No North Dakota Behavioral He Health System Study Bevin Croft, - - PowerPoint PPT Presentation

No North Dakota Behavioral He Health System Study

Bevin Croft, MPP, PhD Human Services Research Institute

AG AGENDA DA

02 02 04 04 01 01 03 03

Ai Aims s & Ap Approach Ke Key Findings Re Recommendations

Di Discussion

AI AIMS & AP APPROACH

1 2 3 4

St Study udy Ai Aims

Co Condu duct an an in in-de dept pth review of No North Da Dakota’s be behavioral health sy syste stem An Analyze e curren ent ut utilization n and nd ex expenditure pat patterns by pa payer so sourc rce

Pr Provid ide ac actio ionab able re recommendations for r enhancing the integra ration, cost- ef effec ectiven enes ess and d re recovery

• ri

rientation of f the sy syst stem to ef effec ectivel ely mee eet com community n needs Es Establish st strategies s for im implementin ing re recommendations

Data Sources

Do Document Review Gather and synthesize existing reports, white papers, and other material relevant to study aims St Stakeholder In Interviews 66 in-depth interviews with 120 stakeholders with in-depth knowledge of the system Me Medicaid Claims ms and St State Se Service Ut Utilization Data Data on utilization and cost for individuals who received Medicaid-funded

• r DHS

behavioral health services

Pr Projec ect Scope pe

Promotion, Prevention, Treatment, and Recovery Adults and Children Mental Health and Substance Use Issues and Brain Injury

A po popu pulation he health h focus includes

4% 4% SM SMI 13 13% Other me mental health co condition 83% 83% No No diagnosed me mental health condition

• Individuals with mild, moderate, and

intensive se service needs ds

• Individuals with und

undiagno nosed be behavioral he health h cha hallenges, including those from hard-to-reach populations

• Adults and children at risk of developing

behavioral health conditions for whom lo low-co cost, proact ctive prevention st strat ategies s could avert the need for behavioral health interventions

A good and modern behavioral health system spans numerous program types and agencies to provide the right mix of services at the right time.

Community Education and Awareness Prevention and Early Intervention Outpatient Treatment Community- Based Services Residential Treatment and Treatment Foster Care Crisis and Inpatient Services Services for Justice- Involved Populations

KE KEY FINDINGS AND RE RECOM OMMENDATION ONS

Re Residential, inpatient, and long-te term care facility services ac accoun unted for a a maj ajority of mental al heal alth system treat atment se service expenditures s in FY2017.

Ad Adult Case Ma Manageme ment 2% 2% Yo Youth Case Ma Manageme ment 8% 8% Ad Adult MH Ou Outpatient 15 15% Yo Youth MH Ou Outpatient 10 10% Ad Adult MH Re Residential 9% 9% Yo Youth MH Re Residential 11 11% MH MH Inpatient 20% 20% Lo Long-Te Term Care Fa Facilit ility 25% 25% Total estimated mental health treatment expenditures were $59 million

Re Residential and inpatient expenditures accounted for about 85% 85% of substance use disorder treatment services in FY20 2017.

Yo Youth SUD Outpatient 1% 1% Ad Adult SUD Outpatient 14 14% SU SUD Residential 78% 78% SU SUD Inpatient 7% 7% Total estimated substance use disorder treatment expenditures were $19 million

A A single, overar arching, inclusive, an and d comprehensive im implementatio ion plan is is needed to coordin inate planned and and ong ngoing ng efforts.

1 1 – De Develop a co comprehensi sive im implementatio ion pl plan

1.1 Reconvene system stakeholders, including service users and their families 1.2 Form an oversight steering committee to coordinate with key stakeholder groups 1.3 Establish work groups to address common themes identified in this report

Th There’s a relative sc scarcity of funds s for prevention and ea early inter erven ention wo work—wh which many stakeholders vi viewed as a mi missed opportunity. .

2 2 - In Invest i in pr preven ention

• n an

and ear early in interventio ion

2.1 Prioritize and implement evidence-based social and emotional wellness initiatives 2.2 Expand existing substance use prevention efforts, restore funding for the Parents Lead program 2.3 Build upon and expand current suicide prevention activities 2.4 Continue to address the needs of substance exposed newborns and their parents 2.5 Expand evidence-based services for first- episode psychosis

We We noted significant re regional vari riation in in the pr propo portions of individuals rec ecei eiving ser ervices es, and per persons with br brain injury fa face sub ubstant ntial barriers to ac accessing ng ne neede ded d services.

