primary population of focus is children, youth and families, but will eventually be accessible to all

statewide (i.e. island community of 160,000 pop.), to address high suicide rate.

• Guam Behavioral Health and Wellness Center (GBHWC) is the lead state agency (mental health &

substance abuse).

• Funding for equipment comes from SOC expansion/implementation grant.
• Local funding for office space and administrative support staff.

Guam: Program Components

• Calls can come directly through the Helpline number
• Calls into 911 will be screened and behavioral health/mental health

issues will be dispatched to the Helpline.

• When mobile response is activated, GPD becomes a critical partner in

ensuring safety of staff responding. *Triage with other key partners such as clinics, VA, housing, etc. will be worked on as well as for referral sources.

Guam: Program Flow

Guam: Barriers/Challenges

• Identify and obtain federal and local funding to

implement and sustain MRSS

Guam: Meeting Objectives

Learn About:

• How others operate MRSS from the point of entry, including

processes, program evaluation, and specific strategies related to suicide.

• What documentation and data are important to collect and how

they can be used to improve services.

• Funding sources such as grants for supporting and sustaining MRSS

Indiana: Alumni, December 2017

Participant Name Title/Role Organization (if applicable) Sirrilla D. Blackmon Deputy Director Youth Services, Addiction Prevention, Cultural Linguistic Competency Division of Mental Health and Addiction Jennifer Tackitt-Dorfmeyer Executive Director Choices Coordinated Care Solutions Elizabeth Oyer VP of Applied Research & Evaluation Choices Coordinated Care Solutions

Indiana: Program Structure

• 92 counties and 25 Certified Community Mental Health Centers (CMHCs) that serve as the safety net for the

state

• Populations served:
• Serious Mentally Ill /Serious Emotionally Disturbed
• Chronically Addicted
• Dually Diagnosed
• Current array of mental health and addiction services are supported by MH Block Grant, SA Block Grant,

Medicaid and other third party payers

• Program implementation of new services will be supported through the Office of Medicaid and the Division
• f Mental Health and Addiction
• Department of Child Services (DCS) utilizes contractual agreements with CMHCs and other providers to

ensure youth involved with child welfare receive mental health services

• Youth with behavioral health issues who are involved with juvenile justice access services through DCS,

services that are court ordered or receive alternative community supports

Indiana: Program Components

• Indiana currently does not have a statewide MRSS program that meets the needs of youth who are

experiencing a crisis in the community

• Indianapolis has a Mobile Crisis Act Team (MCAT):
• Initiated through the Indianapolis Mayor’s office. This is a partnership with the Indianapolis Police

Department, the public hospital and the local Certified Community Mental Health Center (CMHC). MCAT targeted population are individuals who reside in an identified high risk crime areas. The team also has a relationship with the state Bureau of Developmental Disabilities Services. Allocation from the State Targeted Response to Opioid Crisis grant was awarded to two agencies to develop a mobile crisis response model:

• Choices Emergency Response Teams (CERT) is a 24 /7 mobile crisis team based in Ripley County. CERT will

provide crisis response to consumers who reside in seven Indiana counties.

• Centerstone Opioid Crisis Response Teams (OCRT), mobile crisis response intervention teams to engage

individuals experiencing opioid use disorder (OUD) and mitigate instances of opioid overdose in the catchment area comprising of seven Indiana Counties.

Indiana: Program Updates

The Commission for Improving the Status of Children (CISC) has four task forces that address the needs of children in the state:

• Child Safety
• Mental Health and Substance Abuse*
• Education Outcomes
• Cross System Youth and Juvenile Justice

*Development of the MRSS program for Indiana is the focus of the Service Creation subcommittee under the Mental Health and Substance Abuse Task Force with final approval from the CISC.

