Nebraska s Mental Health System. Region VII Meeting

Transcription

1 Nebraska s Mental Health System Region VII Meeting Sheri Dawson, RN Director of the Division of Behavioral Health Nebraska Department of Health and Human Services

2 About the Division of Behavioral Health Designated by federal and state law as the state s single authority for mental health and substance use disorders. Shall serve as the chief behavioral health authority for the State of Nebraska and shall direct the administration and coordination of the public behavioral health system. Neb. Rev. Stat

3 Linking to our Foundational State Partners Six regional Behavioral Health Authorities Behavioral Health Education Center of Nebraska 4

4 It s Healthcare! Nebraska s Integration Lexicon Nebraska s Current Framework Integrated Primary Care or Primary Care Behavioral Health Behavioral Health Care Mental Health Care Substance Use Care Adapted from: Peek, CJ A family tree of related terms based on behavioral health and primary care integration. 5

5 We Need Integrated Behavioral Health Because 25% of pediatric PC visits include behavioral health concerns (Cooper, Valleley, Polaha, Begeny, Evans, 2006) 80% of anti-depressants are prescribed by primary care physicians but 72% of patients had NO Dx in their files (Johns Hopkins 2013) BH training in primary care residency = ONE month plus continuity clinics with attendings From: Integration of Behavioral Health into Primary Care: What s Happening in Nebraska; Joseph H. Evans, Ph.D., Behavioral Health Education Center of Nebraska 5

6 Foundational Building Blocks Mental Health Care + Substance Use Care BH Staff it s the same person. Joint Planning Council (State Advisory Committee) PAC People s Advisory Council Umbrella approach behavioral health prevention and treatment Regulations Title 206 (MH/SUD) SAMHSA-integrated block grant application (MH/SUD) Regional Budget Plan Guidelines NABHO, Family Organizations, Annual Conference 6

7 % Vacant Access Means Workforce BHRN A Success Story *A point in time review of Registered Nurse Vacancy Rates from 9/14/15 produced a baseline vacancy rate of 48%. The target for 2017 = 29%. 60.0% 50.0% 40.0% Monthly Registered Nurse Vacancy Rates at Lincoln Regional Center and Norfolk Regional Center 41.3% 41.3% 43.1% 42.9% 45.3% 42.4% 40.9% 38.7% 38.7% 36.0% 36.0% 33.8% ** On June 1st, 2016 the Behavioral Health Nurse classification and pay change took effect. This change has allowed DBH to be more competitive in recruiting and hiring nurses. 30.0% 20.0% 10.0% 0.0% 0.0% Jan % 4.4% Feb 2016 Mar % 13.2% Apr 2016 May % **Jun % 4.4% Jul 2016 Aug % 28.2% 26.0% 20.9% 20.9% 20.6% 22.6% 16.5% 16.5% 16.5% 16.5% 16.5% 16.5% 16.5% 18.3% 12.6% Sept 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 ***Apr 2017 May 2017 June 2017 Lincoln Regional Center (BHRN) ***Lincoln Regional Center (BHRN / LPN) Norfolk Regional Center (BHRN) *2017 Target = 29% 7

8 Prevention Works School and Community Intervention Program (SCIP teams) Suicide Prevention More than 40,000 K-12 educators and school personnel have received suicide prevention awareness training 364 Clinicians have been trained in Assessing and Managing Suicide Risk 2,812 gatekeepers completed Question, Persuade & Refer [QPR] training Nebraska has 4 active Local Outreach to Suicide Survivors (LOSS) teams with 4 more in development Statewide Suicide Prevention Coalition 8

9 Prevention Works Suicide Prevention Outcomes: Reduction in suicide attempts 9

10 Prevention Works Mental Health First Aid In 2014, the Nebraska legislature, created the Nebraska Mental Health First Aid Training Program Mental Health First Aid (MHFA) is an 8 hour course designed to help citizens develop the skills necessary to approach someone experiencing behavioral health symptoms or in crisis. Through the state fund allocation, over 4500 individuals have completed MHFA trainers since To date, 53 certified MHFA trainers across the state including trainers in the Division of Public Health and local health departments. 10

11 Prevention Works Mental Health First Aid Outcomes Approximately 16% of participants identified as being part of a minority racial or ethnic group. Approximately 52% of participants were from metro areas (Omaha, Lincoln, or Grand Island) and 48% were from rural communities More than 97% of MHFA attendees reported they were confident in reaching out to someone who may be dealing with a mental health problem or crisis. MHFA attendees, more than 95% would recommend the training to others. 11

12 Treatment is Effective In Fiscal Year 2016, DBH funded services for 27,366 individuals. Of those, 19,739 received services addressing mental health and/or co-occurring substance use disorder number of consumers served. According to U.S. Census Bureau data released in June 2016, the prevalence rate for adults with Serious Mental Illness in Nebraska is estimated to be 5.4% of the population (n=76,643). Rates for youth with Serious Emotional Disturbances are estimated to be between 11,649 and 25,629 depending on Level of Functioning Score used. Three First Episode Psychosis Programs One urban, one rural, one University Based 1

