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North th Da Dakota ta Be Behavioral ioral Healt ealth h Vi Visi sion on 20/20: /20: Go Goal al Prio ioritization ritization and d Ref efinem inement ent December 2018 Bevin Croft, MPP, PhD Human Services Research Institute


  1. North th Da Dakota ta Be Behavioral ioral Healt ealth h Vi Visi sion on 20/20: /20: Go Goal al Prio ioritization ritization and d Ref efinem inement ent December 2018 Bevin Croft, MPP, PhD Human Services Research Institute

  2. AGE GENDA 01 01 03 03 Phase se 2: Goal Nomination Priori riti tiza zati tion on and Exercise Refine ineme ment nt 02 02 04 04 Overvi Ov view of the e Strategic ic Plannin ning g Sur urvey y Resul sults ts Process cess

  3. OVER ERVIEW VIEW OF OF S STRA RATE TEGIC GIC PL PLAN ANNING NING PR PROC OCESS ESS

  4. Our approach Support coordinated, data-driven system improvement activities through the implementation of the recommendations from the Behavioral Health System Study , with a focus on the first and last (“bookend”) recommendations Set the course for the community to engage in ongoing system monitoring, planning, and improvements in the long-term

  5. Vision 20/20 Roles and Functions School Districts Local Health Systems Tribal Nations Child Welfare System Housing Authorities Physical/ Free Criminal Justice and Law Enforcement Social Service Agencies Public Health BH through Integration Recovery Children’s Behavioral Work Behavioral Health Group Health Workforce Behavioral Health Task Force Work Group Planning Council Medicaid Tribal Implementation Dual Consultation Status Facilitation Group Youth Initiative ND Rural Health ND Brain Learning Injury 1915(i) Collaborative Network Prevention Work Team Work Group Group Community Providers Peer and Family Advocacy Department of Human Services

  6. 1. Strategic Planning • Finalize purpose, scope, and roles • Operationalize goals (goal matrix) • Develop strategic plan protocol Four 2. Prioritization & 4. Monitoring & Sustaining Phases of Refinement • Monitor ongoing progress • Specify objectives, action steps, • Troubleshoot issues Work and indicators of progress • Initiate additional goals as • Establish priority and timeline needed • Determine responsibilities 3. Initiation • Gather baseline data on each goal and objective • Work with stakeholders to initiate action

  7. Timeline and Deliverables 1. Strategic 2. Prioritization 3. Initiation 4. Monitoring & Planning & Refinement Sustaining • March 2019 progress report • Draft strategic plan • Final strategic plan • Revised/amended protocol (protocol, goals & strategic plan objectives) • Ratified goal • June 2019 progress matrix report Nov. – Dec. Jan. – Mar. Apr. – June Oct. 2018 2018 2019 2019

  8. PH PHAS ASE E 2: 2: PR PRIO IORITIZ RITIZATION TION AN AND REF D REFIN INEMENT EMENT

  9. Phase 2 Activities • Identify a priority order for the goals • Select a subset of goals for the 2019 Strategic Plan • Specify individual tasks, create timelines, determine responsibilities, and identify indicators of progress/success for each selected goal Today’s Objective • Review responses to the Goal Prioritization Survey • Invite “nomination” of goals • Select candidate goals for 2019 (may need an additional round of surveys)

  10. Criteria for Goal Selection Public Has the public identified the goal as having high priority priority? Can stakeholders take actions to advance policy and Actionable practice to reach the goal? Are anticipated barriers to progress surmountable? Can the goal be accomplished in 2019? Or for longer- Timely range goals, can a key objective be accomplished during 2019? Will achieving this goal set the state on a course to Integral continue transformation by changing the underlying structures or practices of the system itself? Values- based Does it promote community values and priorities?