3 3 – En Ensur ure all North Da Dakotans have ti timely access to beha behavior

• ral

al heal health h se service ces

3.1 Coordinate and streamline information on resources 3.2 Expand screening in social service systems and primary care 3.3. Ensure a continuum of timely and accessible crisis response services 3.4 Develop a strategy to remove barriers to services for persons with brain injury 3.5 Continue to invest in evidence-based harm- reduction approaches

4 4 – Ex Expand d

• u
• utpat

patient ent and and co community-bas based ed se service ce array 4.1 Ensure access to needed coordination services 4.2 Continue to shift funding toward evidence-based and promising practices 4.3 Expand the continuum of SUD treatment services for youth and adults 4.4 Support and coordinate efforts to enhance the availability of outpatient services in primary care 4.5 Address housing needs alongside behavioral health needs 4.6 Promote education and employment among behavioral health service users

On Only 41 41.7% of

• f wor
• rking-ag

age adul adults who received d pu publ blicly funded ed outpa patien ent men ental hea ealth ser ervices es we were employed in in 2016.

4 4 – Ex Expand d

• u
• utpat

patient ent and and co community-bas based ed se service ce array (c (continued)

4.7 Restore/enhance funding for Recovery Centers 4.8 Promote timely linkage to community-based services following a crisis 4.9 Examine community-based alternatives to behavioral health services currently provided in long-term care facilities

In In F FY 2 2017, 1 , 16% o

• f a

all p ll publi lic b behavioral h l healt lth se service dollars s in North Dakota went to se services s de delivered d in n lo long-te term care facilities, w , with a a per per capi pita co cost of $12,713.

5 5 – En Enhance and d st streamline sy syst stem of ca care for ch children and yo youth

5.1 Improve coordination between education, early childhood, and service systems 5.2 Expand targeted, proactive in-home supports for at-risk families 5.3 Develop coordinated system to enhance treatment foster care capacity and cultural responsiveness 5.4 Prioritize residential treatment for those with significant/complex needs

St Stak akeholde ders de described d a a “d “double bottleneck” in in the sy syst stem—wi with some children and yo youth underserved wh while ot

• thers are receiving services at a higher level

th than is needed.

6 6 – Co Continue to im implement and re refine cri riminal ju justice strategy

6.1 Ensure collaboration and communication between systems 6.2 Promote behavioral health training among first- responders and others 6.3 Review behavioral health treatment capacity in jails 6.4 Ensure Medicaid enrollment for individuals returning to community

We We observed a great amount of en ener ergy and atten ention to to improving the system’s capacity to to meet et the needs

• f
• f ju

justic ice-in involved in indiv ivid iduals wit ith behavio ioral health ne needs ds. .

7 7 – En Engage in ta targeted efforts ts to re recru ruit and re retain co competent beha behavior

• ral

al heal health h wo workforce

7.1 Establish single entity for supporting workforce implementation 7.2 Develop single database of statewide vacancies for behavioral health positions 7.3 Provide assistance for behavioral health students working in areas of need in the state 7.4 Raise awareness of student internships and rotations 7.5 Conduct comprehensive review of licensure requirements and reciprocity

Is Issues w with ce certifica cation and lice censing, a , as w well a ll as st staffing g and retention, w , were f frequently ly r raised a as k key ba barriers to

• ensuring a well-qu

qualified workforce.

7 7 – En Engage in ta targeted efforts ts to re recru ruit and re retain co competent beha behavior

• ral

al heal health h wo workforce (c (continued)

7.6 Continue establishing training and credentialing program for peer services 7.7 Expand credentialing programs to prevention and rehabilitation practices 7.8 Support a robust peer workforce through training, professional development, competitive wage

We We applaud current initiatives to expand peer peer su support se

• services. T

. These s services m must b be d deli livered ac accordi ding ng to nat national nal prac actice standar andards ds in in a manner th that t mainta tains th the integrity ty of peer support. t.