13 Treatment is Effective Youth System of Care Initiative: Year 1 Successes First ever cross-system service utilization analysis Metric Reduce reliance on inpatient and residential services by increasing community-based services at a rate equal to or greater than the reduction in inpatient and residential services Increase the ratio of other means of financing to state funds spent on youth behavioral health Reduce utilization of residential and inpatient behavioral health care for youth in any youth service system (prevalence rate) Baseline Source / Frequency (2015) 2.2:1 DBH, MLTC, CFS, Probation, Family Foundation. Annually 2:1 DBH, MLTC, CFS, Probation, Family Foundation. Annually 7.1% DBH, MLTC, CFS, Probation, Family Foundation. Annually Cost / youth in BH services $4400 DBH, MLTC, CFS, Probation, Family Foundation. youth - Annually Age of first contact with system 9.38 yrs. DBH, MLTC, CFS, Probation Annually Out-of-Home Placements (prevalence rate) 17.7% DBH, MLTC, CFS, Probation, Family Foundation. Annually School Attendance 95.17% DBH, MLTC, CFS, Probation - Annually 1

14 Treatment is Effective Youth System of Care Initiative: Year 1 Successes Statewide roll out of mobile Youth Crisis Response 4, 5% 79 Calls 3, 4% 2, 3% 1, 1% Outcome 44, 56% 22, 28% 6, 7% Region 5 18, 22% Region 4 Region 3 Region 2 Region 1 59, 74% Youth Remained in Home Youth Admitted to an Inpatient Psychiatric Unit Youth Informally Placed (family/friend) Youth Formally Place *Data from service period May 1, 2017-July 31,

15 Treatment is Effective Adult Crisis Response System DBH is responsible for training Mental Health Boards on Mental Health Commitment Act Program manager of Emergency Services oversees program and policy implementation Emergency System Coordination in each Region Monitor Emergency Protective Custody (EPC) and Mental Health Board Commitment (MHB) process and utilization Coordinate transition planning from community based and state hospitals Train and promote crisis response programs to stakeholders (law enforcement, hospitals and corrections) 15

16 Treatment is Effective Adult Crisis Response Outcomes: 87.74% of crisis response calls are successful in diverting EPCs FY17 Crisis Call and EPC Diversions R1 R2 R3 R4 R5 R6 STATE TOTAL DIVERTED TOTAL CALLS 16

17 Recovery Is Possible DBH invests in a recovery system built on SAMHSA s four dimensions of recovery: Health Community Home Purpose 17

18 Recovery Is Possible By the Numbers FY physical/behavioral integrated clinics 86% of clients responded positively to quality and appropriateness of services (2016 Consumer Survey) 84.1% reported satisfaction with services (2016 Consumer Survey) Percentage of high school students who binge drank alcohol decreased from 14.3% in 2015 to 10.5% in 2017 Consistently below national average for hospital readmissions Health 18

19 Recovery Is Possible Trauma Informed Care In FY16 57% of consumers reported having experienced trauma. Of those, 82% reported trauma. Health experiencing multiple types of DBH retains a consultant to assess trauma-informed services. A total of 73 agency programs participated in 2013 and 86 agency programs participated in the assessment in DBH and network providers have updated policies and workflows to be more trauma sensitive as a result of the work. Ex: DBH no longer requires data fields related to trauma history to be reported at admission but now allows data fields to be updated throughout the course of treatment. Some providers have also embedded welcoming language on intake forms. 19

20 Recovery is Possible TIC - State Domain Averages vs Prog. Procedures & Settings Formal Services Policies Trauma Screening, Assessment, & Service Planning Administrative Support for Prog.-Wide Trauma - Informed Services Staff Trauma Training & Education Human Resources Practices State 2013 (n = 73) State 2015 (n = 86) 20

21 Recovery Is Possible Co-Occurring Competency In 2013 and 2015, the DBH implemented assessment of co-occurring disorder services using the Compass- EZ, a tool that allows behavioral health programs to create baseline measures describing their ability to deliver services to persons with co-occurring disorders. The assessment scores improved from 2013 to 2015 in every domain. Health The following areas were identified as some of opportunities for improvement: 1) quality Improvement and data; 2) integrated treatment and recovery programming; and 3) integrated discharge and transition planning. A sampling of CQI efforts include: implementation of integrated screening and assessment reviewing all policies and service definitions for potential language updates. processes at a provider level; DBH 21

22 Recovery Is Possible Housing Related Assistance Program The Nebraska Housing Assistance Program supports stable and safe housing for people with behavioral health disorders and who are very or extremely low income. The program utilizes dedicated Nebraska state documentary stamp tax monies, a portion of the documentary stamp tax levied on the recorded deeds of transfer of real property, and general state tax dollars. In FY2016, $2.9 million in funding was awarded to the six RBHAs and served 895 unique individuals and their families. Housing assistance can be used for rental payments, utility payments, security and utility deposits, and other housing-related costs, including household formation costs. Home 22