  11. Goal Nomination Each council member is Public priority invited to • nominate one goal for Actionable inclusion in the 2019 Timely strategic plan • provide a rationale Integral for including the goal Values-based based on one or more of the five criteria

  12. Next Steps • If needed, HSRI will host an anonymous survey of BH Planning Council members to narrow list down to a reasonable amount of goals • Once goals have been selected: • HSRI will draft a detailed 2019 Strategic Plan with goals, objectives, action steps, timeline, responsibilities, and indicators of progress for each • The BH Planning Council and other involved stakeholders will review and provide feedback on the 2019 Strategic Plan • Based on this feedback, HSRI will draft a finalized Plan and document benchmark indicators for each goal and objective

  13. SURVEY VEY RE RESUL ULTS TS

  14. • Anonymous • Open to all members of the public the first two weeks of December 2018 Public • Distributed to behavioral health Stakeholder stakeholders via email, press release, social media, word of mouth Survey • Respondents invited to indicate a priority level for 138 strategic goals • 570 people in all took the survey

  15. Respondents represented diverse populations Persons with disabilities 44% Children and youth in schools 39% Adults with SMI 39% Children and youth with SED 37% Adults with SUD 37% All populations 36% Persons experiencing homelessness 31% American Indian populations 30% Persons with brain injury 29% Children and youth in foster care 28% LGBTQ and/or GNC persons 26% Older adults 26% Children and youth with SUD 25% Veterans and/or military service members 23% N=570 Justice-involved adults 23% Most respondents Justice-involved youth (juvenile justice) 22% indicated more than one Other 4%

  16. Respondents held a variety of roles Family member of a person with lived experience 52% Advocate 31% Person with lived experience 31% Government employee 30% Mental health treatment provider 25% Executive, administrator, or department head 24% Direct care staff/support provider 22% Substance use disorder treatment provider 9% School Employee 6% Physical health provider 6% N=570 University employee 5% Most respondents Social worker, counselor or care manager 4% indicated more than one Researcher/analyst 3% role Peer support specialist 3% Housing provider 2% Insurer/payer 2% Elected official 2% Other 4%

  17. And respondents were from different parts of the state Urban 56% Rural 50% Suburban 24% Tribal reservation 10% Statewide 5% Other 1% N=570

  18. Of the 138 Strategic Goals, the Top 10 are… 1. Implement training on trauma-informed approaches - including vicarious trauma and self-care - for all criminal justice staff 2. Expand in-home community supports for children, youth, and families, including family skills training and family peers 3. Implement Crisis Intervention Team training for all law enforcement officers and emergency medical responders statewide, with e-learning options for those in rural areas 4. Review behavioral health treatment capacity in jails and create a plan to fill gaps 5. Expand school-based mental health and SUD treatment services for children and youth.

  19. Top 10 Highest-Priority Goals, continued 6. Expand loan repayment programs for behavioral health students working in areas of need 7. Expand school-based early intervention activities using evidence-based curriculums 8. Expand culturally-responsive, evidence-based wraparound services for children and families involved in multiple systems 9. Expand school-based prevention activities using evidence- based curriculums 10. Implement Zero Suicide statewide

  20. Respondents had the highest levels of disagreement about the following goals… 1. Ensure syringe service programs statewide 2. Foster connections to national advocacy movements by supporting travel and attendance at national conferences and at virtual advocacy networks 3. Create a comprehensive database of behavioral health licensure to identify trends over time 4. Establish a state-level leadership position that represents the perspective of persons with lived experience 5. Establish a formalized training and certification process for peer support specialists

  21. I think we need to pull out all stops in addressing social emotional health for infants, toddlers, and their families as early as we can! With limited resources, please focus on kids first. This will result in tough decisions. Invest in ND youth! Children ARE our infrastructure!

  22. All agencies need to work better. Not one of us is okay where we are, but we all seem to be siloed and protective of our turf. There are too many organizations and funding streams operating in silos. Fragmenting services is tantamount to fragmenting people.

  23. People with lived experiences should be on ALL committees that have to do with services and supports. It is critical, and it is evidence-based. To0 often North Dakota excludes or engages in tokenism.

  24. Native American individuals in ND generally do not feel trust for, or valued by, the state. We experience a high rate of discrimination and structural racism with fewer appropriate treatment services. Promoting collaboration with Tribal leaders and community members is key to determining the needs of tribal members and their road to recovery. We should lend support, listen but they should lead.

  25. We need something between crisis and recovery. Our systems should be designed to work for people, not to make people work to access them.

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