8 8 – Ex Expand d the us use

• f
• f te

telebehavioral heal health

8.1 Support providers to secure necessary equipment/staff 8.2 Expand the reach of services for substance use disorders, children and youth, American Indian populations 8.3 Increase types of services available 8.4 Develop clear, standardized regulatory guidelines

Pe Penetration rates for te telebehavioral he health h services st steadily rose se across ss the st study period, and st stakeholders s sa saw possi ssibilities s for further exp xpansi sion.

9 9 – En Ensur ure the sy syst stem reflect cts s its s va values of person ce centeredness, ss, cu cultural co competence ce, tr trauma-in informed appr approac

• aches

hes

9.1 Promote shared decision-making 9.2 Promote mental health advance directives 9.3 Develop statewide plan to enhance commitment to cultural competence 9.4 Identify cultural/language/service needs 9.5 Ensure effective communication with individuals with limited English proficiency

We We documented si significant d disp sparities, p , particularly f y for LG LGBTQ individuals, New Americans, and American Indian po popu pulations.

9 9 – En Ensur ure the sy syst stem reflect cts s its s va values of person ce centeredness, ss, cu cultural co competence ce, tr trauma-in informed appr approac

• aches

hes

9.6 Implement additional training

9.7 Develop/promote safe spaces for LGBTQ individuals within the behavioral health system 9.8 Ensure a trauma-informed system 9.9 Promote organizational self- assessments

Am Ameri erican Indian populations are overrepresented in in tr treatm atment t setti ttings bu but t und underrepresent nted in n the behavioral heal health h workforce e an and lead eader ershi hip.

Th The Behavioral Health Talking Ci Circle resul ulted d in n Re Recommendation 11 – Pa Partner wi with tribal nations to to increase he health h equity

Collaboration within and among tribal nations, and with state and local human service agencies

Standing Rock Sioux Tribe Spirit Lake Nation Turtle Mountain Band of Chippewa Indians Mandan Hidatsa Arikara Nation

10 10 – En Encour urage and d su support the efforts s

• f
• f com
• mmuni

nities es to

• pr

prom

• mote

e high-qu quality se service ces

10.1 Establish a state-level leadership position representing persons with lived experience 10.2 Strengthen advocacy 10.3 Support the development of and partnerships with peer-run organizations 10.4 Support community efforts to reduce stigma, discrimination, marginalization 10.5 Provide and require coordinated behavioral health training among related service systems

Th The “n “nothing about us without us” ” ma mantra holds that be beha havior

• ral he

health h systems shou hould be be con

• ntinuou
• usly

and and signi nificant antly inf nformed d by people who us use those se services. s.

Th The system could improve its cost-ef efficien ency by dr drawing ng do down n more funds unds fo for community-ba based se services s and employing g prevention and early in interventio ion strategie ies wit ith a hi high h return on

• n

in investment. .

12 12 – Di Diversify and enhanc enhance e fund nding ng for

• r

beha behavior

• ral

al heal health 12.1 Develop an organized system for identifying/responding to funding opportunities 12.2 Pursue 1915(i) Medicaid state plan amendments 12.3 Pursue options for financing peer support and community health workers 12.4 Sustain/expand voucher funding and other flexible funds for recovery supports 12.5 Enroll eligible service users in Medicaid 12.6 Join in federal efforts to ensure behavioral and physical health parity

We We documented a need to ha harmon

• nize data ac

across se services s and sy syst stems s and to ensu sure that data that ar are collected d and and anal analyzed d to in inform system desig ign and and de development nt.

13 13 – Co Conduct

• ng
• ngoi
• ing

ng, system em-si side da data-dr driven n mo monitoring of needs and and ac acces ess

13.1 Enhance and integrate provider data systems 13.2 Develop system metrics to track progress on key goals 13.3 Identify and target services to those with highest service costs

DI DISCUSSION

ME MEET OUR STAFF

Da David Hughes

dhughes@hsri.org

President

Be Bevin Cr Croft

bcroft@hsri.org

Research Associate

Be Ben Ci Cichocki

bcichocki@hsri.org

Research Associate

Me Melissa Burnett

mburnett@hsri.org

Th Thank You.