• The Service Creation subcommittee:
• Has met monthly since the December 2017 MRSS peer meeting; meeting information was shared with the group
• Identified other programs within the state and invited them to present their models
• Developed a timeline to keep this initiative on track
• Is collecting data on emergency room visits and crisis services by analyzing Medicaid claims data.
• Will identify data elements to support the need for this program in the state
• Would like to glean any data related to providing services for youth and families since the newest mobile crisis

response programs are targeted for individuals with substance use disorders

Indiana: Barriers/Challenges

Potential barriers that may impede success are:

• Workforce issues
• Cross agency implementation
• Logistics

Indiana: Meeting Objectives

• Garner feedback regarding if we are on track (process vs procedure)
• Receive technical assistance
• Network with other states to discuss their implementation process

Kansas: Alumni, December 2017

Participant Name Title/Role Organization (if applicable)

Kelsee Torrez SOC Project Director KDADS Nicole Stafford SOC Project Coordinator PACES Jeanne Urban-Wurtz Director of Behavioral Health KDADS

Kansas: Program Structure

• There are 26 Community Mental Health Centers (CMHCs) in Kansas
• CMHC staff are available 24/7 for crisis calls and to assess for

hospitalization

• CMHCs serve anyone in their catchment area; SOC youth are ages birth-

21, with SED, mostly school aged, residing within 16 counties.

• Some CMHCs are under the county’s jurisdiction, others are

independently operated with a board of directors.

• CMHCs are locally (county, state) and federally (Medicaid, Block Grant,

etc.) funded

Kansas: Program Components

Modified MRSS program implementation efforts are currently underway at one CMHC:

• CMHC is working with their largest school district to reduce

school suspensions

• Mobile will respond to the school and provide stabilization

services in lieu of disciplinary action

• Currently working to identify funding, staffing, and training

while developing policy

Kansas: Program Updates

• Kansas is currently in the planning stages of piloting MRSS

programming:

• Reviewing best practices, methods, and program

structures

• Drafting policy and procedures
• State is drafting a MRSS pilot program, so more CMHCs can

implement MRSS

Kansas: Barriers/Challenges

• Identifying funding for infrastructure development
• Culture change (punitive vs trauma informed care practices)
• Policy and procedural development and implementation at both state

and local levels

• Training of staff
• Determining appropriate response times for each call (triage system)
• Developing a data/outcomes tracking system

Kansas: Meeting Objectives

Learn more about:

• The process and structure of other states’ response strategies:

dispatcher, response team, leadership roles, etc.

• Medicaid reimbursement and sustainable financing options
• Policy, procedure, and training that reflects SOC values
• MRSS expansion from one location to a state-wide service

Muskegon County Michigan: Alumni, April 2017

Participant Name Title/Role Organization (if applicable)

Kelly France Transition Age Services Manager Clinical Lead HealthWest MYalliance SOC – Muskegon County Rhonda Emery Youth Manager Clinical Lead Healthwest Myalliance SOC Kate Kesteloot Scarbrough Executive Director Mediation & Restorative Services at the Brian Mattson Center for Restorative Justice

Muskegon County: Program Structure

• Two-fold approach:
• 1. HealthWest implementation
• 2. Juvenile Urgent Response Team (JURT) and Community Leadership

Team

• Serving any youth/family in Muskegon County, 24/7
• Partnerships with:
• Juvenile Justice (JTC)
• Community Leadership Team, hoping to get more proactive, less

reactive

• County wide, mental health crisis driven
• Medicaid, braided funding, JURT

Muskegon County: Program Components

• Currently a HealthWest program
• Utilizing SOC core values, CANS assessment process, home/community

based

• Clinician teamed with a “stabilizer” are dispatched upon request
• Primary team 8a-7p M-TH, 8-5 Friday, on call coverage nights and weekends
• Braided funding with Family Court for JTC response
• Used as entry to county mental health system

Muskegon County: Program Updates

• Full time team of 3 master level clinicians, 3 stabilizers
• “Air traffic controller” and “On-call coordinator”
• School “Cheat Sheets”
• School based clinicians as extensions of MRSS
• Contract with Family Court for JTC response
• JURT funding for training and system mapping
• Entire overhaul of access to mental health system

Muskegon County: Barriers/Challenges

• Capacity issues
• increase in referrals/calls since implementation
• “Fix all” mentality
• One program set up to fail without community training and

development

• Mental Health Services for youth in Muskegon County
• all time high: ACES, opioid epidemic.
• Schools
• how to respond to schools with HIPAA, FERPA and parental

consent

Muskegon County: Meeting Objectives

• Community Leadership:
• how to bring the proactive, trauma informed training and

development to the community?