23 % in Stable Housing at Discharge Recovery Is Possible DBH supports a Regional Housing Coordinator in each RBHA Functional separation of housing and services Permanence Tenant-based rental housing (funds follow the consumer) Integration in a community setting Home DBH 2017 Performance Goal: 90.0% Grow Nebraska: Increase % of consumers in stable living at discharge 85.0% 2017 Target = [VALUE] 80.0% 83.8% 82.8% 84.0% 82.9% 83.3% 82.8% 80.1% 75.0% 70.0% Jul-Sept 2015 Oct-Dec 2015 Jan-Mar 2016 Apr-Jun 2016 Jul-Sept 2016 Oct-Dec 2016 Jan-Mar 2017 Statewide % in Stable Housing 2017 Target *Baseline data from 2016 revealed an average of 83.3% of consumers were in stable housing upon discharge from service. The target for 2017 is 23

24 Recovery Is Possible Supported Housing is one of four services selected by Nebraska s Joint Advisory Committee to collect access measures on: Supported Housing voucher applications will be reviewed and determinations made within 3 days of receipt by the Regions. Consumers will be notified of determination within 5 days of receipt of the complete application. Housing vouchers will be issued within 14 days of the application being approved. Consumers will be offered a safe, stable housing option within 90 days of the voucher being issued Home 95% of consumers admitted to Supported Housing will report satisfactory access to services. 24

25 % Employed at Discharge Recovery Is Possible Nebraska has a higher percentage of MH consumers who are in the labor force (employed or seeking) than the US average (2016: NE = 59% vs. US = 50.1%). Nebraska also has a higher percent of active employment amongst all MH consumers compared to the US average (2016: NE = 32.1% vs. US = 24.5%). Performance Goal: 62.0% 61.0% 60.0% 59.0% 58.0% 57.0% 56.0% 55.0% 54.0% 53.0% Grow Nebraska: Increase the number of Behavioral Health consumers employed at discharge from service by 5% 60.8% 56.9% 55.6% 58.2% Q1 Target = [VALUE] Q2 Target = [VALUE] 56.1% 55.9% Q3 Target = [VALUE] Q4 Target = 60% Jan-Mar 2016 Apr-Jun 2016 July-Sept 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sept 2017 Oct-Dec 2017 Purpose % Employed at Discharge Target *Baseline data from 2016 revealed an average of 57.7% of consumers in the labor market were employed upon discharge from service. The target for December 2017 is 60%. 25

26 Recovery Is Possible DBH and Nebraska Vocational Rehabilitation have partnered to provide Supported Employment services to Nebraskans with Serious Mental Illness (SMI). Purpose In 2016, 652 individuals with SMI received Supported Employment service through the braided funding model. A consumer can be in Supported Employment (including Long Term Supports) up to 24 months from date of job stabilization. Milestones and Payment System Milestone 1 Plan for Employment and Job Development Milestone 2 Job Search and Placement Milestone 3 Job Stabilization and Coaching Milestone 4 VR Closure and Job Retention Plan Milestone 5 Long Term Supports 26

27 Recovery Is Possible Nebraska Highlight: H.O.P.E. (Higher Opportunities through the Power of Employment). Supported employment program operated by the Mental Health Association of Nebraska, a peer run organization. Nebraska s Joint Advisory Committee identified Supported Employment as another service to include in access measure monitoring: Consumers referred to Supported Employment services will admit to services within 7 days of complete 95% of consumers admitted to Supported Employment services will report referral received. Supported Employment Purpose satisfactory access to services. 27

28 Recovery Is Possible Building a consumer-involved and informed behavioral health system: Nothing about us without us During FY17, exceeded 400 individuals who completed peer support training and testing requirements. Peer Support has been added as a Medicaid reimbursed service starting in July 2017 Nebraska People s Council Mission: The Council will utilize personal lived experience to identify and advocate for an integrated recovery oriented behavioral health system which supports adults, children, and their families. Community Keya House: Peer Run organization operating a crisis line program. and hospital diversion 28

29 Resources: Helpline Implemented in 2009 under the Children and Family Behavioral Health Support Act Since inception, has received around 32,000 from parents or guardians from 88 of 93 counties The helpline connects families with crisis interventions and referrals for services, including Family Navigation: Engagement with family within 72 hours of referral from helpline Provides approximately 8 contact hours over 60 days of direct parent peer support to help family identify and connect with services 29

30 Resources: Access Tool - Network of Care A Source for Consumers with Information, Services, Wellness Tools & Recovery Support Groups

31 Sheri Dawson, RN Director, Division of Behavioral Health NE Department of Health and Human Services (402)