How Do Participants in Mental Health Self Direction Use their Budgets? Numbers and Narratives from the States Bevin Croft, Human Services Research Institute Pam Bennett, Utah Division of Substance Abuse and Mental Health Deborah Monroe, Recovery Concepts, Michigan David Sarchet, Florida Self-Directed Care May 9, 2017
2 Presentation Overview Utah: Access Basics of Michigan: Self- to Recovery Florida Self- Mental Health Determination for Mental Directed Care Self-Direction Arrangements Health
3 Bevin Croft, Human Services Research Institute Mental Health Self Direction Basics
Mental Health Self-Direction Elements Person-Centered Brokerage Individual Budget Plan Support • Based on • Amounts and • Works with the participants’ methods for person to strengths, setting the develop the plan capabilities, budget vary. and administer preferences, and the budget • Often used for goals non-traditional • Peers with lived • Creativity and goods and experience flexibility are services and often act as essential traditional support brokers services
5 Three Priorities from the Last International Learning Exchange Stakeholder communication is essential and must People with lived include quantitative experience are data and personal involved and narratives Self-direction supported at every represents a culture level shift for value-based system change
Toward Self-Direction in U.S. Mental Health Systems Current Consumer/ Mental Olmstead v. U.S. Health Survivor Health Care Health L.C. (1999) Reform Movement Transformation Landscape • Advocated for • Care must be • New Freedom Institute of • Self-direction increased in the least Commission: Medicine: has bi-partisan service user restrictive “Mental health Service user is appeal choice and environment care is the “locus of • Emphasis on voice consumer and • Community control” personal family driven” • Peer-delivered integration a Affordable Care responsibility services key focus • SAMHSA - Self- Act: Changes to and state promote self- direction is 1915(i) state plan innovation in defined part of a “good option keeping with wellness and and modern” current foster hope behavioral health system” administration’s priorities
U.S. Mental Health Self-Direction Efforts •Established in state legislature Florida Self-Directed Care •Largest and longest-standing effort to date •Certified Peer Specialists are Independent Support Facilitators Michigan Self-Determination •Financed through Medicaid Managed Care Waiver Utah Mental Health Access to •Established in Salt Lake County in 2014, ended 2015 Recovery •Based on Access to Recovery for substance use populations Pennsylvania Consumer •Brokers and leadership are Certified Peer Specialists Recovery Investment Fund-SDC •Financed through managed care reinvestment funds •WIN study has physical health and wellness focus Texas SDC and Wellness Incentives Navigation Program •Both randomized trials; new effort rolling out in 2017 •Anticipated to begin summer 2017 New York Self-Directed Services •Financed through Medicaid 1115 Waiver Authority
8 Pam Bennett and Shanel Long, Utah Department of Human Services, Division of Substance Abuse and Mental Health Numbers and Narratives: Utah
Access to Recovery (ATR) - Goal • To assist in helping individuals need of mental health and substance abuse services and to increase family unity by assisting parents in obtaining employment to support their family and gain skills to be united in working together to raise their children.
Access to Recovery (ATR) - Details • 300% of Federal Poverty level • Substance Use Disorders • Recovery support services - bus passes or gas vouchers, GED testing, state ID cards, child car, medication assisted recovery, sober housing, and other recovery oriented services • Budget and VMS
PATR Spending Results Individual Group Services Bus Passes Services 6% 15% 12% Fuel/Gas Voucher Assessment 6% 4% Medical/Dental 0% Special Needs 4% Sober Housing Case Management 5% 37% Emergency Housing 6% Drug Testing 5%
Transformation Transfer Initiative (TTI) • Development of self-directed services within the mental health system in Salt Lake County • Built on the same voucher system, and designed to increase self-directed care opportunities for individuals who are not having their needs met through traditional services.