• Capacity!
• How to get buy in from community partners for a community MRSS

response so all the weight is not on one agency

• FUNDING
• TRAINING

Nevada: Alumni, April 2017

Participant Name Title/Role Organization (if applicable)

Ann Polakowski Clinical Program Manger II Division of Child and Family Services

Nevada: Program Structure

• Program is housed in the Division of Child and Family Services (DCFS), in the

Department of Health and Human Services

• Serve any youth age birth to 18 presenting with an emergent behavioral or

mental health concern requesting immediate support, assessment

• A behavioral health program within DCFS, partnering with child welfare,

juvenile justice, parents, private and public providers

• Statewide
• Funded by a blend of state and grant funding, some insurance billing

revenue

Nevada: Program Components

• Phone screening and triage
• Immediate in person (or tele med in the rural area) response by team of

two:

• A master’s level mental health counselor and bachelor’s level psychiatric caseworker
• Crisis Assessment Tool (CAT), Crisis Needs Assessment and Safety Planning
• Recommendation following assessments may include the following:
• Hospitalization
• Stabilization and case management for up to 30-45 days
• Refer back to current services
• Family may decline or no services are needed

Nevada: Program Updates

• Increased access for youth accessing rural mobile crisis by using Clark County

24/7/365 crisis line

• Dedicated overnight teams
• Increased partnerships with community, additional response sites and

referrals

• Tracking additional stressors for calls, including bullying
• Monthly statewide Mobile Crisis Response Team (MCRT) managers meetings
• Increased response to child welfare, juvenile justice populations
• Team sited at our juvenile assessment center
• Partnering with Safe Voice

Nevada: Barriers/Challenges

• System continues to have a “wrong door”
• Technology
• Lack of respite services, informal wraparound supports
• Increase in legal 2000
• Rural MCRT sustainability

Nevada: Meeting Objectives

• Networking and idea sharing with teams in other states for new

and innovative ideas to advance practice

• How other states have been able to secure informal wraparound

supports and respite services as part of their continuum of care for youth in crisis

• Tools other states are using for mobile assessment, safety

planning

North Carolina: Alumni, April 2017

Participant Name Title/Role Organization (if applicable)

Tim Lentz Clinical Director/Provider Catawba Valley Behavioral Health Allison Gosda Whole Person Care Director Partners Behavioral Health Management Eric Harbour Child Team Lead NC Division of MH/DD/SAS

North Carolina: Program Structure

• Mobile Outreach, Response, Engagement, and Stabilization (MORES) pilot

developed by team of state, MCO, provider and peer representatives.

• Once developed, pilot handed off to MCO for implementation.
• Focus on children, youth and young adults ages 3-21.
• Will work within the systems of care approach.
• Pilot will start in two counties, Burke (rural) and Gaston (urban)
• Funding through an alternative payment arrangement, supporting

established service codes through EPSDT

North Carolina: Program Components

Mobile Outreach, Response, Engagement, and Stabilization (MORES) - Mobile Intervention for Youth & Young Adults

Experiencing escalating emotional or behavioral symptoms or traumatic circumstances Youth’s ability to function has been compromised Disruption in the Youth’s environment – family, school, community, including transition in/out of foster care

North Carolina: Program Updates

MORES Services implemented May 1, 2018, replacing Mobile Crisis:

• Improved clinical effectiveness of current treatment & better outcomes
• Strengths & needs assessment:
• resolve the precipitating event and keep the youth in the home
• Case management & care coordination
• connect & engage youth/family in services
• Skill/Asset development
• assist in skill reinforcement to maintain stabilization
• Family Partner
• support and preserve family structure
• Alternative payment arrangement for bundling of services
• MORES Comprehensive Competency & Training Plan
• Community outreach & communication
• Complements partner’s System of Care expansion grant

North Carolina: Barriers/Challenges

Family Partner Recruitment

Training & Transition

• f Current

Staff Pilot Limited to Medicaid Youth

North Carolina: Meeting Objectives

• 1. Learn about shared funding options for mobile crisis management

services (DSS, DJJ, and school systems).

• 2. How to overcome barriers with community partners?
• 3. Ideas on how to move from alternative payment mechanism to

value based payment system.

Oklahoma: Alumni, December 2016

Participant Name Title/Role Organization (if applicable)

Sheamekah Williams Senior Director Oklahoma Systems of Care Oklahoma Department of Mental Health and Substance Abuse Services

Oklahoma: Program Structure Children Mobile Response & Stabilization System

• State contracted system
• Serves children, youth and young adults
• 0 -25 years old
• Youth in Transition/ Young Adults 18-25
• Youth in state custody
• Systems of care model (i.e. Wraparound)
• Funded through SAMHSA/CMHI federal and state allocations

Oklahoma: Program Components

• Available 24/7 - 365
• Accessed through statewide call center 1-800 number
• 77 contracted counties in Oklahoma
• Mobile Response and Stabilization Teams
• Immediate and deferred services
• Community based authorization
• 24/7 licensed behavioral health provider (LBHP)
• 8 week Stabilization Services
• In home and community behavioral health aides

Medical necessity criteria for acute psychiatric admissions for children (OAC 317:30-5-95.25) Acute psychiatric admissions for children must meet the terms or conditions contained in (1), (2),(3), (4) and one of (5)(A) to (5)(D), and one of (6)(A) to (6)(C) of this subsection. 1. Yes No A diagnosis that is the primary focus of treatment outlined from the most recent edition of "The Diagnostic and Statistical Manual

• f Mental Disorders" (DSM) with the exception of V-codes, adjustment disorders, and substance related disorders,

accompanied by a detailed description of the symptoms supporting the diagnosis. In lieu of a qualifying primary diagnosis, children 18-21 years of age may have any sequential personality disorders. 2. Yes No Conditions are directly attributable to a psychiatric disorder as the primary need for professional attention (this does not include placement issues, criminal behavior, status offenses). Adjustment or substance related disorder may be a secondary to the primary diagnosis. 3. Yes No It has been determined by the reviewer that the current disabling symptoms could not have been managed, or have not been manageable, in a less intensive treatment program. 4. Yes No Child must be medically stable. 5. Yes No Within the past 48 hours, the behaviors present an imminent life threatening emergency such as evidenced by: A. Yes No Specifically described suicide attempts, suicide intent, or serious threat by the patient. B. Yes No Specifically described patterns of escalating incidents of self-mutilating behaviors. C. Yes No Specifically described episodes of unprovoked significant physical aggression and patterns of escalating physical aggression in intensity and duration. D. Yes No Specifically described episodes of incapacitating depression or psychosis that result in an inability to function or care for basic needs. 6. Yes No Requires secure 24-hour nursing/medical supervision as evidenced by: A. Yes No Stabilization of acute psychiatric symptoms. B. Yes No Needs extensive treatment under physician direction. C. Yes No Physiological evidence or expectation of withdrawal symptoms which require 24-hour medical supervision.

OK: Medical Necessity Criteria for Acute Psychiatric Admission

Oklahoma: Program Updates

• Mobile Response and Stabilization Teams
• Behavioral Health Aides
• Access to 24/7 LBHP
• Community Based Authorization
• Medicaid and state funding for mobile response
• Face to face telehealth services for crisis
• Implementation of iPad utilization

Oklahoma: Barriers/Challenges

• Rural and frontier
• Workforce shortage
• Respite options
• Co occurring MH/DD
• Not enough substance abuse beds

Oklahoma: Meeting Objectives

• Explore strategies for crisis revision for the ID and DDS population
• Identify training for clinicians serving the ID and DDS populations
• Building Bridges Initiative for working with inpatient providers

Philadelphia PA: Alumni, April 2106

Participant Name Title/Role Organization (if applicable)

Lauren DellaCava Clinical Director, Children’s Services Community Behavioral Health Philadelphia, PA

• The Department of Behavioral Health and Intellectual disAbilities (DBHIDS) is responsible for administering a

broad array of supports, treatment, intervention and prevention programs for children, adults, and families impacted by mental health, substance use and intellectual disabilities.