Changes within the Program • Enrollment and Recruitment – Medicaid, engaged in MH services, income less than $32,000/year – Increased number of providers – Added unfunded participants (up to 25%) – Minimum age increased to 13 • Peer support specialists are critical partners when engaging this younger population. • Client budget cap started at $1200 and was then increased to $2000
Case Management and Peer Support • Increased number of Support Brokers • All Support Brokers are being certified as Case Managers • Peer Support Specialists play a critical role • Peer support billing rates have been increased to $7.35 per 15 min (individual) and $2.50 per 15 min (group). • Local Mental Health Authorities (LMHA) have been encouraged to increase peer support
15 Participant Expenditures, April 2014 to December 2015 Total expenditures for 153 participants: $149,791.51 Transportation, 19.9% Support Broker, 30.0% Housing, 11.0% Other, 1.4% Psychosocial Medical or Dental Rehabilitation, 4.6% Services, 8.2% Wellness and Self- Care, 11.1% Special Needs, 13.7%
Ongoing funding • There are types of services provided by this program which continue to be gaps within the system • TAN-F funds, Mental Health Block Grant funds, Medicaid capitation and the Medicaid 1915(b)(3) waiver can be used to maintain and sustain portions of the program.
Summary • Utah-TTI funded activities have helped create critical groundwork for self-directed and family driven care for individuals with serious mental illness and severe emotional disturbance in Salt Lake County. This will serve as a template as self-direction is promoted across the state. • “When I started with the TTI program, I was homeless… had a hard time finding a doctor…I was off my medication and I was a nervous wreck. I was able to get a car…now I have an apartment and my real estate business is going. I couldn’t have dreamed it without this program. My life has completely turned around and it’s right where I hoped it would be”. Terry B.
18 Deborah Monroe, Michigan Certified Peer Support Specialist, Lead Support Broker in Transformation Transfer Initiative Numbers and Narratives: Michigan
19 Michigan TTI project Michigan
20 Michigan TTI project MDHHS 1915 (b)(c) Managed Care Specialty Services Waiver • Medicaid Provider Manual for Peer Specialist Covered Services approved by CMS since 2006 • Fiscal Intermediary Services is a 1915(b) waiver service as Additional “b3” covered services • “Supports Broker" revised to “Independent Supports Broker" in Medicaid manual. Demonstrates competence in areas of job responsibilities for • services and supports broker. Selected by beneficiary • Functions under the supervision of a supports coordinator. • At least 18 years of age. •
21 Michigan TTI project Goals for 12 Participants ( Oct 2016- May 2017 )
22 Michigan TTI project Estimated Costs Savings • Oct 2016- May 2017 Eight months • Eight budgets decreased • Two budgets resulted in an increase • Two were neutral • $76,611.70 estimated savings • Budgets did not include cost savings in the areas of emergency services, crisis planning and/or inpatient care
Michigan TTI project 23 B ro o ke Before Self-Direction After Self-Direction -Use emergency services - Two hospital visits during nine months both for med review daily -Updated person-centered plan -Hospitalized 1x a week based results of individual -In crisis mode and budget monitoring therefore not engaged in - Demonstrates good employer services or community administration skills without -Struggled a great deal and any agency and minimal appeared without hope support from the Independent Support Broker - Obtained service dog
Michigan TTI project 24 Kelly Before Self-Direction After Self-Direction • Has a home • Homeless • Changed payee • Not engaged in • Directed person-centered community or plan traditional services • Reduced budget • Unaware of person- • Making health care centered planning appointments • Hospitalized with • Actively supports self- multiple physical issues direction for others who use traditional services
25 David Sarchet, Florida Self-Directed Care Numbers and Narratives: Florida
26 In the Florida Self-Directed Care (SDC) program we are working together to expand the horizons of recovery. We have seen the power of hope, choice, and self-direction in transforming lives. Our vision is for everyone to see their inherent value, pursue their dreams and enjoy a fulfilled productive life. Painting by S. Hunter
Recommend
More recommend