• DBHIDS functions as single payer for Medicaid, Federal, State and Local Grant (Medicaid managed by City)

dollars for behavioral health services and serves more than 150,000 Philadelphians each year.

• Community Behavioral Health (CBH) sits within DBHIDS and manages the full spectrum of behavioral services

for child and adult Medicaid recipients.

Philadelphia: Program Structure

• Joint Procurement of City/County of Philadelphia’s DBHIDS and CBH
• 2 components:
• Children’s Mobile Crisis Team (CMCT) serves all youth under 21 in Philadelphia,

regardless of insurance status

• Children’s Mobile Intervention Service serves all CBH and uninsured youth in

Philadelphia under age 18, up to age 21 for youth with ID/ASD

• Child welfare and school district are key cross-systems partners and stakeholders.
• Partnership of city and BH-MCO; DBHIDS Office of Mental Health delegates dispatches

CMCT teams; clinical care management oversight provided by CBH

• Start-up funding covered by county reinvestment dollars; treatment services will be

billed to Medicaid, city will cover funding for non Medicaid youth

Philadelphia: Program Components

Children’s Mobile Crisis Team (CMCT) Children’s Mobile Intervention Service (CMIS) Length Up to 72 hours Up to 8 weeks Staffing Clinical Director Full Time Clinical Supervisor 5 Crisis Workers (Bachelor’s Level) 2 Family Advocates Clinical Director Board Certified Child Psychiatrist or Certified Registered Nurse Practitioner (CRNP) 2 Clinical Team Supervisors 5 Master’s Level Intervention Specialists 3 Mental Health Case Managers Capacity (at scale) 3 teams Up to 150 children

Philadelphia: Program Updates

Both services, along with a new brick and mortar Children’s Crisis Response Center and Crisis Stabilization unit have been recently procured:

• CMCT launched in November 2017
• CMIS soft launched with one provider in September 2017, city wide in

December 2017

• CRC and CSU opened January 2018

Philadelphia: Barriers/Challenges

• System wide understanding of resolution-focused treatment
• Education of stakeholders across a large system
• Overall capacity in the children’s system
• Access to appropriate technology for tracking/monitoring

Philadelphia: Meeting Objectives

• Strategies for ongoing training needs
• Best practices for monitoring and sustainability
• Additional ideas for partnership with cross-systems

stakeholders

Stark County, Ohio: Alumni, December 2016

Participant Name Title/Role Organization (if applicable)

Jeff Allen Executive Director Crisis Intervention and Recovery Center Michele Boone Director of Clinical Services Stark County Mental Health and Addiction Services

Stark County: Program Structure

Mobile Response Youth Program (MRYP):

• Serves all of Stark County children, youth and young adults birth to age 18
• .5 FTE Manager, 1 Supervising Clinician, 3 Clinicians, 2 Case Managers

(CPST), and 1 Family Peer Supporter

• Funded by Stark County Mental Health and Addiction Recovery
• SAMHSA System of Care grant, Medicaid, Local levy
• Mobile response requests can be made by any individual or any system at

any time

• No request for service refused

Stark County: Program Components

• 3 Response Pathways – Rapid, Accelerated or Supportive
• Behavioral health consultation, crisis management, assessment,

care plan, linkage, and postvention

• Embedded clinical practices
• Intervention aim is to avert hospitalization and out of home

placement of youth in crisis

• Suicide postvention response

Stark County: Program Updates

• Added three of the team positions due to increased need
• Trained and implemented C-SSRS, Brown Stanley Safety Plan, and

Collaborative Assessment and Management of Suicidality (CAMS)

• Began postvention caring contacts
• Collaborative with Akron Children’s and Aultman Hospitals
• Data tracking sheet and reporting – ongoing evolution

Stark County: Barriers/Challenges

• Implementation of Ohio Behavioral Health Redesign
• Clarity about documents needed to bill Medicaid

Stark County: Meeting Objectives

• Talent management and retention ideas
• Lessons learned from other states and providers of service
• Learn about any new or emerging evidence based practice or

best practice

South Carolina: Alumni, April 2016

Participant Name Title/Role Organization (if applicable) Christian Barnes-Young Assistant Deputy Director of Community Mental Health Services South Carolina Department of Mental Health, Division of Community Mental Health Services Amanda Gilchrist Program Director, Community Crisis Response and Intervention South Carolina Department of Mental Health, Division of Community Mental Health Services

South Carolina Program Structure

Community Crisis Response and Intervention (CCRI):

• Currently 100% state funding

– Anticipate county funding once local outcomes are demonstrated

• South Carolina has a robust state agency network including departments of social

services (DSS), juvenile justice (DJJ) and mental health (DMH) – Funded through contract with the Department of Health and Human Services (DHHS) – Will create multi-agency stakeholder meetings regarding continuity of care and service delivery improvements

• Statewide, with a focus on customizing services to meet the needs of the area

served

South Carolina Program Components

CCRI will provide:

• 24/7 warm line staffed with individuals who have mental health and crisis experience

to field the calls to the designated local DMH clinicians

• Clinical screening in order to de-escalate the crisis and provide linkage to ongoing

treatment and other resources. Services will be rendered: – In person at the location of the crisis – In person at a Community Mental Health Center Clinic – Telephonically – Telehealth (pilot)

• Statewide clinical and administrative supervision via a centralized office
• Staff to build relationships and resources with community partners

South Carolina Barriers/Challenges

• Finding an experienced workforce for supervisory and clinician positions
• Gaining the support of all necessary community partners, specifically law

enforcement and probate courts

• Completing a service design for areas that lack adequate resources

South Carolina Meeting Objectives

To learn about:

• Best practices to inform future policy decisions
• Quality and outcome measurements/indicators
• Financing strategies to continue to fund CCRI

Ride Along Debrief

Alumni Panels: Lessons Learned

State Panel:

• Indiana
• Nevada
• North Carolina
• Oklahoma
• South Carolina

County Panel:

• Broward County, FL
• Muskegon County, MI
• Philadelphia, PA
• Stark County, OH

Affinity Group Facilitated Peer Sessions

AFFINITY GROUP FACULTY FACILITATOR(S) ROOM Service Array Liz and Dayana Library Staffing/Training/Supervision Chris Boardroom A Financing & Policy Shannon, Bruce & Chad Salon Ensuring Quality Tim Boardroom B IT Ruby and Stacy Boardroom C

Affinity Groups Report Out

• Service Array
• Staffing, Training & Supervision
• Financing & Policy
• Ensuring Quality
• IT

Day 2 Agenda: Concurrent Separate Tracks

• First Time Participant Teams:
• Adapting Clinical Best Practices and Strategies and What’s Next in the

Evolution of MRSS

• Facilitated Individual Team Meetings
• Lunch (on your own)
• Facilitated Individual Team Meetings
• Alumni:
• Cohorts Rotate through 4 Targeted TA Sessions (see next slides)
• Joint Wrap Up and Next Steps

Day 2 Agenda: Alumni Track

Cohort 1 Cohort 2 Cohort 3 Cohort 4

8:00-9:30AM Quality/IT Service Array Finance & Policy Supervision, Training, Staffing 9:30-11:00AM Service Array Finance & Policy Supervision, Training, Staffing Quality/IT 11:00-11:15AM Break 11:15-12:45AM Finance & Policy Supervision, Training, Staffing Quality/IT Service Array 12:45-1:30PM Lunch (on your own) 1:30-3:00PM Supervision, Training, Staffing Quality/IT Service Array Finance & Policy 3:00-3:30PM Joint Wrap Up & Next Steps

Alumni Track Meeting Rooms

Team Faculty Room Finance & Policy Dayana Salon Quality & IT Jeff Library Service Array Liz Boardroom B Supervision, Training & Staffing Chris Boardroom C